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1.
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
2.
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
3.
Cardiovasc Ther ; 2019: 3824823, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31885691

RESUMEN

In statin therapy, the prognostic role of achieved low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) in cardiovascular outcomes has not been fully elucidated. A total of 4,803 percutaneous coronary intervention (PCI)-naïve patients who prescribed moderate intensity of statin therapy were followed up. Total and each component of major adverse cardiovascular events (MACE) according to LDL-C and hsCRP quartiles were compared. The incidence of 5-year total MACEs in the highest quartile group according to the followed-up hsCRP was higher than that in the lowest quartile (hazard ratio (HR) = 2.16, p < 0.001). However, there was no difference between the highest and lowest quartiles of the achieved LDL-C (HR = 0.95, p = 0.743). After adjustment of potential confounders, the incidence of total death, de novo PCI, atrial fibrillation, and heart failure in the highest quartile of followed-up hsCRP, was higher than that in the lowest quartile (all p < 0.05). However, other components except for de novo PCI in the highest quartile by achieved LDL-C was not different to that in the lowest quartile. These results suggest that followed-up hsCRP can be more useful for predicting future cardiovascular outcome than achieved LDL-C in PCI-naïve patients with statin therapy.


Asunto(s)
Antiinflamatorios/uso terapéutico , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/prevención & control , LDL-Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inflamación/tratamiento farmacológico , Anciano , Antiinflamatorios/efectos adversos , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Regulación hacia Abajo , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/mortalidad , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Incidencia , Inflamación/sangre , Inflamación/diagnóstico , Inflamación/mortalidad , Masculino , Persona de Mediana Edad , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
4.
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
5.
Prog Cardiovasc Dis ; 62(5): 390-394, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31669768

RESUMEN

Symptoms during statin therapy are common and often attributed to statin intolerance. Recent data suggest few patients are truly intolerant to statins. Muscle symptoms are similar in statin and control groups in blinded treatment periods of clinical trials. The "nocebo" effect may occur during open-label statin treatment, when previously asymptomatic study participants report symptoms attributed to statin therapy, or during placebo-controlled trials. Most patients reporting statin intolerance can tolerate blinded moderate intensity statin therapy. In clinical practice the large majority of patients are willing to retry a statin, and of those who do, >80-90% successfully remain on statin therapy long-term. Emerging evidence from brain imaging studies and contemporary approaches to pain management suggests that building trust and managing patient expectations can minimize the "nocebo" effect in statin-treated patients.


Asunto(s)
Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Lípidos/sangre , Enfermedades Musculares/terapia , Biomarcadores/sangre , Ensayos Clínicos como Asunto , Dislipidemias/sangre , Dislipidemias/diagnóstico , Humanos , Enfermedades Musculares/inducido químicamente , Enfermedades Musculares/epidemiología , Efecto Nocebo , Estudios Observacionales como Asunto , Medición de Riesgo , Factores de Riesgo
6.
Rev Port Cardiol ; 38(8): 559-569, 2019 08.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31706732

RESUMEN

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal. Hypercholesterolemia has a causal role in atherosclerotic CVD. Guidelines recommend that cardiovascular (CV) risk reduction should be individualized and treatment goals identified. Low-density lipoprotein cholesterol (LDL-C) is the primary treatment target. METHODS: DISGEN-LIPID was a cross-sectional observational study conducted in 24 centers in Portugal in dyslipidemic patients aged ≥40 years, on lipid-lowering therapy (LLT) for at least three months and with an available lipid profile in the previous six months. RESULTS: A total of 368 patients were analyzed: 48.9% men and 51.1% women (93.9% postmenopausal), of whom 73% had a SCORE of high or very high CV risk. One quarter had a family history of premature CVD; 31% had diabetes; 26% coronary heart disease; 9.5% cerebrovascular disease; and 4.1% peripheral arterial disease. Mean baseline lipid values were total cholesterol (TC) 189 mg/dl, LDL-C 116 mg/dl, high-density lipoprotein cholesterol (HDL-C) 53.5 mg/dl, and triglycerides (TG) 135 mg/dl. Women had higher TC (p<0.001), LDL-C (non-significant) and HDL-C (p<0.001), and lower TG (p=0.002); 57% of men and 63% of women had LDL-C>100 mg/dl (p=0.28), and 58% of men and 47% of women had LDL-C>70 mg/dl (p=0.933). CONCLUSION: These observational data show that, despite their high-risk profile, more than half of patients under LLT, both men and women, did not achieve the recommended target levels for LDL-C, and a large proportion also had abnormal HDL-C and/or TG. This is a renewed opportunity to improve clinical practice in CV prevention.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Dislipidemias/sangre , Hipolipemiantes/uso terapéutico , Lípidos/sangre , Sistema de Registros , Adulto , Anciano , Biomarcadores/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Portugal/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
7.
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
8.
Prog Cardiovasc Dis ; 62(5): 431-435, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31711788

RESUMEN

In the past five decades, cardiorespiratory fitness (CRF) has become fairly established as an important risk factor or marker for cardiovascular disease (CVD), as well as CVD - and all-cause mortality. Substantial evidence supports a strong inverse association between baseline levels of CRF and the risk of developing CVD risk factors, including dyslipidemia. Additionally, accumulating evidence also supports that maintaining or improving a certain level of CRF over time leads to a lower rate of developing CVD risk factors, such as dyslipidemia, and also improves survival. Recent evidence also supports the role of resistance exercise and muscular strength to reduce the development of metabolic syndrome and hypercholesterolemia and potentially reduce development of diabetes as well, in addition to improving survival. Therefore, great efforts are needed to increase both CRF and muscle strength with aerobic exercise and resistance exercise in the primary and secondary prevention of CVD.


Asunto(s)
Capacidad Cardiovascular , Enfermedades Cardiovasculares/prevención & control , Dislipidemias/prevención & control , Estilo de Vida Saludable , Lípidos/sangre , Conducta de Reducción del Riesgo , Biomarcadores/sangre , Enfermedades Cardiovasculares/mortalidad , Dislipidemias/sangre , Dislipidemias/mortalidad , Estado de Salud , Humanos , Fuerza Muscular , Pronóstico , Factores Protectores , Entrenamiento de Resistencia , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
10.
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
11.
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
12.
Arq Gastroenterol ; 56(3): 270-275, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31633724

RESUMEN

BACKGROUND: Metabolic risk factors of non alcoholic fatty liver disease (NAFLD) in non diabetic teetotallers who constitute a definite group are not well defined. OBJECTIVE: To identify the metabolic risk factors of NAFLD if any in non diabetic subjects who do not consume alcohol. METHODS: In a cross sectional study the effect of metabolic parameters (BMI, individual lipid levels, hemoglobinA1c (HbA1c), HOMA IR and the metabolic syndrome components) of 150 consecutive non diabetic teetotallers (90 with normal glucose tolerance and 60 prediabetics) on their NFS (quantifiable severity parameter of NAFLD) was studied by linear regression analysis. Similar study was done in the normal glucose tolerance and prediabetes groups separately. These parameters were then compared with those of 75 matched diabetic teetotallers with NAFLD. To analyse further the difference between normal glucose tolerance, prediabetic and overt diabetic groups, binary logistic regression of the factors was carried out taking prediabetes and diabetes as outcome variable. RESULTS: All the metabolic parameters were significantly higher in diabetics compared to non diabetics and in prediabetics compared to those with normal glucose tolerance except high-density lipoprotein cholesterol. Triglyceride, high-density lipoprotein cholesterol and BMI significantly predicted NFS in the overall (adjusted R2 68.7%, P=0.000) and normal glucose tolerance groups (adjusted R2 73.2%, P=0.000) whereas BMI, triglyceride, low-density lipoprotein cholesterol and HbA1c did in prediabetics (adjusted R2 89%, P=0.000). The metabolic syndrome was significantly associated with NFS in the overall and prediabetic groups. High triglyceride (odds ratio1.08), low-density lipoprotein cholesterol (odds ratio1.03) and HbA1c (odds ratio 11.54) were positively associated with prediabetes compared to normal glucose tolerance group. CONCLUSION: In nondiabetic teetotallers dyslipidemias are the prime contributors to the development of NAFLD.


Asunto(s)
Dislipidemias/metabolismo , Resistencia a la Insulina/fisiología , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Adulto , Anciano , Índice de Masa Corporal , Estudios Transversales , Diabetes Mellitus Tipo 2/metabolismo , Dislipidemias/sangre , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Síndrome Metabólico/metabolismo , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/etiología , Obesidad/metabolismo , Factores de Riesgo , Triglicéridos/sangre
14.
Diabetes Metab Syndr ; 13(4): 2387-2392, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31405648

RESUMEN

AIM: Dyslipidemia is an established marker for endothelial dysfunction and cardiovascular risk in diabetes. So we aimed to explore the prevalence of dyslipidemia in patients with type2 diabetes mellitus (DM) and to determine the association between dyslipidemia and other health care and biochemical indicators. MATERIALS AND METHODS: A cross-sectional study was carried out at private health care center. A total of 291 diabetic patients aged 18 years and above attended the clinic from August 2017 through April 2018 were included. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using (SPSS, version 23). RESULTS: out of the 291 diabetes patients recruited 22.3% had hypercholesterolemia (TC ≥ 200) and 61.9% had hypertriglyceridemia. Abnormal LDL-C levels (≥130) were found in 8.9% of patients and HDL-C was less than 40 mg/dl in 54.3%. There was a statistically significant difference (P = 0.048) in abnormal HDL levels (˂ 40 mg/dl) among females (59.3%) and males (47.6). Patients with HbA1c values ≥ 7.0%had significantly higher values of total cholesterol (TC) and abnormal LDL-C compared with the patients who had HbA1c ˂ 7.0%. CONCLUSION: dyslipidemia is highly prevalent among diabetic population particularly in those with poorly controlled diabetes. This calls for early and universal screening of lipid profile. There is also an urgent demand for measures that target tight glycemic, optimal lipid profile control and life style modifications is also required to all diabetic patients to achieve target value of HbA1C ≤ 7.


Asunto(s)
Biomarcadores/sangre , Diabetes Mellitus Tipo 2/complicaciones , Dislipidemias/epidemiología , Hipercolesterolemia/fisiopatología , Hipertrigliceridemia/fisiopatología , Lípidos/sangre , Glucemia/análisis , Estudios Transversales , Dislipidemias/sangre , Dislipidemias/etiología , Femenino , Estudios de Seguimiento , Hemoglobina A Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Emiratos Árabes Unidos/epidemiología
15.
Rev Port Cardiol ; 38(8): 531-542, 2019 08.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31447268

RESUMEN

INTRODUCTION AND AIMS: Atherogenic dyslipidemia is an important contributor to residual cardiovascular (CV) risk, but it is underdiagnosed and undertreated. This study aimed to assess the opinion of Portuguese experts to generate a consensus concerning the diagnosis and treatment of atherogenic dyslipidemia, as well as to contribute toward standardization of clinical practice in this disorder. METHODS: The study consisted in the application of a questionnaire to an expert panel, following a modified Delphi methodology. RESULTS: The majority (88.4%) of the proposed items were found to be consensual. The expert panel recognized the importance of the atherogenic dyslipidemia phenotype, the role played by low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol as risk markers and therapeutic targets, the choice of statins as first-line lipid-lowering drugs, and the value of associating statins with fenofibrate as a means to reduce residual CV risk. However, the role played by triglycerides in CV risk and the therapeutic value of fibrates lacked consensus. Taking into consideration the state of the art and the opinions expressed in this study, the scientific committee developed a treatment algorithm aimed to improve the perception and treatment of atherogenic dyslipidemia. CONCLUSIONS: The experts involved in this study were shown to be familiar with the concept and the importance of atherogenic dyslipidemia. The few situations in which a consensus could not be found were mainly related to the interpretation and/or relevance of the available evidence.


Asunto(s)
Aterosclerosis/tratamiento farmacológico , LDL-Colesterol/sangre , Consenso , Manejo de la Enfermedad , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipolipemiantes/uso terapéutico , Aterosclerosis/sangre , Aterosclerosis/etiología , Biomarcadores/sangre , Dislipidemias/sangre , Dislipidemias/complicaciones , Humanos , Portugal , Factores de Riesgo
16.
Int J Mol Sci ; 20(16)2019 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-31430893

RESUMEN

Female stress urinary incontinence (FSUI) is prevalent in women with type 2 diabetes/obesity (T2D/O), and treatment is not optimal. Autograph stem cell therapy surprisingly has poor efficacy. In the male rat model of T2D/O, it was demonstrated that epigenetic changes, triggered by long-term exposure to the dyslipidemic milieu, led to abnormal global transcriptional signatures (GTS) of genes and microRNAs (miR), and impaired the repair capacity of muscle-derived stem cells (MDSC). This was mimicked in vitro by treatment of MDSC with dyslipidemic serum or lipid factors. The current study aimed to predict whether these changes also occur in stem cells from female 12 weeks old T2D/O rats, a model of FSUI. MDSCs from T2D/O (ZF4-SC) and normal female rats (ZL4-SC) were treated in vitro with either dyslipidemic serum (ZFS) from late T2D/O 24 weeks old female Zucker fatty (ZF) rats, or normal serum (ZLS) from 24 weeks old female Zucker lean (ZL) rats, for 4 days and subjected to assays for fat deposition, apoptosis, scratch closing, myostatin, interleukin-6, and miR-GTS. The dyslipidemic ZFS affected both female stem cells more severely than in the male MDSC, with some gender-specific differences in miR-GTS. The changes in miR-GTS and myostatin/interleukin-6 balance may predict in vivo noxious effects of the T2D/O milieu that might impair autograft stem cell (SC) therapy for FSUI, but this requires future studies.


Asunto(s)
Diabetes Mellitus Tipo 2/patología , Dislipidemias/patología , Células Madre/patología , Incontinencia Urinaria/patología , Animales , Apoptosis , Células Cultivadas , Modelos Animales de Enfermedad , Dislipidemias/sangre , Femenino , Masculino , Ratas , Ratas Zucker , Trasplante de Células Madre
17.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 159-163, 2019 08 29.
Artículo en Español | MEDLINE | ID: mdl-31465183

RESUMEN

Background: Excess weight (EW) and alterations in lipid metabolism constitute risk factors for cardiovascular disease in adults and children. Prevalence of dyslipidemia in schoolchildren from Jujuy with EW is analyzed in this study. Methods: Cross-sectional descriptive study of 891 schoolchildren 10-14 years old (367 girls; 524 boys) from the province of Jujuy (Northwestern Argentina). Prevalence of dyslipidemia for Overweight (OW) and Obesity (OB) were calculated, according to the International Obesity Task Force cut-off points. Prevalence of lipid alterations were analyzed and 7 dyslipidemic profiles were established. Comparisons and associations between variables were analyzed by Chi-square test. Crude and adjusted odds ratio were estimated from a logistic regressions. Results: Regardless of sex and nutritional status, 13.7%, 21.8%, and 16.5% of schoolchildren showed high values of total cholesterol, triglycerides, and LDL cholesterol, respectively, and 20.3% had low HDL cholesterol. Significantly higher values of HDL cholesterol were found in OW, and of triglycerides in OB. A significant association was recorded between OB and high triglycerides. Schoolchildren with OB have a 54% more chances of showing at least one lipid alteration. Conclusion: EW, and especially OB, constitutes an important risk factor in the development of dyslipidemia in schoolchildren from Jujuy.


Asunto(s)
Dislipidemias/sangre , Dislipidemias/etiología , Sobrepeso/complicaciones , Adolescente , Argentina/epidemiología , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Niño , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Dislipidemias/epidemiología , Femenino , Humanos , Masculino , Obesidad/complicaciones , Sobrepeso/epidemiología , Prevalencia , Instituciones Académicas , Triglicéridos/sangre
18.
High Blood Press Cardiovasc Prev ; 26(5): 399-404, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31463886

RESUMEN

INTRODUCTION: Polytherapy is often required to treat the comorbidity of hypertension and hyperlipidemia. Fixed-dose co-formulation, rather than free combinations, simplifies medication taking and also improves adherence to medication, which is the key for a successful management of these conditions. AIM: To determine the number of patients potentially eligible for treatment with triple fixed-dose atorvastatin/perindopril/amlodipine (CTAPA), and to estimate if an unmet medical need exists among CTAPA free combination treated patients. METHODS: This observational retrospective study was based on administrative databases of 3 Italian Local Health Units. The cohort comprised adult patients with at least one prescription of amlodipine and perindopril (either as free combination or co-formulated) and atorvastatin during 2014. Follow-up period started on the date of prescription of the 3 molecules (index date) and lasted 1 year. Adherence to CTAPA was analyzed during follow-up, by using the proportion of days covered (PDC). RESULTS: 2292 patients (9.1 per 10,000 beneficiaries) had a prescription for CTAPA as free combination. Only 1249 (54.5%) were adherent to the therapy (PDC ≥ 80%); among them, a small percentage required dosage modification. The number of patients with CTAPA increased during the study period. Discontinuation of drugs prescribed the year before interested 582 patients in 2014, and 522 in 2015. Considering the Italian national population (n = 60,782,668), it was estimated that 69,542 hypertensive patients could be eligible for fixed-dose CTAPA during 2014. CONCLUSIONS: Real-world analysis among patients with free combination therapy can be applied to estimate the eligible population for fixed combination, and to evaluate the appropriateness of their prescriptions. Moreover, fixed-dose CTAPA could effectively improve adherence, which was calculated to be low in the free combination cohort.


Asunto(s)
Amlodipino/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Atorvastatina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/uso terapéutico , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertensión/tratamiento farmacológico , Perindopril/uso terapéutico , Anciano , Biomarcadores/sangre , Bases de Datos Factuales , Quimioterapia Combinada , Dislipidemias/sangre , Dislipidemias/diagnóstico , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Italia , Lípidos/sangre , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
19.
Rev Port Cardiol ; 38(6): 391-405, 2019 06.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31324407

RESUMEN

Reducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategies for reducing the risk of cardiovascular events. However, in clinical practice, a high proportion of patients do not achieve recommended LDL-C levels through lifestyle and lipid-lowering therapy with statins and ezetimibe. PCSK9 inhibitors (PCSK9i) are a new therapeutic option that significantly (50-60%) reduces LDL-C levels, which in clinical trials translates into an additional reduction in risk for cardiovascular events, and has a good safety profile. However, it is a high-cost therapy, and therefore its use in clinical practice should take its cost-effectiveness into account. Priority should be given to use in patients at higher cardiovascular risk and those in whom high LDL-C levels persist despite optimal lipid-lowering therapy. This consensus document aims to summarize the main data on the clinical use of PCSK9i and to make recommendations for Portugal on the profile of patients who may benefit most from this therapy.


Asunto(s)
LDL-Colesterol/sangre , Dislipidemias/tratamiento farmacológico , Ezetimiba/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Proproteína Convertasa 9/antagonistas & inhibidores , Anticolesterolemiantes/uso terapéutico , LDL-Colesterol/efectos de los fármacos , Dislipidemias/sangre , Dislipidemias/epidemiología , Humanos , Incidencia , Portugal/epidemiología
20.
Bull Exp Biol Med ; 167(3): 343-346, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31346865

RESUMEN

We studied the effect of streptozotocin-induced diabetes mellitus on the level of glycemia and some other indices of lipid metabolism, including fatty acid metabolism and LPO intensity, during the development of diabetes mellitus in rats. Even at the early terms of diabetes development, hypertriglyceridemia and hypercholesterolemia were accompanied by changes in the blood content of fatty acid (at the expense of ω3 and ω6 fatty acids) that persisted throughout the observation period. Intensification of LPO against the background of suppressed activity of antioxidant enzymes and reduced level of ω3 fatty acids attested to the development of oxidative stress. These data attest to antioxidant property of ω3 fatty acids, which is seen from positive correlations between these fatty acids and activity of antioxidant enzymes.


Asunto(s)
Diabetes Mellitus Experimental/patología , Dislipidemias/sangre , Ácidos Grasos Omega-3/sangre , Ácidos Grasos Omega-3/metabolismo , Metabolismo de los Lípidos/fisiología , Estrés Oxidativo/fisiología , Animales , Diabetes Mellitus Experimental/sangre , Femenino , Índice Glucémico , Hipercolesterolemia/patología , Hipertrigliceridemia/patología , Masculino , Ratas , Ratas Wistar , Estreptozocina
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