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1.
J Clin Lipidol ; 2020 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-32423761

RESUMEN

BACKGROUND: Homozygous familial hypercholesterolemia (HoFH) is a rare, life-threatening disease due to high serum low-density lipoprotein (LDL) cholesterol levels. LDL cholesterol-lowering interventions are fundamental for patients with HoFH. OBJECTIVE: It was aimed to investigate the association between the mental status of patients with HoFH and healthy lifestyle behaviors. METHODS: This subgroup analysis of the A-HIT1 population included the data of patients aged ≥18 years with a clinical diagnosis of HoFH undergoing therapeutic LDL apheresis. Besides the demographic and clinical characteristics of patients, healthy lifestyle behaviors were assessed, and psychiatric symptoms were screened by Symptom Check List (SCL-90-R). RESULTS: The highest percentage for pathology was observed in dimensions of obsessive-compulsive, somatization, interpersonal sensitivity, and depression in SCL-90-R. Patients with any cardiovascular condition have more psychiatric symptoms in different fields of SCL-90-R. The outcomes of the correlative analysis indicated that lower the age of the first coronary event better the psychiatric status, probably denoting a better adaptation to disease and its treatment. Among 68 patients, 36 patients were not exercising regularly. Patients with regular physical activity had significantly lower scores in most dimensions of SCL-90-R and there was no association between regular physical activity and other investigated variables. The strongest predictor of regular exercising was global severity index of SCL-90-R. CONCLUSION: In the HoFH population, there was a high prevalence of mental disturbances. Better psychiatric status was associated with regular exercising. Therefore, assessing the mental status of patients with HoFH and referring patients in need, to a psychiatrist, may improve the outcome of patients.

2.
Postgrad Med ; : 1-6, 2020 Apr 28.
Artículo en Inglés | MEDLINE | ID: mdl-32345082

RESUMEN

Objectives: Dyslipidemia is one of the risk factors for atherosclerotic cardiovascular disease. Cardiovascular events decrease with decreasing LDL-C levels and all guidelines emphasize the importance of LDL-C lowering. However, implementation in real life is suboptimal. This study aimed to evaluate the treatment approaches to the dyslipidemia of physicians.Methods: This study was conducted as an online survey for internal medicine specialists and residents. The survey included questions on the physicians' demographics, their attitudes toward dyslipidemia management in three different case scenarios and questions. The physicians were asked to indicate their treatment and guideline preferences in the three cases.Results: Among the 366 participants 67.5% were internal medicine specialists and 18.9% were internal medicine residents. Fourteen percent of physicians did not use guidelines in clinical practice. Five percent of specialists and 10.1% of residents doubted the necessity of dyslipidemia treatment, 30% of both specialists and residents were affected by the patient's reluctance. The specialists were more likely to state that reaching the target LDL-C should be a priority compared to the residents (p = 0.003). Most physicians (58.7%) treated the patients according to the guideline recommendations if the patients were at high risk. They were less likely to get to guideline recommendation goals if the patients were at low risk (29.8%).Conclusion: Despite overwhelming evidence, some physicians did not use guidelines and some physicians doubted the necessity of dyslipidemia treatment. A significant proportion of physicians were affected by the patient's reluctance. There is a clear need to educate physicians about the importance of guidelines.

3.
Handb Exp Pharmacol ; 2020 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-32274580

RESUMEN

Cardiovascular disease is the leading cause of death globally The past few decades have shown that especially low- and middle-income countries have undergone rapid industrialization, urbanization, economic development and market globalization. Although these developments led to many positive changes in health outcomes and increased life expectancies, they all also caused inappropriate dietary patterns, physical inactivity and obesity. Evidence shows that a large proportion of the cardiovascular disease burden can be explained by behavioural factors such as low physical activity, unhealthy diet and smoking. Controlling these risk factors from early ages is important for maintaining cardiovascular health. Even in patients with genetic susceptibility to cardiovascular disease, risk factor modification is beneficial. Despite the tremendous advances in the medical treatment of cardiovascular risk factors to reduce overall cardiovascular risk, the modern lifestyle which has led to greater sedentary time, lower participation in active transport and time spent in leisure or purposeful physical activity, unhealthy diets and increased exposure to stress, noise and pollution have diminished the beneficial effects of contemporary medical cardiovascular prevention strategies. Therefore attenuating or eliminating these health risk behaviours and risk factors is imperative in the prevention of cardiovascular diseases.

5.
Turk Kardiyol Dern Ars ; 48(2): 137-148, 2020 Mar.
Artículo en Turco | MEDLINE | ID: mdl-32147651

RESUMEN

OBJECTIVE: The aim of this study was to examine and present the effect of statin treatment on the low-density lipoprotein (LDL) cholesterol level of patients in Turkey by evaluating the data of studies conducted in the country. METHODS: Manuscripts published between January 1, 2008 and December 31, 2017 with terms 'LDL' and 'TURK' in the title or abstract and reporting LDL cholesterol data of patients treated with statins were evaluated for inclusion in the study. From the initial search result a total of 1795 papers, 39 manuscripts with 63 study arms were selected for analysis and the data of 3486 patients were included. Descriptive analysis was used to assess the data. Weighted averages of the data were also calculated. RESULTS: The female/male ratio was 42/58. The mean age was 52.9±10.1 years. The proportion of patients with the recommended LDL cholesterol level of <70 mg/dL after treatment with statins was 15.3%;. In all, 10.2% of the patients who were prescribed a low-dose statin and 28.0% of those who were prescribed a high-dose statin had an LDL cholesterol of <70 mg/dL after treatment. Among patients who were being treated with statins for ≤2 months, 25.7% achieved an LDL cholesterol level of <70 mg/dL. Among those who were being treated with statins for 2-4 months and >4 months the proportion was 11.4% and 9.7%, respectively. The percentage of patients at the target level was 21.8%, 21.7%, 17.9%;, 8.6%, and 0.8% among those using atorvastatin, simvastatin, rosuvastatin, fluvastatin, and pravastatin, respectively. CONCLUSION: In Turkey, only 15% of the patients who had received statin therapy had a LDL cholesterol level of <70 mg/dL. Revision of the current treatment should be considered to reach the target levels recommended in the guidelines, especially for patients with high cardiovascular risk.

6.
Anatol J Cardiol ; 23(3): 160-168, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32120368

RESUMEN

OBJECTIVE: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. METHODS: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. RESULTS: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7-17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ≤1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year. CONCLUSION: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year.

8.
Lancet Diabetes Endocrinol ; 8(1): 50-67, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31582260

RESUMEN

Genome sequencing and gene-based therapies appear poised to advance the management of rare lipoprotein disorders and associated dyslipidaemias. However, in practice, underdiagnosis and undertreatment of these disorders are common, in large part due to interindividual variability in the genetic causes and phenotypic presentation of these conditions. To address these challenges, the European Atherosclerosis Society formed a task force to provide practical clinical guidance focusing on patients with extreme concentrations (either low or high) of plasma low-density lipoprotein cholesterol, triglycerides, or high-density lipoprotein cholesterol. The task force also recognises the scarcity of quality information regarding the prevalence and outcomes of these conditions. Collaborative registries are needed to improve health policy for the care of patients with rare dyslipidaemias.

10.
Front Biosci (Landmark Ed) ; 25: 242-269, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31585888

RESUMEN

Cardiovascular disease (CVD) is the leading cause of death. Although once considered merely as a lipid storage disease, studies indicate the role of inflammation in initiation and progression of atherosclerotic CVD, as well as the development of thrombotic complications. Despite significant advances in treatment of atherosclerosis, there still exists a residual risk for CVD-related morbidity and mortality. Even with optimal treatment, the rate of a new event after an index acute coronary syndrome event, such as myocardial ischemia or infarction, in the first three years has been reported to be as high as 20%. In the last decades, inflammation due to apoB-lipoproteins and other traditional risk factors, such as hypertension, diabetes and smoking, is accepted as a new target for CVD prevention. Up to now, several anti-inflammatory drugs have been tested for use in atherosclerosis. This review focuses on the current status of anti-inflammatory drug therapy for atherosclerotic CVD in humans.

12.
J Cardiol ; 2019 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-31629664

RESUMEN

BACKGROUND: Cardiovascular (CV) disease prevention guidelines have addressed how imaging may influence CV risk determined by established risk score systems in primary prevention. Nevertheless, data are lacking regarding the use of femoral artery ultrasonography for CV risk modification. Herein, we hypothesized that femoral artery plaque and its characteristics, as well as femoral intima-media thickness (fIMT) measurements, may predict major adverse cardiovascular events (MACE). METHODS: Subjects free from documented CV disease who were scheduled for coronary computed tomographic angiography at our institution from September 2016-June 2017 were included. IMT measurements and plaque assessment were performed at femoral and carotid arteries. Coronary artery calcium score (CACS) was recorded. Patients were followed-up for MACE. RESULTS: A total of 215 subjects (mean age: 54.85 years, 47.91% male) were eligible. Median number of CV risk factors was 3. Median 10-year atherosclerotic CV disease risk based on Pooled Cohort Equation (PCE) equation was 6.3%. At a median follow-up of 24 months, 9 subjects (4.19%) had MACE. Patients who experienced MACE at follow-up were older (p=0.047), more of male gender (p=0.015), had higher serum creatinine levels despite being within reference limits (p=0.031) and PCE equation risk score (p=0.011). In patients who experienced MACE at follow-up, distal (p=0.027), bifurcation (p=0.007), and proximal carotid IMT (p=0.030) and fIMT (p=0.015) were increased. Surface irregularities and ulceration in femoral artery plaques were more common (p=0.001) and CACS was higher (p<0.001). When adjusted for other subclinical atherosclerosis imaging markers, femoral artery plaque surface irregularities and ulceration and only coronary calcification (without concomitant carotid or femoral atherosclerosis) were found to be independent predictors of MACE at follow-up (both p=0.004). CONCLUSIONS: Our data emphasize that baseline ultrasonographic assessment of the femoral arteries to define plaque characteristics may provide prognostic information for predicting MACE in a primary prevention cohort.

14.
Eur J Prev Cardiol ; : 2047487319874898, 2019 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-31500460

RESUMEN

AIMS: Recent European guidelines recommend in patients with atherosclerotic cardiovascular disease to achieve a reduction of low-density lipoprotein-cholesterol of at least 50% if the baseline low-density lipoprotein-cholesterol level is between 1.8 and 3.5 mmol/L. Systematic reviews have associated a given statin/dose combination with a fixed percentage low-density lipoprotein-cholesterol response. Algorithms for detecting cases and estimating the prevalence of familial hypercholesterolaemia often rely on such fixed percentage reductions. METHODS AND RESULTS: We used data from 915 coronary patients participating in the EUROASPIRE V study in whom atorvastatin or rosuvastatin therapy was initiated at hospital discharge and who were still using these drugs at the same dose at a follow-up visit 6 or more months later. Pre and on-treatment low-density lipoprotein-cholesterol levels were compared across the full low-density lipoprotein-cholesterol range. The prevalence of FH was estimated using the Dutch Lipid Clinic Network criteria, once using observed pre-treatment low-density lipoprotein-cholesterol and once using imputed pre-treatment low-density lipoprotein-cholesterol by following the common strategy of applying fixed correction factors to on-treatment low-density lipoprotein-cholesterol. Inter-individual variation in the low-density lipoprotein-cholesterol response to a fixed statin and dose was considerable, with a strong inverse relation of percentage reductions to pre-treatment low-density lipoprotein-cholesterol. The percentage low-density lipoprotein-cholesterol response was markedly lower at the left end of the pre-treatment low-density lipoprotein-cholesterol range especially for levels less than 3 mmol/L. The estimated prevalence of familial hypercholesterolaemia was 2% if using observed pre-treatment low-density lipoprotein-cholesterol and 10% when using imputed low-density lipoprotein-cholesterol. CONCLUSION: The inter-individual variation in the percentage low-density lipoprotein-cholesterol response to a given dose of a statin is largely dependent on the pre-treatment level: the lower the pre-treatment low-density lipoprotein-cholesterol level the smaller the percentage low-density lipoprotein-cholesterol reduction. The use of uniform correction factors to estimate pre-treatment low-density lipoprotein-cholesterol is not justified.

15.
Nat Rev Dis Primers ; 5(1): 56, 2019 08 16.
Artículo en Inglés | MEDLINE | ID: mdl-31420554

RESUMEN

Atherosclerosis, the formation of fibrofatty lesions in the artery wall, causes much morbidity and mortality worldwide, including most myocardial infarctions and many strokes, as well as disabling peripheral artery disease. Development of atherosclerotic lesions probably requires low-density lipoprotein, a particle that carries cholesterol through the blood. Other risk factors for atherosclerosis and its thrombotic complications include hypertension, cigarette smoking and diabetes mellitus. Increasing evidence also points to a role of the immune system, as emerging risk factors include inflammation and clonal haematopoiesis. Studies of the cell and molecular biology of atherogenesis have provided considerable insight into the mechanisms that link all these risk factors to atheroma development and the clinical manifestations of this disease. An array of diagnostic techniques, both invasive (such as selective coronary arteriography) and noninvasive (such as blood biomarkers, stress testing, CT and nuclear scanning), permit assessment of cardiovascular disease risk and targeting of therapies. An expanding armamentarium of therapies that can modify risk factors and confer clinical benefit is available; however, we face considerable challenge in providing equitable access to these treatments and in maximizing adherence. Yet, the clinical application of the fruits of research has advanced preventive strategies, enhanced clinical outcomes in affected individuals, and improved their quality of life. Rapidly accelerating knowledge and continued research promise to provide further progress in combating this common chronic disease.

16.
Atherosclerosis ; 288: 146-155, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31404822

RESUMEN

Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality despite excellent pharmacological and revascularization approaches. Low-density lipoproteins (LDL) are undoubtedly the most significant biochemical variables associated with atheroma, however, compelling data identify inflammation as critical for the maintenance of the atherosclerotic process, underlying some of the most feared vascular complications. Although its causal role is questionable, high-sensitivity C-reactive protein (hs-CRP) represents a major biomarker of inflammation and associated risk in CVD. While statin-associated reduced risk may be related to the lowering of both LDL-C and hs-CRP, PCSK9 inhibitors leading to dramatic LDL-C reductions do no alter hs-CRP levels. On the other hand, hs-CRP levels identify groups of patients with a high risk of CV disease achieving better ASCVD prevention in response to PCSK9 inhibition. In the FOURIER study, even in patients with extremely low levels of LDL-C, there was a stepwise risk increment according to the values of hs-CRP: +9% (<1 mg/L), +10.8% (1-3 mg/L) and +13.1% (>3 mg/L). Likewise, in the SPIRE-1 and -2 studies, bococizumab patients with hs-CRP> 3 mg/L had a 60% greater risk of future CV events. Most of the patients enrolled in the PCSK9 trials were on maximally tolerated statin therapy at baseline, and an elevated hs-CRP may reflect residual inflammatory risk after standard LDL-C lowering therapy. Moreover, data on changes in inflammation markers in carriers of PCSK9 loss-of-function mutations are scanty and not conclusive, thus, evidence from the effects of anti-inflammatory molecules on PCSK9 levels might help unravel this hitherto complex tangle.

17.
Turk Kardiyol Dern Ars ; 47(Suppl 2): 1-34, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31364995

RESUMEN

Cardiac amyloidosis (CA) is a progressive cardiomyopathy in which misfolded endogenous proteins form amyloid fibrils that deposit in the heart as well as kidneys, liver, gastrointestinal tract and soft tissues. The most common forms of CA include immunoglobulin light chain (AL) amyloidosis and transthyretin (TTR) amyloidosis. Although cardiac amyloidosis is thought to be a very rare disease, emerging data suggested that 13% of heart failure patients with preserved ejection fraction and 16-26% of advanced aged patients with severe aortic stenosis may have TTR-CA. Amyloidosis with cardiac involvement shows poor prognosis with a median survival of 6 months in AL-CA and 26-43 months in TTR-CA. Early diagnosis and novel therapeutic options have been shown to significantly improve prognosis. Recent diagnostic techniques such as cardiac MR or nuclear scintigraphy using bone isotopes as well as increasingly wide use of echocardiography, genetic testing, biopsy and histopathological analysis allow the clinicians to make early diagnosis of CA. The aim of this paper is to provide a comprehensive review including etiology, clinical presentation, diagnosis and management of CA and to address recent important advances in noninvasive cardiac imaging techniques and novel therapeutic approaches based on the available data in the literature.


Asunto(s)
Amiloidosis/diagnóstico por imagen , Cardiomiopatías/diagnóstico por imagen , Amiloidosis/terapia , Cardiomiopatías/terapia , Humanos
18.
Anatol J Cardiol ; 22(2): 77-84, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31375653

RESUMEN

OBJECTIVE: A well-developed coronary collateral circulation lowers both in-hospital and long-term morbidity and mortality limiting the infarct. Angiogenin (AGN) and osteopontin (OPN) are known to be potent inducers of angiogenesis. The aim of the present study was to investigate the relationship between serum ANG and OPN levels and collateral filling grade in subjects with stable coronary artery disease (SCAD). METHODS: A total of 122 age- and gender-matched consecutive patients who were found to have total occlusion (n=70) and no significant stenosis in epicardial coronary arteries (n=52) who underwent coronary angiography due to SCAD between January 2015 and July 2017 were included in the study. AGN and OPN levels were measured using enzyme linked immunosorbent assay. Coronary collateral circulation was graded using Rentrop's classification of collateral filling. RESULTS: A total of 52 patients (61.60±11.78 years, 61.5% male) without significant epicardial coronary artery stenosis and 70 patients (62.87±8.24 years, 65.7% male) with totally occluded coronary arteries were included in the study. Subjects with total occlusion had significantly higher levels of AGN [122.00 (79.00-623.00) pg/mL vs. 98.00 (18.00-160.00) pg/mL, p<0.001] and OPN [1863.50 (125.00-6500.00) pg/mL vs. 451.00 (112.00- 1850.00) pg/mL, p<0.001] than those without significant stenosis. In addition, AGN [127.00 (87.00-623.00) pg/mL vs. 110.00 (79.00-188.00) pg/mL, p=0.011] and OPN [2681.00 (126.00-6500.00) pg/mL vs. 649.00 (125.00-4255.00) pg/mL, p=0.001] levels were significantly higher in patients with better developed collaterals. Serum AGN and OPN levels were found to be significantly associated with coronary collateral development. CONCLUSION: AGN and OPN are associated with better developed coronary collateral circulation and may have therapeutic implications for the promotion of coronary collateral development.


Asunto(s)
Circulación Colateral , Enfermedad de la Arteria Coronaria/diagnóstico , Circulación Coronaria , Osteopontina/sangre , Ribonucleasa Pancreática/sangre , Estudios de Casos y Controles , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/sangre , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad
19.
Cardiovasc Diabetol ; 18(1): 71, 2019 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-31164165

RESUMEN

In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low levels of high-density lipoprotein cholesterol (HDL-C), offer a key modifiable component of this common dyslipidemia, especially in insulin resistant conditions such as type 2 diabetes mellitus. The development of selective peroxisome proliferator-activated receptor alpha modulators (SPPARMα) offers an approach to address this treatment gap. This Joint Consensus Panel appraised evidence for the first SPPARMα agonist and concluded that this agent represents a novel therapeutic class, distinct from fibrates, based on pharmacological activity, and, importantly, a safe hepatic and renal profile. The ongoing PROMINENT cardiovascular outcomes trial is testing in 10,000 patients with type 2 diabetes mellitus, elevated triglycerides, and low levels of HDL-C whether treatment with this SPPARMα agonist safely reduces residual cardiovascular risk.


Asunto(s)
Benzoxazoles/uso terapéutico , Butiratos/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Dislipidemias/tratamiento farmacológico , Hipolipemiantes/uso terapéutico , Lípidos/sangre , PPAR alfa/agonistas , Animales , Benzoxazoles/efectos adversos , Biomarcadores/sangre , Butiratos/efectos adversos , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/diagnóstico , Consenso , Dislipidemias/sangre , Dislipidemias/diagnóstico , Humanos , Hipolipemiantes/efectos adversos , Terapia Molecular Dirigida , PPAR alfa/metabolismo , Seguridad del Paciente , Medición de Riesgo , Factores de Riesgo , Transducción de Señal , Resultado del Tratamiento
20.
Atherosclerosis ; 285: 135-146, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31054483

RESUMEN

BACKGROUND AND AIMS: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. METHODS: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. RESULTS: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. CONCLUSIONS: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient.

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