Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.446
Filtrar
1.
Arterioscler Thromb Vasc Biol ; 40(9): 1970-1981, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32762461

RESUMO

Dyslipidemias include both rare single gene disorders and common conditions that have a complex underlying basis. In London, ON, there is fortuitous close physical proximity between the Lipid Genetics Clinic and the London Regional Genomics Centre. For >30 years, we have applied DNA sequencing of clinical samples to help answer scientific questions. More than 2000 patients referred with dyslipidemias have participated in an ongoing translational research program. In 2013, we transitioned to next-generation sequencing; our targeted panel is designed to concurrently assess both monogenic and polygenic contributions to dyslipidemias. Patient DNA is screened for rare variants underlying 25 mendelian dyslipidemias, including familial hypercholesterolemia, hepatic lipase deficiency, abetalipoproteinemia, and familial chylomicronemia syndrome. Furthermore, polygenic scores for LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol, and triglycerides are calculated for each patient. We thus simultaneously document both rare and common genetic variants, allowing for a broad view of genetic predisposition for both individual patients and cohorts. For instance, among patients referred with severe hypertriglyceridemia, defined as ≥10 mmol/L (≥885 mg/dL), <1% have a mendelian disorder (ie, autosomal recessive familial chylomicronemia syndrome), ≈15% have heterozygous rare variants (a >3-fold increase over normolipidemic individuals), and ≈35% have an extreme polygenic score (a >3-fold increase over normolipidemic individuals). Other dyslipidemias show a different mix of genetic determinants. Genetic results are discussed with patients and can support clinical decision-making. Integrating DNA testing into clinical care allows for a bidirectional flow of information, which facilitates scientific discoveries and clinical translation.


Assuntos
Dislipidemias/genética , Variação Genética , Lipídeos/sangue , Biomarcadores/sangue , Variações do Número de Cópias de DNA , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/história , Predisposição Genética para Doença , Testes Genéticos , Sequenciamento de Nucleotídeos em Larga Escala , História do Século XX , História do Século XXI , Humanos , Herança Multifatorial , Fenótipo , Prognóstico , Medição de Risco , Fatores de Risco
2.
Clín. investig. arterioscler. (Ed. impr.) ; 32(3): 101-110, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193354

RESUMO

ANTECEDENTES Y OBJETIVO: Los datos sobre la distribución de las dislipidemias en Colombia son limitados. El objetivo primario de este estudio fue describir la frecuencia de las dislipidemias; los objetivos secundarios fueron: la frecuencia de comorbilidades cardiovasculares, el uso de estatinas y otros hipolipemiantes, la frecuencia de intolerancia a estatinas, el porcentaje de pacientes en metas de c-LDL, y estimar la distribución del riesgo cardiovascular (RCV). MATERIALES Y MÉTODOS: Estudio transversal con recolección de datos retrospectiva que incluyó a 461 pacientes con diagnóstico de dislipidemia tratados en 17 centros cardiovasculares de alta complejidad en las 6 principales áreas geográficas y económicas de Colombia. RESULTADOS: La media (DE) de edad de los pacientes incluidos fue de 66,4 (±12,3) años. El 53,4% (246) eran mujeres. Las dislipidemias se distribuyeron así: dislipidemia mixta (51,4%), hipercolesterolemia (41,0%), hipertrigliceridemia (5,4%), hipercolesterolemia familiar (3,3%) y c-HDL bajo (0,7%). El medicamento más prescrito fue atorvastatina (75,7%), seguido de rosuvastatina (24,9%). El 55% del total de pacientes y el 28,6% de aquellos con enfermedad coronaria no estaban en metas de c-LDL a pesar del tratamiento. La frecuencia de intolerancia a estatinas fue del 2,6%. CONCLUSIONES: La dislipidemia mixta y la hipercolesterolemia son las dislipidemias más frecuentes. Un porcentaje considerable de pacientes en tratamiento, incluidos aquellos con enfermedad coronaria, no lograron sus objetivos de c-LDL. Este inadecuado control lipídico influye en el RCV y requiere un cambio en las estrategias terapéuticas, intensificando el tratamiento con estatinas o adicionando nuevos fármacos en los pacientes con mayor RCV


BACKGROUND AND OBJECTIVE: Data is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). MATERIALS AND METHODS: Cross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. RESULTS: Mean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. CONCLUSIONS: Mixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Dislipidemias/terapia , Dislipidemias/epidemiologia , Comorbidade , Colômbia/epidemiologia , Doenças Cardiovasculares/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/uso terapêutico , Estudos Transversais , Dislipidemias/diagnóstico , Hipercolesterolemia/tratamento farmacológico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hipertrigliceridemia/tratamento farmacológico
4.
PLoS One ; 15(6): e0234433, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32511269

RESUMO

BACKGROUND: Several previous studies have suggested that Helicobacter pylori (H. pylori) infection affects the serum lipid profile. However, it remains controversial and the mechanism has not been elucidated. The purpose of this study is to use an epidemiological perspective to evaluate the association between H. pylori infection and the serum lipid profile. METHODS: Multivariate analysis was performed using the data of serum lipid profile, infection status of H. pylori, fitness/lifestyle habits, and various subjects' characteristics which were derived from the 15,679 generally healthy individuals in Japan. The average treatment effects (ATEs) of H. pylori infection on the serum lipid profile were estimated using augmented inverse probability weighting (AIPW). A meta-analysis was also performed using the 27 studies worldwide in which the status of H. pylori infection and at least one serum examination value (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), or triglyceride (TG)) were described. RESULTS: The ATEs determined with AIPW showed that H. pylori infection has significant positive effects on LDL-C and TC (ATE (95% confidence interval [95%CI]) = 3.4 (2.36-4.49) and 1.7 (0.58-2.88), respectively) but has significant negative effects on HDL-C and TG (ATE (95%CI) = -1.2 (-1.74 to -0.72) and -3.5 (-5.92 to -1.06), respectively). The meta-analysis to estimate the association between H. pylori infection and the serum lipid profile revealed that H. pylori infection is positively associated with LDL-C, TC, and TG (standardized mean difference [SMD] (95%CI) = 0.11 (0.09-0.12), 0.09 (0.07-0.10) and 0.06 (0.05-0.08), respectively) and negatively associated with HDL-C (SMD = -0.13 (-0.14 to -0.12)). CONCLUSION: Both our multivariate analyses and meta-analysis showed that H. pylori infection significantly affects the serum lipid profile, which might lead to various dyslipidemia-induced severe diseases like coronary thrombosis or cerebral infarction.


Assuntos
Dislipidemias/epidemiologia , Infecções por Helicobacter/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/etiologia , Feminino , Infecções por Helicobacter/sangue , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Japão/epidemiologia , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Pontuação de Propensão , Fatores de Risco , Triglicerídeos/sangue , Adulto Jovem
5.
PLoS One ; 15(5): e0233166, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407418

RESUMO

Retinal fundus photography provides a non-invasive approach for identifying early microcirculatory alterations of chronic diseases prior to the onset of overt clinical complications. Here, we developed neural network models to predict hypertension, hyperglycemia, dyslipidemia, and a range of risk factors from retinal fundus images obtained from a cross-sectional study of chronic diseases in rural areas of Xinxiang County, Henan, in central China. 1222 high-quality retinal images and over 50 measurements of anthropometry and biochemical parameters were generated from 625 subjects. The models in this study achieved an area under the ROC curve (AUC) of 0.880 in predicting hyperglycemia, of 0.766 in predicting hypertension, and of 0.703 in predicting dyslipidemia. In addition, these models can predict with AUC>0.7 several blood test erythrocyte parameters, including hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), and a cluster of cardiovascular disease (CVD) risk factors. Taken together, deep learning approaches are feasible for predicting hypertension, dyslipidemia, diabetes, and risks of other chronic diseases.


Assuntos
Aprendizado Profundo , Dislipidemias/diagnóstico , Fundo de Olho , Hiperglicemia/diagnóstico , Hipertensão/diagnóstico , Retina/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Doença Crônica , Estudos Transversais , Dislipidemias/diagnóstico por imagem , Feminino , Humanos , Hiperglicemia/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Curva ROC , Fatores de Risco , Adulto Jovem
6.
Cardiovasc Ther ; 2020: 3987065, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411300

RESUMO

Objective: The drug efficacy may differ among different statins, and evidence from head-to-head comparisons is sparse and inconsistent. The study is aimed at comparing the lipid-lowering/increasing effects of 7 different statins in patients with dyslipidemia, cardiovascular diseases, or diabetes mellitus by conducting systematic review and network meta-analyses (NMA) of the lipid changes after certain statins' use. Methods: In this study, we searched four electronic databases for randomized controlled trials (RCTs) published through February 25, 2020, comparing the lipid-lowering efficacy of no less than two of the included statins (or statin vs. placebo). Three reviewers independently extracted data in duplicate. Firstly, mixed treatment overall comparison analyses, in the form of frequentist NMAs, were conducted using STATA 15.0 software. Then, subgroup analyses were conducted according to different baseline diseases. At last, sensitivity analyses were conducted according to age and follow-up duration. The trial was registered with PROSPERO (number CRD42018108799). Results: As a result, seven statin monotherapy treatments in 50 studies (51956 participants) were used for the analyses. The statins included simvastatin (SIM), fluvastatin (FLU), atorvastatin (ATO), rosuvastatin (ROS), lovastatin (LOV), pravastatin (PRA), and pitavastatin (PIT). In terms of LDL-C lowering, rosuvastatin ranked 1st with a surface under cumulated ranking (SUCRA) value of 93.1%. The comparative treatment efficacy for LDL-C lowering was ROS>ATO>PIT>SIM>PRA>FLU>LOV>PLA. All of the other ranking and NMA results were reported in SUCRA plots and league tables. Conclusions: According to the NMAs, it can be concluded that rosuvastatin ranked 1st in LDL-C, ApoB-lowering efficacy and ApoA1-increasing efficacy. Lovastatin ranked 1st in TC- and TG-lowering efficacy, and fluvastatin ranked 1st in HDL-C-increasing efficacy. The results should be interpreted with caution due to some limitations in our review. However, they can provide references and evidence-based foundation for drug selection in both statin monotherapies and statin combination therapies.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipídeos/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Regulação para Baixo , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
7.
Cardiovasc Diabetol ; 19(1): 45, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245386

RESUMO

BACKGROUND: Elevation in small dense low-density lipoprotein (sdLDL) is common in patients with diabetes mellitus (DM), which has already been reported to be associated with incidence of coronary artery disease (CAD). The aim of the present study was to investigate the prognostic value of plasma sdLDL level in patients with stable CAD and DM. METHODS: A total of 4148 consecutive patients with stable CAD were prospectively enrolled into the study and followed up for major cardiovascular events (MACEs) up to 8.5 years. Plasma sdLDL level was measured in each patient by a direct method using automated chemistry analyzer. The patients were subsequently divided into four groups by the quartiles of sdLDL and the association of sdLDL level with MACEs in different status of glucose metabolism [DM, Pre-DM, normal glycaemia regulation (NGR)] was evaluated. RESULTS: A total of 464 MACEs were documented. Both Kaplan-Meier analysis and Cox regression analysis indicated that the patients in quartile 4 but not quartile 2 or 3 of sdLDL level had significantly higher rate of MACEs than that in lowest quartile. When the prognostic value of high sdLDL was assessed in different glucose metabolism status, the results showed that the high sdLDL plus DM was associated with worse outcome after adjustment of confounding risk factors (hazard ratio: 1.83, 95% confident interval: 1.24-2.70, p < 0.05). However, no significant association was observed for high sdLDL plus Pre-DM or NGR. CONCLUSIONS: The present study firstly indicated that elevated levels of plasma sdLDL were associated with increased risk of MACEs among DM patients with proven CAD, suggesting that sdLDL may be useful for CAD risk stratification in DM.


Assuntos
Glicemia/metabolismo , LDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Diabetes Mellitus/sangue , Dislipidemias/sangue , Idoso , Pequim/epidemiologia , Biomarcadores/sangue , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Regulação para Cima
8.
Ann Palliat Med ; 9(2): 414-419, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233629

RESUMO

BACKGROUND: Dyslipidemia is common among the general population, and its prevention is urgently needed particularly for the health of students. The purpose of our study was to explore the relationship between serum iron level and blood lipids. METHODS: A sample of 290 university students was collected in this cross-section study. The blood lipids and serum iron levels were determined. Pearson's correlation coefficient was used to determine the correlation between serum iron level and blood lipids. RESULTS: The prevalence of dyslipidemia was 8.8% among male students and 5.4% among female students. The overall prevalence of dyslipidemia was7.2% among the total students. The results showed that serum iron level was negatively correlated with triglyceride (TG), but was positively correlated with high-density lipoprotein cholesterol (HDL)-cholesterol, low-density lipoprotein cholesterol (LDL)-cholesterol, and total cholesterol (TC) in female students. Female students with serum iron less than 15 mmol/L had higher levels of serum TG than female students with serum iron 15 mmol/L or above (P<0.05). CONCLUSIONS: These findings suggest that lower serum iron levels may be a risk factor of high serum TG in female students. Supplementation of iron may be a strategy for prevention of high serum TG in female students.


Assuntos
Dislipidemias/sangue , Ferro/sangue , Estudantes/estatística & dados numéricos , Triglicerídeos/sangue , Anemia Ferropriva/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Estudos Transversais , Dislipidemias/diagnóstico , Feminino , Humanos , Masculino , Fatores Sexuais , Universidades , Adulto Jovem
9.
Cardiovasc Diabetol ; 19(1): 28, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138746

RESUMO

BACKGROUND: The Action to Control Cardiovascular Risk in Diabetes (ACCORD)-Lipid study found no evidence of a beneficial effect of statin-fibrate combined treatment, compared to statins alone, on cardiovascular outcomes and mortality in type 2 diabetes mellitus after 5 years of active treatment. However, a beneficial reduction in major CVD events was shown in a pre-specified sub-group of participants with dyslipidemia. The extended follow-up of this trial provides the opportunity to further investigate possible beneficial effects of fibrates in this group of patients. We aimed to evaluate possible "legacy effects" of fibrate add-on therapy on mortality and major cardiovascular outcomes in patients with dyslipidemia. METHODS: The ACCORD-lipid study was a randomized controlled trial of 5518 participants assigned to receive simvastatin plus fenofibrate vs simvastatin plus placebo. After randomized treatment allocation had finished at the end of the trial, all surviving participants were invited to attend an extended follow-up study (ACCORDION) to continue prospective collection of clinical outcomes. We undertook a secondary analysis of trial and post-trial data in patients who had dyslipidemia. The primary outcome was all-cause and cardiovascular mortality, and secondary outcomes were nonfatal myocardial infarction, stroke, congestive heart failure and major coronary heart disease. We used an intention-to-treat approach to analysis to make comparisons between the original randomized treatment groups. RESULTS: 853 participants with dyslipidemia had survived at the end of the trial. Most participants continued to use statins, but few used fibrates in either group during the post-trial period. The incidence rates in the fenofibrate group were lower with respect to all-cause mortality, CVD mortality, nonfatal myocardial infarction, congestive heart failure and major coronary heart disease than those in the placebo group over a post-trial follow-up. Allocation to the combined fibrate-statin treatment arm during the trial period had a beneficial legacy effect on all-cause mortality (adjusted HR = 0.65, 95% CI 0.45-0.94; P = 0.02). CONCLUSIONS: Fibrate treatment during the initial trial period was associated with a legacy benefit of improved survival over a post-trial follow-up. These findings support re-evaluation of fibrates as an add-on strategy to statins in order to reduce cardiovascular risk in diabetic patients with dyslipidemia. Trial registration clinicaltrials.gov, Identifier: NCT00000620.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Fenofibrato/uso terapêutico , Lipídeos/sangue , Sinvastatina/uso terapêutico , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Causas de Morte , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Quimioterapia Combinada , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/mortalidade , Feminino , Fenofibrato/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sinvastatina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
10.
Acta Diabetol ; 57(7): 861-866, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32114640

RESUMO

AIMS: Hyperreflective foci (HF), detected in the retina of diabetic patients, suggest the presence of microglial activation and migration, while controversies still remain for the origin of HF to be precursors of hard exudates. We investigated the presence of HF and their association with dyslipidemia in serous retinal detachment (SRD)-type diabetic macular edema (DME). METHODS: Forty-two eyes in 42 patients with diabetic retinopathy (DR) and 22 eyes in 22 patients with branch retinal vascular occlusion (BRVO) showing macular edema were included in this study. The medical records and OCT findings were retrospectively reviewed in patients with SRD-type DME and compared with those with BRVO. The mean number of HF, the mean choroidal thickness, and lipid profiles were analyzed and compared between groups. RESULTS: The mean number of HF was significantly higher in DR group compared to BRVO group. Significant correlation of HF was noted with triglycerides (r = 0.523, P = 0.002). Triglycerides were significantly associated with HF by linear regression (ß = 0.012, 95% CI 0.001-0.024, P = 0.034) and remained significantly associated by multiple linear regression (ß = 0.014, 95% CI 0.003-0.025, P = 0.014). CONCLUSIONS: HF on OCT of DME patients could be indicative of activated microglia. HF are associated with dyslipidemia, especially high triglycerides, suggesting inflammatory reaction from dyslipidemia in diabetic retina.


Assuntos
Retinopatia Diabética/complicações , Dislipidemias/complicações , Edema Macular/complicações , Microglia/patologia , Retina/patologia , Descolamento Retiniano/complicações , Adulto , Idoso , Movimento Celular , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/patologia , Dislipidemias/diagnóstico , Dislipidemias/patologia , Feminino , Humanos , Edema Macular/diagnóstico , Edema Macular/patologia , Masculino , Microglia/fisiologia , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/fisiopatologia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/patologia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
11.
Rev Med Suisse ; 16(684): 433-437, 2020 Mar 04.
Artigo em Francês | MEDLINE | ID: mdl-32134221

RESUMO

Familial dyslipidemia is rare compared to polygenetic causes. Nevertheless, it is important not to miss this diagnosis, as it is more strongly associated with an increased risk of early cardiovascular disease and scores for calculating cardiovascular risk are not valid in this population. Early detection and management based on lifestyle optimization and treatment of cardiovascular risk factors can delay the onset of cardiovascular complications and thus improve patients' quality of life. A LDL-Cholesterol of 4,9 mmol/l has recently been suggested as the cut-off for starting lipid lowering therapy, but remains controversial because the majority of people above this threshold do not have primary monogenic dyslipidemia. The age at which therapy should be initiated as well as the targets for treatment are also controversial.


Assuntos
Dislipidemias/diagnóstico , Dislipidemias/terapia , LDL-Colesterol/sangue , Dislipidemias/sangue , Dislipidemias/genética , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Qualidade de Vida , Fatores de Risco
12.
High Blood Press Cardiovasc Prev ; 27(3): 231-238, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32219668

RESUMO

INTRODUCTION: Age is traditionally considered a major cardiovascular (CV) risk factor, but its real weight in the absence of other modifiable risk factors is not clear. AIM: To compare the prevalence of subclinical carotid atherosclerosis, and its association with the main CV risk factors, between older adults and hypertensive adults. METHODS: Cross-sectional study on 210 consecutive patients: 70 older adults (age ≥ 80 years), and 140 hypertensive adults having at least another CV risk factor. Patients had no history of peripheral artery disease or major CV events. RESULTS: Mean age was 54.2 ± 7.2 years in hypertensive adults and 88.5 ± 5.5 years in older adults with a female prevalence in the latter group. Dyslipidemia and smoking were more prevalent in hypertensive adults, while chronic kidney disease was more prevalent in older adults. Prevalence of carotid plaques did not differ between hypertensive adults and older adults (48.2% vs 55.6%, respectively, p = 0.311). Age ≥ 80 years was not associated with a higher risk of carotid plaques even after adjusting for other risk factors (p = 0.204). Hypertension and dyslipidemia were the risk factors more strongly associated with carotid plaques in older adults and hypertensive adults, respectively. When older adults with hypertension were excluded from the analysis, prevalence of carotid plaques was significantly higher in hypertensive adults (p = 0.042). CONCLUSION: Hypertension and dyslipidemia are the major determinant of atherosclerosis regardless of age in our study. Our findings support the concept that aging is not necessarily synonymous with atherosclerosis and highlight the key role played by superimposed CV risk factors on arterial ''bad aging''.


Assuntos
Envelhecimento , Aterosclerose/epidemiologia , Doenças das Artérias Carótidas/epidemiologia , Dislipidemias/epidemiologia , Hipertensão/epidemiologia , Adulto , Fatores Etários , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Aterosclerose/diagnóstico por imagem , Biomarcadores/sangue , Pressão Sanguínea , Doenças das Artérias Carótidas/diagnóstico por imagem , Estudos Transversais , Dislipidemias/sangue , Dislipidemias/diagnóstico , Feminino , Nível de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Itália/epidemiologia , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais
13.
High Blood Press Cardiovasc Prev ; 27(2): 157-164, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32219670

RESUMO

INTRODUCTION: Cardiovascular diseases (CVD) represent the first cause of mortality in western countries. Hypertension and dyslipidemia are strong risk factors for CVD, and are prevalent either alone or in combination. Although effective substances for the treatment of both factors are available, there is space for optimization of treatment regimens due to poor patient's adherence to medication, which is usually a combination of several substances. Adherence decreases with the number of pills a patient needs to take. A combination of substances in one single-pill (single pill combination, SPC), might increase adherence, and lead to a better clinical outcome. AIM: We conducted a meta-analysis to compare the effect of SPC with that of free-combination treatment (FCT) in patients with either hypertension, dyslipidemia or the combination of both diseases under conditions of daily practice. METHODS: Studies were identified by searching in PubMed from November 2014 until February 2015. Search criteria focused on trials in identical hypertension and/or dyslipidemia treatment as FCT therapy or as SPC. Adherence and persistence outcome included proportion-of-days-covered (PDC), medication possession ratio (MPR), time-to treatment gap of 30 and 60 days and no treatment gap of 30 days (y/n). Clinical outcomes were all cause hospitalisation, hypertension-related hospitalisation, all cause emergency room visits, hypertension-related emergency room visits, outpatient visits, hypertension-related outpatient visits, and number of patients reaching blood pressure goal. Randomized clinical studies were excluded because they usually do not reflect daily practice. RESULTS: 11 out of 1.465 studies met the predefined inclusion criteria. PDC ≥ 80% showed an odds ratio (OR) of 1.78 (95% CI: 1.30-2.45; p = 0.004) after 6 months and an OR of 1.85 (95% CI: 1.71; 2.37; p < 0.001) after ≥ 12 months in favour to the SPC. MPR ≥ 80% after 12 months also was in favour to SPC (OR 2.13; 95% CI: 1.30; 3.47; p = 0.003). Persistence was positively affected by SPC after 6, 12, and 18 months. Time to treatment gap of 60 days resulted in a hazard ratio (HR) of 2.03 (95% CI: 1.77; 2.33, p < 0.001). The use of SPC was associated with a significant improvement in systolic blood pressure reduction, leading to a higher number of patients reaching individual blood pressure goals (FCT vs SPC results in OR = 0.77; 95% CI: 0.69; 0.85, p < 0.001). Outpatient visits, emergency room visits and hospitalisations, both overall and hypertension-related were reduced by SPC: all-cause hospitalisation (SPC vs FCT: 15.0% vs 18.2%, OR 0.79, 95% CI 0.67; 0.94, p = 0.009), all-cause emergency room visits (SPC vs FCT: 25.7% vs 31.4%, OR 0.75, 95% CI 0.65; 0.87, p = 0.001) and hypertension related emergency room visits (SPC vs FCT: 9.7% vs 14.1%, OR 0.65, 95% CI 0.54; 0.80, p < 0.001). CONCLUSIONS: SPC improved medication adherence and clinical outcome parameter in patients suffering from hypertension and/or dyslipidemia and led to a better clinical outcome compared to FCT under conditions of daily practice.


Assuntos
Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Hipertensão/tratamento farmacológico , Hipolipemiantes/administração & dosagem , Lipídeos/sangue , Adesão à Medicação , Administração Oral , Idoso , Anti-Hipertensivos/efeitos adversos , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Esquema de Medicação , Combinação de Medicamentos , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipolipemiantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Comprimidos , Fatores de Tempo , Resultado do Tratamento
14.
Maturitas ; 135: 82-88, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32209279

RESUMO

INTRODUCTION: Dyslipidemias are common and increase the risk of cardiovascular disease. The menopause transition is associated with an atherogenic lipid profile, with an increase in the concentrations of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein B (apoB) and potentially lipoprotein (a) [Lp(a)], and a decrease in the concentration of high-density lipoprotein cholesterol (HDL-C). AIM: The aim of this clinical guide is to provide an evidence-based approach to management of menopausal symptoms and dyslipidemia in postmenopausal women. The guide evaluates the effects on the lipid profile both of menopausal hormone therapy and of non-estrogen-based treatments for menopausal symptoms. MATERIALS AND METHODS: Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS: Initial management depends on whether the dyslipidemia is primary or secondary. An assessment of the 10-year risk of fatal cardiovascular disease, based on the Systematic Coronary Risk Estimation (SCORE) system, should be used to set the optimal LDL-C target. Dietary changes and pharmacological management of dyslipidemias should be tailored to the type of dyslipidemia, with statins constituting the mainstay of treatment. With regard to menopausal hormone therapy, systemic estrogens induce a dose-dependent reduction in TC, LDL-C and Lp(a), as well as an increase in HDL-C concentrations; these effects are more prominent with oral administration. Transdermal rather than oral estrogens should be used in women with hypertriglyceridemia. Micronized progesterone or dydrogesterone are the preferred progestogens due to their neutral effect on the lipid profile. Tibolone may decrease TC, LDL-C, TG and Lp(a), but also HDL-C concentrations. Low-dose vaginal estrogen and ospemifene exert a favorable effect on the lipid profile, but data are scant regarding dehydroepiandrosterone (DHEA). Non-estrogen-based therapies, such as fluoxetine and citalopram, exert a more favorable effect on the lipid profile than do sertraline, paroxetine and venlafaxine. Non-oral testosterone, used for the treatment of hypoactive sexual desire disorder/dysfunction, has little or no effect on the lipid profile.


Assuntos
Dislipidemias/terapia , Menopausa , Dislipidemias/sangue , Dislipidemias/diagnóstico , Feminino , Humanos , Lipídeos/sangue , Programas de Rastreamento
15.
Open Heart ; 7(1): e001003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32201580

RESUMO

Spirulina, a cyanobacteria commonly referred to as a blue-green algae, is one of the oldest lifeforms on Earth. Spirulina grows in both fresh and saltwater sources and is known for its high protein and micronutrient content. This review paper will cover the effects of spirulina on weight loss and blood lipids. The currently literature supports the benefits of spirulina for reducing body fat, waist circumference, body mass index and appetite and shows that spirulina has significant benefits for improving blood lipids.


Assuntos
Fármacos Antiobesidade/uso terapêutico , Suplementos Nutricionais , Dislipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Obesidade/tratamento farmacológico , Spirulina , Perda de Peso/efeitos dos fármacos , Animais , Fármacos Antiobesidade/efeitos adversos , Biomarcadores/sangue , Suplementos Nutricionais/efeitos adversos , Dislipidemias/sangue , Dislipidemias/diagnóstico , Humanos , Hipolipemiantes/efeitos adversos , Obesidade/diagnóstico , Obesidade/fisiopatologia , Resultado do Tratamento
17.
Arterioscler Thromb Vasc Biol ; 40(5): 1135-1147, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32212849

RESUMO

Patients with well-controlled LDL (low-density lipoprotein) levels still have residual cardiovascular risk associated with elevated triglycerides. Epidemiological studies have shown that elevated fasting triglyceride levels associate independently with incident cardiovascular events, and abundant recent human genetic data support the causality of TGRLs (triglyceride-rich lipoproteins) in atherothrombosis. Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), lower blood triglyceride concentrations but likely exert additional atheroprotective properties at higher doses. Omega-3 fatty acids modulate T-cell differentiation and give rise to various prostaglandins and specialized proresolving lipid mediators that promote resolution of tissue injury and inflammation. The REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) with an EPA-only formulation lowered a composite of cardiovascular events by 25% in patients with established cardiovascular disease or diabetes mellitus and other cardiovascular risk factors. This clinical benefit likely arises from multiple molecular mechanisms discussed in this review. Indeed, human plaques readily incorporate EPA, which may render them less likely to trigger clinical events. EPA and DHA differ in their effects on membrane structure, rates of lipid oxidation, inflammatory biomarkers, and endothelial function as well as tissue distributions. Trials that have evaluated DHA-containing high-dose omega-3 fatty acids have thus far not shown the benefits of EPA alone demonstrated in REDUCE-IT. This review will consider the mechanistic evidence that helps to understand the potential mechanisms of benefit of EPA.


Assuntos
Anti-Inflamatórios/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Suplementos Nutricionais , Dislipidemias/tratamento farmacológico , Ácido Eicosapentaenoico/uso terapêutico , Hipolipemiantes/uso terapêutico , Inflamação/tratamento farmacológico , Animais , Anti-Inflamatórios/efeitos adversos , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Suplementos Nutricionais/efeitos adversos , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Ácido Eicosapentaenoico/efeitos adversos , Medicina Baseada em Evidências , Humanos , Hipolipemiantes/efeitos adversos , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/epidemiologia , Lipídeos/sangue , Fatores de Proteção , Medição de Risco , Fatores de Risco , Resultado do Tratamento
18.
BMC Cardiovasc Disord ; 20(1): 102, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111165

RESUMO

BACKGROUND: Peripheral arterial disease (PAD) is a risk factor for diabetic foot ulcer, limb amputation as well as coronary heart disease. It is more common in patients with diabetes mellitus (DM) and co-exists with peripheral neuropathy. Prevalence of PAD in type 2 DM patients in northern Nigeria is largely unknown. We investigated the occurrence and factors associated with PAD among patients with type 2 DM in a tertiary hospital in northern Nigeria. METHODS: This was a cross- sectional analytic study. We recruited 200 patients with type 2 DM consecutively from the diabetes clinic of the Jos University Teaching Hospital. Ankle brachial index was assessed for each participant. Clinical information, anthropometric indices and blood samples were collected for assay. Data was analysed using CDC Epi-Info and logistic regression analysis was used to determine independent correlates of PAD. RESULTS: PAD was present in 38.5%(n = 77) of subjects and it was associated with the female sex, age ≥ 50 years, Body mass index (BMI) ≥ 25 kg/m2 and low HDL cholesterol levels. However, on multiple logistic regression, a BMI ≥ 25 kg/m2 and a low HDL cholesterol level were independent correlates of PAD(adjusted OR = 2.13,95% CI = 1.04-4.36 and adjusted OR = 2.31, 95% CI = 1.04-5.15, respectively). CONCLUSION: PAD is present in more than a third of patients with type 2 DM in a tertiary hospital in northern Nigeria. A BMI of ≥25 kg/m2 and low HDL cholesterol levels were independent correlates of PAD.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hospitais de Ensino , Doença Arterial Periférica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Biomarcadores/sangue , Índice de Massa Corporal , HDL-Colesterol/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Doença Arterial Periférica/diagnóstico , Prevalência , Medição de Risco , Fatores de Risco
19.
BMC Cardiovasc Disord ; 20(1): 113, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138676

RESUMO

BACKGROUND: Whether pre-diabetes in the absence of hypertension (HTN) or dyslipidemia (DLP) is a risk factor for occurrence of major adverse cardiovascular events (MACE) is not fully established. We investigated the effect of impaired fasting glucose (IFG) alone and in combination with HTN, DLP or both on subsequent occurrence of MACE as well as individual MACE components. METHODS: This longitudinal population-based study included 11,374 inhabitants of Northeastern Iran. The participants were free of any cardiovascular disease at baseline and were followed yearly from 2010 to 2017. Cox proportional hazard models were fitted to measure the hazard of IFG alone or in combination with HTN and DLP on occurrence of MACE as the primary endpoint. RESULTS: Four hundred thirty-seven MACE were recorded during 6.2 ± 0.1 years follow up. IFG alone compared to normal fasting glucose (NFG) was not associated with an increase in occurrence of MACE (HR, 0.87; 95% CI, 0.19-4.02; p, 0.854). However, combination of IFG and HTN (HR, 2.88; 95% CI, 2.04-4.07; p, 0.000) or HTN + DLP (HR, 2.98; 95% CI, 1.89-4.71; p, 0.000) significantly increased the risk for MACE. Moreover, IFG + DM with or without HTN, DLP, or both was also associated with an increase in the incidence of MACE. CONCLUSION: IFG, per se, does not appear to increase hazard of MACE. However, IFG with HTN or HTN + DLP conferred a significant hazard for MACE in an incremental manner. Moreover, IFG without HTN, adjusted for DLP, can be associated with an increase in the risk for CVD- death.


Assuntos
Glicemia/metabolismo , Dislipidemias/sangue , Jejum/sangue , Transtornos do Metabolismo de Glucose/sangue , Hipertensão/sangue , Lipídeos/sangue , Adulto , Idoso , Biomarcadores/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Feminino , Transtornos do Metabolismo de Glucose/diagnóstico , Transtornos do Metabolismo de Glucose/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Irã (Geográfico)/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
20.
Nutr Metab Cardiovasc Dis ; 30(5): 777-787, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32131987

RESUMO

BACKGROUND AND AIMS: Dyslipidemia has been identified as a major risk factor for cardiovascular disease. We aimed to identify metabolites and metabolite modules showing novel association with lipids among Bogalusa Heart Study (BHS) participants using untargeted metabolomics. METHODS AND RESULTS: Untargeted ultrahigh performance liquid chromatography-tandem mass spectroscopy was used to quantify serum metabolites of 1 243 BHS participants (816 whites and 427 African-Americans). The association of single metabolites with lipids was assessed using multiple linear regression models to adjust for covariables. Weighted correlation network analysis was utilized to identify modules of co-abundant metabolites and examine their covariable adjusted correlations with lipids. All analyses were conducted according to race and using Bonferroni-corrected α-thresholds to determine statistical significance. Thirteen metabolites with known biochemical identities showing novel association achieved Bonferroni-significance, p < 1.04 × 10-5, and showed consistent effect directions in both whites and African-Americans. Twelve were from lipid sub-pathways including fatty acid metabolism (arachidonoylcholine, dihomo-linolenoyl-choline, docosahexaenoylcholine, linoleoylcholine, oleoylcholine, palmitoylcholine, and stearoylcholine), monohydroxy fatty acids (2-hydroxybehenate, 2-hydroxypalmitate, and 2-hydroxystearate), and lysoplasmalogens [1-(1-enyl-oleoyl)-GPE (P-18:1) and 1-(1-enyl-stearoyl)-GPE (P-18:0)]. The gamma-glutamylglutamine, peptide from the gamma-glutamyl amino acid sub-pathway, were also identified. In addition, four metabolite modules achieved Bonferroni-significance, p < 1.39 × 10-3, in both whites and African-Americans. These four modules were largely comprised of metabolites from lipid sub-pathways, with one module comprised of metabolites which were not identified in the single metabolite analyses. CONCLUSION: The current study identified 13 metabolites and 4 metabolite modules showing novel association with lipids, providing new insights into the physiological mechanisms regulating lipid levels.


Assuntos
Doenças Cardiovasculares/sangue , Cromatografia Líquida de Alta Pressão , Dislipidemias/sangue , Lipídeos/sangue , Metabolômica , Espectrometria de Massas em Tandem , Adulto , Afro-Americanos , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etnologia , Estudos Transversais , Dislipidemias/diagnóstico , Dislipidemias/etnologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Louisiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Fatores Raciais , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA