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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(1): 54-59, 2020 Jan.
Artículo en Chino | MEDLINE | ID: mdl-31950790

RESUMEN

Objective: To analyze the risk factors of dyslipidemia of adult residents in Shunqing District of Nanchong City. Methods: A five-stage stratified cluster sampling method was used to select adult residents from 9 communities in the urban area of Shunqing District of Nanchong City from January 2013 to April 2018 for questionnaires survey,physical measurement and laboratory test. Univariate analysis and multivariate logistic regression analysis were used to study the influencing factors of dyslipidemia. Results: A total of 105 956 people was investigated,and the prevalence rate of dyslipidemia was 34.2% (36 272 cases). Among them, the prevalence rate of male was 38.11%, and 31.91% for female ( P<0.01). The proportion of dyslipidemia with hypertension, diabetes, and coronary heart disease was 13.46%, 5.74%, and 0.39%, respectively. The proportion of hypertension with diabetes was 2.79%. Multivariate logistic regression analysis showed that gender (odds ratio ( OR)=1.276, P<0.001), body mass index ( OR=1.052, P<0.001), education level (set ≤elementary school as reference, high school OR=1.094, P<0.001, ≥graduated OR=1.185, P<0.001), smoking history ( OR=1.124, P<0.001), coronary heart disease ( OR=1.189, P<0.001), hypertension ( OR=1.148, P<0.001),sdiabetes ( OR=1.967, P<0.001), and family history of dyslipidemia ( OR=1.760, P<0.001) were the influencing factors of dyslipidemia in residents of this region. Conclusions The dyslipidemia of urban residents in Nanchong area is highly concerned with hypertension, diabetes, and coronary heart disease. Male, obesity, high education level, smoking, coronary heart disease, hypertension, diabetes, and family history of dyslipidemia are risk factors for dyslipidemia in urban residents of Nanchong area. It is necessary to actively target the above risk factors and high-risk groups.


Asunto(s)
Dislipidemias , Adulto , China/epidemiología , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Obesidad/epidemiología , Prevalencia , Factores de Riesgo
2.
Mymensingh Med J ; 29(1): 187-194, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915357

RESUMEN

Coronary artery disease is the most common form of heart disease and single most important cause of premature death in developed countries. Off pump coronary artery bypass grafting surgery has recently became widespread internationally and has produced good clinical outcome even in left main coronary artery disease following off pump coronary artery bypass grafting surgery. A prospective observational study was conducted in the department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh from January 2015 to September 2016 after fulfillment of enrollment criteria, 428 patients were studied for the purpose of the study and they were grouped in two, significant left main coronary artery disease in group A and non left main coronary artery disease requiring surgery in group B. Comparison of risk factors between groups demonstrates that diabetes mellitus and smoking habit between two groups were almost identical. 69.2% of patient with significant left main coronary artery group were hypertensive and 25.2% were dyslipidaemic in comparison to non left main coronary artery disease group which were 50.9% and 6.5% respectively. Requirement of per operative inotropic support was significantly higher in left main coronary artery group. 33.6% of patient of left main coronary artery group required per operative inotropic support whereas non left main coronary artery group require 24.8%. Postoperative inotropic support, mechanical ventilation time, ICU stay, hospital stay and complication were similar in both these groups. So, we can say that off pump coronary artery bypass grafting surgery for significant left main coronary artery disease is as safe as non left main coronary artery disease.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad Coronaria/cirugía , Bangladesh/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Dislipidemias/epidemiología , Humanos , Hipertensión/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Factores de Riesgo , Resultado del Tratamiento
3.
Adv Exp Med Biol ; 1216: 29-38, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894544

RESUMEN

This chapter focuses on the epidemiology of cardiovascular diseases in elderly adults who are 65 or older. Risk factors for morbidity and mortality, as well as variables associated with disability and physical and social functional decline in the elderly individuals are considered. Modifiable risk factors, such as life habits are differentiated from unmodifiable ones, such as age and sex. The chapter concentrates in particular on the impact of hypertension, dyslipidemia and diabetes on cardiovascular diseases and mortality, as well as the effect of cigarettes smoking, physical activity, obesity and isolation on cardiovascular diseases and quality of life. The results demonstrate that cardiovascular diseases are not necessarily a consequence of aging; instead, they are often linked to modifiable risk factors. We can conclude that specific, targeted prevention interventions should preferably be implemented when individuals are young, but they are also useful in the elderly not only to prolong life but also to improve their quality of life.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus Tipo 2/epidemiología , Dislipidemias/epidemiología , Anciano Frágil , Humanos , Hipertensión/epidemiología , Calidad de Vida , Factores de Riesgo
4.
Angiology ; 71(1): 17-26, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31129986

RESUMEN

The Middle East and North Africa (MENA) region has a high burden of morbidity and mortality due to premature (≤55 years in men; ≤65 years in women) myocardial infarction (MI) and acute coronary syndrome (ACS). Despite this, the prevalence of risk factors in patients presenting with premature MI or ACS is incompletely described. We compared lifestyle, clinical risk factors, and biomarkers associated with premature MI/ACS in the MENA region with selected non-MENA high-income countries. We identified English-language, peer-reviewed publications through PubMed (up to March 2018). We used the World Bank classification system to categorize countries. Patients with premature MI/ACS in the MENA region had a higher prevalence of smoking than older patients with MI/ACS but a lower prevalence of diabetes, hypertension, and dyslipidemia. Men with premature MI/ACS had a higher prevalence of smoking than women but a lower prevalence of diabetes and hypertension. The MENA region had sparse data on lifestyle, diet, psychological stress, and physical activity. To address these knowledge gaps, we initiated the ongoing Gulf Population Risks and Epidemiology of Vascular Events and Treatment (Gulf PREVENT) case-control study to improve primary and secondary prevention of premature MI in the United Arab Emirates, a high-income country in the MENA region.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Infarto del Miocardio/epidemiología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/prevención & control , África del Norte/epidemiología , Edad de Inicio , Anciano , Estudios de Casos y Controles , Comorbilidad , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Medio Oriente/epidemiología , Mortalidad Prematura , Infarto del Miocardio/mortalidad , Infarto del Miocardio/prevención & control , Prevalencia , Prevención Primaria , Pronóstico , Proyectos de Investigación , Factores de Riesgo , Prevención Secundaria , Factores Sexuales , Fumar/efectos adversos , Fumar/epidemiología
5.
Angiology ; 71(1): 10-16, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30966756

RESUMEN

Cardiovascular disease (CVD) remains the major cause of death and disability worldwide, and residual risk after implementing all current therapies is still high. In this context, the latest (2016) European Cardiology Society/European Atherosclerosis Society guidelines recommend that triglyceride (TG)-lowering drugs should be used in high-risk patients with TGs levels >2.3 mmol/L (200 mg/dL), after lifestyle measures fail to lower them. After several neutral CVD outcome trials with n-3 fatty acids, the Reduction of Cardiovascular Events with EPA-Intervention Trial met its primary end point, that is, among patients with elevated TGs levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower in those who received 4 g of icosapent ethyl daily. In this review, we comment on the findings of previous and recently published randomized controlled CVD outcome trials assessing n-3 fatty acids supplementation. Both efficacy and safety, as well as future perspectives, are discussed.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Suplementos Dietéticos , Dislipidemias/tratamiento farmacológico , Ácido Eicosapentaenoico/análogos & derivados , Ácidos Grasos Insaturados/uso terapéutico , Lípidos/sangre , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Suplementos Dietéticos/efectos adversos , Dislipidemias/sangre , Dislipidemias/epidemiología , Ácido Eicosapentaenoico/efectos adversos , Ácido Eicosapentaenoico/uso terapéutico , Ácidos Grasos Insaturados/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Resultado del Tratamiento
6.
Vasc Health Risk Manag ; 15: 533-538, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31824165

RESUMEN

Purpose: Real-world data may provide insight into relationships between high triglycerides (TG), a modifiable cardiovascular (CV) risk factor, and increased heart failure (HF) risk. Patients and methods: This retrospective administrative claims analysis included statin-treated patients aged ≥45 years with diabetes and/or atherosclerotic CV disease enrolled in 2010 and followed for ≥6 months to March 2016. Patients with TG ≥150 mg/dL and a comparator cohort with TG <150 mg/dL and high-density lipoprotein cholesterol >40 mg/dL were included. A sub-analysis was conducted in patients with TG 200-499 mg/dL. Hazard ratios (HR) were calculated from multivariate analyses controlled for patient characteristics and comorbidities using Cox proportional hazard modeling. New diagnosis of HF required diagnosis in the follow-up period without prior evidence of HF. Results: Multivariate analyses revealed a 19% higher rate of new HF diagnosis in the TG ≥150 mg/dL cohort (HR=1.192; 95% confidence interval [CI]=1.134-1.252; P<0.001; n=24,043) and a 24% higher rate in the TG 200-499 mg/dL sub-cohort (HR=1.235; 95% CI=1.160-1.315; P<0.001; n=11,657), each versus the comparator cohort (n=30,218). Conclusion: In a real-world analysis of statin-treated patients with high CV risk, elevated and high TG were significant predictors of new HF diagnosis.


Asunto(s)
Dislipidemias/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Triglicéridos/sangre , Reclamos Administrativos en el Cuidado de la Salud , Anciano , Biomarcadores/sangre , Bases de Datos Factuales , Dislipidemias/sangre , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Femenino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/epidemiología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiología , Regulación hacia Arriba
7.
Prog Cardiovasc Dis ; 62(5): 401-405, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31666183

RESUMEN

The REDUCE-IT study found that patients at elevated risk for cardiovascular disease (CVD) who were already taking statins obtained a marked benefit by taking 4 g/d of eicosapentaenoic acid ethyl esters (icosapent ethyl, IPE; Vascepa) over about 5 years. Although approved for triglyceride (TG) lowering, IPE had only a modest TG-lowering effect in REDUCE-IT, largely because median TG levels were relatively low already. Hence the question of what mechanisms IPE might be working through is of great interest. At present, it appears that the best mechanistic candidates would be anti-platelet effects and/or anti-inflammatory effects. Whatever the cause, the powerful effects of IPE on CVD risk have renewed interest in the clinical utility of omega-3 fatty acids.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Dislipidemias/tratamiento farmacológico , Ácido Eicosapentaenoico/análogos & derivados , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , LDL-Colesterol/sangre , Quimioterapia Combinada , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Ácido Eicosapentaenoico/efectos adversos , Ácido Eicosapentaenoico/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Resultado del Tratamiento , Triglicéridos/sangre
8.
Prog Cardiovasc Dis ; 62(5): 406-413, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31672610

RESUMEN

In our increasingly cost-conscious health system, patients, clinicians, hospitals, and payers all agree about the urgent need to rein in runaway healthcare costs. High pharmaceutical costs make drugs unaffordable to many patients who may benefit from them, including some insured patients who face prohibitive out-of-pocket costs. Health systems and payers can use the systematic framework of cost-effectiveness analysis and estimated budgetary impact to prioritize the adoption of new therapies and technologies. In this review article, we discuss basic principles of cost-effectiveness research for practicing clinicians, the concept of cost-effectiveness versus affordability, other considerations relevant to resource allocation, and limitations of cost-effectiveness research. We use the example of lipid lowering therapies to discuss application of cost-effectiveness research in informing health care policy, its use for health care systems and in the development of clinical practice guidelines, and its implications for clinicians and patients. As clinicians and patients become more cognizant of the cost-implications of new therapies, professional societies can help improve the quality of decision-making by incorporating unbiased value statements into their expert guidelines.


Asunto(s)
Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/economía , Costos de los Medicamentos , Dislipidemias/tratamiento farmacológico , Dislipidemias/economía , Hipolipemiantes/economía , Hipolipemiantes/uso terapéutico , Formulación de Políticas , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Análisis Costo-Beneficio , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Humanos , Guías de Práctica Clínica como Asunto , Prevención Primaria/economía , Prevención Primaria/legislación & jurisprudencia , Prevención Secundaria/economía , Prevención Secundaria/legislación & jurisprudencia , Resultado del Tratamiento
9.
Medicine (Baltimore) ; 98(44): e17602, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689764

RESUMEN

Although attention has been paid to the relationship between malignant diseases and cardiovascular diseases, few data have been reported. Moreover, there have also been few reports in which the preventive factors were examined in patients with or without malignant disease histories requiring percutaneous coronary intervention (PCI).This was a retrospective, single-center, observational study. A total of 1003 post-PCI patients were divided into a malignant group, with current or past malignant disease, and a nonmalignant group. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, stroke, revascularization, and admission due to heart failure within 5 years of PCI. Kaplan-Meier analysis showed a significantly higher probability of the primary endpoint in the malignant group (P = .002). Multivariable Cox hazard analyses showed that in patients without a history of malignant, body mass index (BMI) and the presence of dyslipidemia were independent and significant negative predictors of the primary endpoint (BMI: hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.53-0.99, P = .041; prevalence of dyslipidemia: HR 0.72, 95% CI 0.52-0.99, P = .048), and the presence of multi-vessel disease (MVD) and the prevalence of peripheral artery disease (PAD) were independent and significant positive predictors of the primary endpoint (prevalence of MVD: HR 1.68, 95% CI 1.18-2.40, P = .004; prevalence of PAD: HR 1.51, 95% CI 1.03-2.21, P = .034). In patients with histories of malignancy, no significant independent predictive factors were identified.Patients undergoing PCI with malignancy had significantly higher rates of adverse cardiovascular events but might not have the conventional prognostic factors.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Neoplasias/epidemiología , Anciano , Anciano de 80 o más Años , Glucemia , Presión Sanguínea , Índice de Masa Corporal , Enfermedades Cardiovasculares/mortalidad , Dislipidemias/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Neoplasias/mortalidad , Intervención Coronaria Percutánea/estadística & datos numéricos , Enfermedad Arterial Periférica/epidemiología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
10.
Prog Cardiovasc Dis ; 62(5): 375-383, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31733217

RESUMEN

The authors review more than three decades of progress in providing clinicians and patients with guidance on risk assessment, patient evaluation and cholesterol management. Beginning with the National Cholesterol Education Program's Initial Adult Treatment Panel report, the cholesterol guidelines increasingly reflect the progress made in understanding the benefits of improved lifestyle and nutrition to improve lipid profiles, major risk factors and reduce ASCVD risk. Moreover, they now provide qualitative and quantitative assessment tools to guide appropriate risk reduction LDL-C lowering therapy. Use of the Pooled Cohort Equations to determine Low, Borderline, Intermediate and High 10-year ASCVD risk is now joined by recognition of conditions and biomarkers that enhance ASCVD risk. This personalizes the risk discussion for the patient. An important addition is the selective use of coronary artery calcium (CAC) scoring to reclassify risk in patients at borderline or intermediate risk, but for whom a risk decision regarding statin therapy is uncertain. In secondary prevention, current guidelines provide criteria for determining a "very high" risk group in whom risk is especially high and in whom aggressive LDL-C lowering can be shown to provide increased absolute benefit. Current guidelines provide a comprehensive look at children and adolescents, young adults, elderly, women and issues specific to women through the life course. They provide guidance for those adults at risk due to severe hypercholesterolemia, persistent hypertriglyceridemia after secondary causes have been addressed, those with inflammatory disorders and HIV, those adults with chronic kidney disease, and those affected by issues of race/ethnicity. They conclude with a brief summary of recommendations emphasizing important concepts for providing safety with LDL-C lowering therapy. This combination of best external evidence and clinical expertise from the expert panel should provide a solid foundation for lipid management of patients at risk for or with clinical ASCVD.


Asunto(s)
Anticolesterolemiantes/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Medicina Basada en la Evidencia , Guías de Práctica Clínica como Asunto , Anticolesterolemiantes/efectos adversos , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Difusión de Innovaciones , Dislipidemias/sangre , Dislipidemias/epidemiología , Dislipidemias/historia , Medicina Basada en la Evidencia/historia , Medicina Basada en la Evidencia/tendencias , Predicción , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Factores Protectores , Factores de Riesgo , Resultado del Tratamiento
12.
Prog Cardiovasc Dis ; 62(5): 423-430, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31715194

RESUMEN

The 2018 and 2019 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend consideration of so-called "risk-enhancing factors" in borderline to intermediate risk individuals. These include high-risk race/ethnicity (e.g. South Asian origin), chronic kidney disease, a family history of premature ASCVD, the metabolic syndrome, chronic inflammatory disorders (e.g. rheumatoid arthritis [RA], psoriasis, or chronic human immunodeficiency virus [HIV]), and conditions specific to women, among others. Studies suggest, however, that risk may be highly heterogeneous within these subgroups. The AHA/ACC guidelines also recommend consideration of coronary artery calcium (CAC) scoring for further risk assessment in borderline to intermediate risk individuals in whom management is uncertain. Although the combination of risk enhancing factors and CAC burden (together with Pooled Cohort estimates) may lead to more accurate ASCVD risk assessment, few publications have closely examined the interplay between risk enhancing factors and CAC scoring for personalized risk estimation. Our aim is to review the relevant literature in this area. Although further research is clearly needed, CAC assessment seems a highly valuable option to inform individualized ASCVD risk management in these important, often highly heterogeneous patient subgroups.


Asunto(s)
Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Dislipidemias/tratamiento farmacológico , Guías de Práctica Clínica como Asunto/normas , Prevención Primaria/normas , Calcificación Vascular/tratamiento farmacológico , Factores de Edad , Toma de Decisiones Clínicas , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Femenino , Humanos , Masculino , Selección de Paciente , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/epidemiología
13.
Prog Cardiovasc Dis ; 62(5): 395-400, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31715195

RESUMEN

Statin therapy is effective in primary and secondary prevention, but substantial residual risk remains on statin treatment, especially among high risk and very high risk patients. Add-on therapy with ezetimibe and proprotein convertase subtilisin /kexin type 9 (PCSK9) inhibitors provides additional risk reduction through further reduction in low density lipoprotein cholesterol. Elevated triglycerides/triglyceride rich lipoproteins contribute to atherogenesis and to the residual risk on statin therapy. Addition of icosapent ethyl to statins has recently been shown to markedly lower risk of ASCVD events in patients with established atherosclerotic CVD (ASCVD) and high risk patients with type II diabetes mellitus. These data are discussed in the context of current guidelines and synthesized in a decision pathway to guide combination lipid-lowering therapy in patients at high ASCVD risk.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Dislipidemias/tratamiento farmacológico , Ácido Eicosapentaenoico/análogos & derivados , Ezetimiba/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Proproteína Convertasa 9/antagonistas & inhibidores , Ensayos Clínicos Controlados Aleatorios como Asunto , Inhibidores de Serina Proteinasa/uso terapéutico , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , LDL-Colesterol/sangre , Quimioterapia Combinada , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Ácido Eicosapentaenoico/efectos adversos , Ácido Eicosapentaenoico/uso terapéutico , Ezetimiba/efectos adversos , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Guías de Práctica Clínica como Asunto , Proproteína Convertasa 9/metabolismo , Factores de Riesgo , Inhibidores de Serina Proteinasa/efectos adversos , Resultado del Tratamiento , Triglicéridos/sangre
14.
Prog Cardiovasc Dis ; 62(5): 384-389, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31669499

RESUMEN

The 2018 AHA/ACC cholesterol guideline builds on the 2013 ACC/AHA cholesterol guideline statin recommendations to provide more detailed recommendations for the use of nonstatin therapy risk stratification for primary prevention statin use. New information has become available after the development of the 2018 AHA/ACC cholesterol guideline that can further inform clinical practice. Proprotein convertase subtilisin kexin type-9 (PCSK9) monoclonal antibodies are now a reasonable or even good value following over 60% reductions in their acquisition price, and the identification of high risk patient groups most likely to benefit from further low-density lipoprotein cholesterol (LDL-C) lowering. Meta-analyses and clinical trial data now show that patients with LDL-C ≥ 100 mg/dl are more likely to experience progressively greater reductions in the risk of cardiovascular and total mortality and coronary heart disease events for progressively higher LDL-C levels. Icosapent ethyl, a highly concentrated form of modified EPA has been shown to reduce cardiovascular events in high risk patients with moderate hypertriglyceridemia on statin therapy. Comparisons with other statin guidelines revealed that statin initiation for those with ≥7.5% 10-year atherosclerotic cardiovascular disease (ASCVD) risk is the most effective strategy for reducing the most ASCVD events for the proportion of the population treated. Data from younger populations finally became available for coronary artery calcium (CAC) scoring (mean age of 51 years) which confirmed the value of CAC > 0 for identifying individuals at increased ASCVD risk most likely to benefit from statin initiation. This analysis also found that statins could keep CAC = 0 in those with risk factors. Epidemiologic pooling studies now clearly show that LDL-C and non-high-density lipoprotein cholesterol levels in young adulthood confer excess risk for ASCVD later in life. Accumulating data support earlier risk factor intervention trials as the next research priority.


Asunto(s)
Anticolesterolemiantes/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Anticolesterolemiantes/efectos adversos , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Humanos , Factores Protectores , Factores de Riesgo , Resultado del Tratamiento
15.
Zhonghua Nei Ke Za Zhi ; 58(10): 751-757, 2019 Oct 01.
Artículo en Chino | MEDLINE | ID: mdl-31594173

RESUMEN

Objective: To investigate the characteristics of body composition (BC) in gout patients and its clinical significance. Methods: Consecutive gout patients were recruited between August 2017 and December 2018. Demographic information, clinical characteristics and comorbidities were collected. BC was assessed by bioelectric impedance analysis including body fat percentage (BF%), trunk and limb BF%, appendicular skeletal muscle index. Overfat was defined by BF% ≥25% for male and ≥35% for female. The association between BC and serum uric acid (sUA) was evaluated by multiple linear regression. Results: A total of 362 gout patients were recruited with median age 38 (30, 52) years, 96.1% (348/362) were male. Mean sUA was (551±133) µmol/L. The mean BF% was (25.8±6.4)% with 53.6%(194/362) patients overfat. Male gout patients with overfat showed more affected joints [4(2, 6) vs. 2(2, 5)], higher sUA [(576±126)µmol/L vs. (523±134) µmol/L], higher prevalence of dyslipidemia [70.1%(131/187) vs. 54.0%(87/161)], metabolic syndrome [60.8%(118/187) vs. 28.0%(47/161)], fatty liver [58.2%(113/187) vs. 35.1%(59/161)] and hypertension [44.4%(83/187) vs. 25.5%(41/161)] than male patients with normal fat (all P<0.05). Their BF%, trunk BF% and limb BF% were positively correlated with the numbers of affected joints, sUA, metabolic syndrome, fatty liver, and hypertension, respectively (r=0.154-0.435, all P<0.05). Multivariable linear regression suggested that BF% (ß=4.29, P=0.020) and trunk BF% (ß=9.11, P=0.007), but not limb BF%, were positively correlated with sUA. Conclusion: Overfat is very common in gout patients. The proportion of trunk fat in male patients is positively correlated with sUA. When assessing obesity in gout patients clinically, body composition analysis should be performed simultaneously.


Asunto(s)
Composición Corporal/fisiología , Gota/diagnóstico , Obesidad/epidemiología , Ácido Úrico/sangre , Adulto , Dislipidemias/epidemiología , Femenino , Gota/sangre , Gota/epidemiología , Humanos , Hipertensión/sangre , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/sangre , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Obesidad/sangre , Prevalencia
17.
Medicine (Baltimore) ; 98(40): e17153, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577706

RESUMEN

The present study evaluated the association between appendectomy and rheumatoid arthritis (RA) using a national sample cohort of the Korean population. In this cohort study, the Korean National Health Insurance Service-National Sample Cohort of individuals ≥20 years old was collected from 2002 to 2013. A total of 14,995 appendectomy participants were 1:4 matched with 59,980 control subjects for age, group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the occurrence of RA in both the appendectomy and control groups. Appendectomies were identified using operation codes for appendicitis only. RA was defined by International Classification of Disease-10 codes (M05 or M06) and medication histories. Crude and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. Subgroup analyses were performed on groups stratified by age and sex. The adjusted HR for RA was 1.02 (95% confidence interval = 0.76-1.38) in the appendectomy group (P = .883). In all of the subgroup analyses according to age and sex, the adjusted HRs for RA were not higher in the appendectomy group than those in the control group. We could not identify any significant relationship between appendectomy and RA.


Asunto(s)
Apendicectomía/estadística & datos numéricos , Apendicitis/cirugía , Artritis Reumatoide/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Depresión/epidemiología , Dislipidemias/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Características de la Residencia , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Adulto Joven
18.
J Assoc Physicians India ; 67(7): 30-33, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31559765

RESUMEN

Objectives: Individual with diabetes may have several from of Dyslipidemia. Dyslipidemia has been considered to be factor that plays a risk in progression of micro vascular disease, especially in diabetes.1 The present study is intended to Study of correlation between Apolipoprotein B and Dyslipidemia in type 2 diabetes patients and prevalence of dyslipidemia in type 2 diabetic patients. Material and Methods: Prospective cross- sectional study conducted on 100 cases of type 2 diabetes mellitus. Groups are divided according to A/C ratio and association of dyslipidemia was seen. Serum Apolipoprotein B was measured using immunoturbidimetric method. Results: Pearson's correlation analysis of Apo B with lipid parameters in diabetic patients showed that, LDL, TC and Tg were positively correlated with Apo- B. There was a positive and linear correlation between LDL and Tg. Apo- B was negatively correlated with HDL-C. Conclusion: The majority of patients studied had low HDL-C, elevated non HDL- C, elevated total cholesterol, elevated triglycerides, elevated LDL -C and elevated apo B. Apolipoprotein B had a positive linear correlation with total cholesterol, triglycerides, LDL-C, non-HDL-C. The strongest positive correlation was with nonHDL-C. Patients with low HDL-C had high apo B levels.


Asunto(s)
Apolipoproteínas B/metabolismo , Diabetes Mellitus Tipo 2/epidemiología , Dislipidemias/epidemiología , Proteinuria/metabolismo , HDL-Colesterol , Humanos , Estudios Prospectivos , Centros de Atención Terciaria , Triglicéridos
19.
Biomed Environ Sci ; 32(8): 559-570, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31488232

RESUMEN

OBJECTIVE To investigate the trends of lipid profiles and dyslipidemia among Chinese adults from 2002 to 2015. METHODS Data were collected from three nationally representative cross-sectional surveys. Fasting venous blood samples were collected and serum lipids were tested by biochemical analysis and enzymatic determination. Lipid levels and the prevalence of dyslipidemia among adults were analyzed with complex sampling weighting adjustment for age and gender. RESULTS The weighted means of TC, TG, and LDL-c significantly increased linearly from 3.93, 1.12, and 2.12 mmol/L in 2002 to 4.59, 1.41, and 2.78 mmol/L in 2010 and then to 4.63, 1.47, and 2.87 mmol/L in 2015, respectively; by contrast, HDL-c levels decreased significantly from 1.30 mmol/L to 1.26 mmol/L over the same period. Similar trends in mean non-HDL-c and lipid-related ratios were observed. The weighted dyslipidemia prevalence linearly increased; in particular, hypercholesterolemia increased from 1.6% to 5.6% and then to 5.8%, hypertriglyceridemia increased from 5.7% to 13.6% and then to 15.0%, low HDL-c increased from 18.8% to 35.5% and then to 24.9%, and high LDL-c increased from 1.3% to 5.6% and then to 7.2% (P for trend < 0.001). CONCLUSION Dyslipidemia increased among Chinese adults from 2002 to 2015. Development of a comprehensive strategy to decrease lipid levels in this population is urgently required.


Asunto(s)
HDL-Colesterol/sangre , LDL-Colesterol/sangre , Dislipidemias/epidemiología , Triglicéridos/sangre , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Femenino , Humanos , Hipercolesterolemia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
20.
Mayo Clin Proc ; 94(12): 2415-2426, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31477320

RESUMEN

OBJECTIVE: To examine the effects of interval walking training (IWT) on the estimated peak aerobic capacity (eV˙O2peak) and lifestyle-related disease (LSD) score while focusing on exercise intensity and volume in middle-aged and older people. PARTICIPANTS AND METHODS: Men and women (N=679; mean age, 65±7 SD years) completed 5-month IWT. Participants were instructed to repeat 5 or more sets of fast and slow walking for 3 minutes each at 70% or more and 40% eV˙O2peak for walking, respectively, per day for 4 or more d/wk. This study was conducted from April 1, 2005, through February 29, 2008. RESULTS: Interval walking training increased eV˙O2peak by 14% and decreased LSD score by 17% on average (P<.001). During 5-month IWT, fast and slow walking times were 88±65 SD and 100±86 min/wk, respectively, but varied among participants. We divided participants into approximately 10 bins for 6 minutes each of fast and slow walking times per week up to 60 min/wk, and above this time, approximately 8 bins for 30 or 60 minutes each of fast and slow walking up to the maximal time. We found that both eV˙O2peak and LSD score improved as fast walking time per week increased up to 50 min/wk (R2=0.94; P<.001 for eV˙O2peak; R2=0.51; P=.03 for LSDS) but plateaued above this time. In contrast, improvement in neither eV˙O2peak nor LSDS was positively correlated with slow or total walking time per week. Multiple regression analyses confirmed that fast walking time per week was the major determinant of improvements in eV˙O2peak (P<.001) and LSD score (P=.001). CONCLUSION: High-intensity walking time during IWT is a key factor to increase eV˙O2peak and decrease LSD score in middle-aged and older people.


Asunto(s)
Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Tolerancia al Ejercicio/fisiología , Entrenamiento de Intervalos de Alta Intensidad , Hipertensión/epidemiología , Aptitud Física/fisiología , Anciano , Diabetes Mellitus/fisiopatología , Dislipidemias/fisiopatología , Femenino , Humanos , Hipertensión/fisiopatología , Incidencia , Estilo de Vida , Masculino , Persona de Mediana Edad , Caminata/fisiología
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