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1.
Zhonghua Nei Ke Za Zhi ; 59(1): 18-22, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887831

RESUMO

The prevalence of dyslipidemia in Chinese adult is increasing dramatically, which poses a severe challenge to the prevention and treatment of atherosclerotic cardiovascular diseases. In recent years, a series of new research results have been published, providing a lot of new information for the management strategy of dyslipidemia. In order to apply these new research results to clinical practice for the further prevention and treatment of dyslipidemia more reasonably and effectively, the China Cholesterol Education Program (CCEP) Working Committee organized joint expert meeting and revised the "Expert Advice on Prevention and Treatment of Dyslipidemia in China Cholesterol Education Program 2014", in which a new classification standard for cardiovascular risk stratification has been proposed, and the target value of lipid-lowering therapy has been updated.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , Dislipidemias , Guias de Prática Clínica como Assunto , Adulto , China , Dislipidemias/prevenção & controle , Dislipidemias/terapia , Humanos , Fatores de Risco
2.
Arch Oral Biol ; 109: 104553, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31563004

RESUMO

This study evaluated the effects of replacing a saturated fat diet by n-3 polyunsaturated fatty acids (n-3PUFA), on alveolar bone loss in hypercholesterolemic rats with experimental periodontitis (PD). METHODS: Eight week old Wistar rats were assigned according to dietary intake. Control group (C, n = 15) fed a commercial diet throughout the experiment. Atherogenic group (AT, n = 30) fed AT diet for 3 weeks; thereafter, AT was randomized to receive either a n-3PUFA (n = 15) or to continue with AT (n = 15) diet. Subsequently, PD was induced in all groups by unilateral ligature (L) of the first molar (M1) of the left mandible, non-ligated contralateral molars served as controls. After every week of PD induction, 5 rats per group were euthanized. Serum was collected for lipids assays and hemi-mandibles were subjected to histomorphometric (% upper and lower interradicular bone volume and periodontal ligament height, hPDL) and radiographic analyses (periodontal bone support, PBS, in ligated teeth, between M1-M2). RESULTS: Rats fed n-3PUFA diet rapidly induced a significant reduction in the serum lipids (p < 0.001). In all rats the ligated teeth showed a greater bone loss as compared with the unligated molars. At the end of the experiment the AT + L was the worst in % lower bone volume (p < 0.01), hPDL and PBS (p < 0.05). In contrast, rats fed n-3PUFA + L was similar to those rats fed C diet (p > 0.05). CONCLUSION: Alveolar bone and dyslipidemia improved by substituting saturated fat intake for a n-3PUFA rich diet, in hypercholesterolemic rats with PD.


Assuntos
Perda do Osso Alveolar/terapia , Dieta , Ácidos Graxos Ômega-3/administração & dosagem , Óleos de Peixe/administração & dosagem , Hipercolesterolemia/fisiopatologia , Periodontite/fisiopatologia , Animais , Dislipidemias/terapia , Distribuição Aleatória , Ratos , Ratos Wistar
5.
Artigo em Chinês | MEDLINE | ID: mdl-31245949

RESUMO

OBJECTIVE: To evaluate the effects of 12 weeks high intensity interval training(HIIT) on serum lipids profile in patients with dyslipidemia of different apolipoprotein E(ApoE) genotypes. METHODS: Eighty-eight patients with dyslipidemia were screened by fasting blood lipid as subjects. Apolipoprotein E genotypes were detected in oral mucosa of subjects. Serum lipids before and after 12 weeks high intensity interval training were measured to analysis the effect of high intensity interval training on serum lipids. RESULTS: Five genotypes were detected in 88 cases of dyslipidemia. The distributions were ApoE3/3>ApoE3/4>ApoE2/3>ApoE2/2>ApoE2/4,and allele ε3>ε2=ε4. Before exercise intervention, the level of total cholesterol in patients with ε4 allele was significant higher than those in patients with ε2 and ε3 (P<0.01), low density lipoprotein cholesterol in patients with ε4 was significant higher than that of patients with ε2 (P<0.05), and the other indexes had no significant difference among the groups (P> 0.05). After 12 weeks high intensity interval training, the levels of total cholesterol, triglyceride and low density lipoprotein cholesterol were decreased significantly ,while the level of high density lipoprotein cholesterol was increased in those patients with ε3 genotype. For those individuals with ε4 genotype , their serum levels of total cholesterol and low density lipoprotein cholesterol were reduced after 12 weeks high intensity interval training , but there was no changes in serum levels of triglyceride and high density lipoprotein cholesterol. For those individuals with ε2 genotype, there was no significant improvement in serum lipids after 12 weeks high intensity interval training interventions. CONCLUSION: The polymorphisms of apolipoprotein E gene resulted in different effects of exercise interventions on serum lipids of dyslipidemia. Twelve weeks high intensity interval training can be used as an intervention method to regulate serum lipids of dyslipidemia with ε3 and ε4 alleles.


Assuntos
Apolipoproteínas E , Dislipidemias , Treinamento Intervalado de Alta Intensidade , Lipídeos , Apolipoproteínas E/genética , Dislipidemias/genética , Dislipidemias/terapia , Genótipo , Humanos , Lipídeos/sangue
7.
Med. clín (Ed. impr.) ; 152(12): 473-481, jun. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183317

RESUMO

Background: Recent clinical studies have yielded controversial results regarding the effect of probiotics on lipid profiles. To assess the efficacy of probiotics in lowering serum lipid concentrations, we conducted a meta-analysis of randomized controlled trials (RCTs). Methods: Literature from the PubMed, Embase and Cochrane databases were searched and screened. The effects of probiotics on lipid profiles were assessed by mean difference (MD) and 95% confidence interval (CI). All included studies were analyzed using Review Manager 5.3 (Cochrane Collaboration, 2014). Results: A total of 19 RCTs, including 967 participants, met the inclusion criteria. Probiotic interventions reduced total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) compared to controls (placebo or no treatment) by −0.25mmol/L (95% CI: −0.39, −0.12) and −0.17mmol/L (95% CI: −0.25, −0.09), respectively. No significant effects of probiotics on triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels were found. The effects of probiotics on decreasing TC and LDL-C levels were greater for longer intervention times, certain probiotic strains, and in younger mildly hypercholesterolaemic subjects. Conclusion: This meta-analysis revealed that the use of probiotics can significantly lower TC and LDL-C levels in hypercholesterolaemic adults, which brings hope for reducing the risk factors for developing cardiovascular disease


Antecedentes: Los resultados obtenidos por estudios clínicos recientes sobre el efecto de los probióticos en los perfiles lipídicos han generado cierta controversia. Para evaluar la eficacia de los probióticos en la reducción de las concentraciones séricas de lípidos, se realizó un metaanálisis de estudios comparativos aleatorizados (ECA). Métodos: Se realizó una búsqueda y posterior cribado bibliográfico en las bases de datos PubMed, Embase y Cochrane. Se evaluaron los efectos de los probióticos en los perfiles de lípidos mediante la diferencia de medias (DM) y el intervalo de confianza (IC) del 95%. Todos los estudios incluidos se analizaron con Review Manager 5.3 (Cochrane Collaboration, 2014). Resultados: Cumplieron con los criterios de inclusión un total de 19 ECA, que incluyeron 967 participantes. Las intervenciones probióticas redujeron el colesterol total (CT) y el colesterol de lipoproteínas de baja densidad (c-LDL) en −0,25mmol/l (IC 95%: −0,39, −0,12) y −0,17mmol/l (IC 95%: −0,25, −0,09), respectivamente, en comparación con los controles (placebo o ningún tratamiento). No se observaron efectos significativos de los probióticos en los niveles de triglicéridos (TG) y en el colesterol de lipoproteínas de alta densidad (c-HDL). Los efectos de los probióticos en la disminución de los niveles de CT y c-LDL fueron mayores en los casos donde la intervención duró más tiempo, en ciertas cepas probióticas y en sujetos más jóvenes con hipercolesterolemia leve. Conclusión: Este metaanálisis reveló que el uso de probióticos puede reducir significativamente los niveles de CT y c-LDL en adultos hipercolesterolémicos, lo que brinda la esperanza de reducir los factores de riesgo relativos al desarrollo de enfermedad cardiovascular


Assuntos
Adulto , Humanos , Probióticos/administração & dosagem , Metabolismo dos Lipídeos/efeitos dos fármacos , Hipercolesterolemia/complicações , Fatores de Risco , Doenças Cardiovasculares/prevenção & controle , Hipercolesterolemia/tratamento farmacológico , Colesterol/sangue , Anticolesterolemiantes/administração & dosagem , Dislipidemias/sangue , Dislipidemias/terapia
8.
Methodist Debakey Cardiovasc J ; 15(1): 62-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31049151

RESUMO

Cardiovascular disease is the leading cause of death worldwide, and elevated lipid levels is a major contributor. Gene delivery, which involves controlled transfer of nucleic acids into cells and tissues, has been widely used in research to study lipid metabolism and physiology. Several technologies have been developed to somatically overexpress, silence, or disrupt genes in animal models and have greatly advanced our knowledge of metabolism. This is particularly true with regard to the liver, which plays a central role in lipoprotein metabolism and is amenable to many delivery approaches. In addition to basic science applications, many of these delivery technologies have potential as gene therapies for both common and rare lipid disorders. This review discusses three major gene delivery technologies used in lipid research-including adeno-associated viral vector overexpression, antisense oligonucleotides and small interfering RNAs, and the Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 genome editing system-and examines their potential therapeutic applications.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dislipidemias/terapia , Terapia Genética/métodos , Metabolismo dos Lipídeos/genética , Lipídeos/sangue , Animais , Sistemas CRISPR-Cas , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/genética , Dependovirus/genética , Dislipidemias/sangue , Dislipidemias/epidemiologia , Dislipidemias/genética , Edição de Genes/métodos , Terapia Genética/efeitos adversos , Vetores Genéticos , Humanos , Oligonucleotídeos Antissenso/genética , RNA Interferente Pequeno/genética , Terapêutica com RNAi/métodos , Resultado do Tratamento
9.
High Blood Press Cardiovasc Prev ; 26(3): 191-197, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041682

RESUMO

The atherosclerotic alterations that are the basis of cardiovascular diseases can start already in childhood. For this reason the prevention of cardiovascular diseases should be undertaken very early both in the general population and, in a targeted manner, in subjects at cardiovascular risk. Preventive strategies should include measures to encourage physical activity and correct eating habits and to reduce exposure to pollutants. The main actors responsible for carrying out these preventive interventions are the local and national political authorities. Moreover, particular attention should be paid to the first thousand days of life starting from conception, to prevent unfavorable epigenetic modifications. In addition to initiatives aimed at the general population, interventions should be planned by the medical community to assess the individual risk profile. The current obesity epidemic has in fact made it relatively frequent even among children and adolescents to find some cardiovascular risk factors known in adults such as arterial hypertension, dyslipidemia, glucose metabolism disorders and increased of uric acid values. The purpose of this review is to indicate lines of intervention for cardiovascular prevention in children and adolescents.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Síndrome Metabólica/terapia , Serviços Preventivos de Saúde/métodos , Adolescente , Idade de Início , Pressão Arterial , Biomarcadores/sangue , Glicemia/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Criança , Comorbidade , Dislipidemias/sangue , Dislipidemias/epidemiologia , Dislipidemias/terapia , Transtornos do Metabolismo de Glucose/sangue , Transtornos do Metabolismo de Glucose/epidemiologia , Transtornos do Metabolismo de Glucose/terapia , Nível de Saúde , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertensão/terapia , Hiperuricemia/sangue , Hiperuricemia/epidemiologia , Hiperuricemia/terapia , Lipídeos/sangue , Síndrome Metabólica/sangue , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/terapia , Fatores de Proteção , Fatores de Risco , Ácido Úrico/sangue , Ganho de Peso
11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2): 148-154, abr.-jun. 2019. graf
Artigo em Português | LILACS | ID: biblio-1009485

RESUMO

As doenças cardiovasculares continuam sendo a principal causa de morte no Brasil desde o final da década de 1960, a despeito da tendência de queda observada nos últimos anos. A mudança de estilo de vida relacionada à urbanização e globalização, com alta ingestão calórica e menor gasto energético, o rápido aumento da população idosa devido à maior expectativa de vida levaram à maior prevalência de obesidade e dislipidemias e, consequentemente, doenças cardiovasculares e metabólicas. Pesquisas de base populacional, estudos de coorte e de caso e de controle apontam para a importância do crescimento dos fatores de risco e diferenças regionais indicam que as políticas públicas e o atendimento médico devem priorizar intervenções de saúde tendo como objetivo a prevenção e controle dos fatores de risco mais prevalentes em nosso meio. A abordagem terapêutica da obesidade deve incluir não apenas a redução isolada do peso, e sim, atrelada à melhora metabólica ampla que se associe à diminuição do risco de complicações cardiovasculares. De um modo geral, a perda de peso é mais frequentemente alcançada ao longo dos primeiros meses ou do primeiro ano de exposição aos fármacos e embora alguns sejam mais efetivos, eventos adversos são frequentes, limitando o tratamento a longo prazo. O grande avanço e a maior segurança nos últimos anos vieram com o uso de medicamentos antiiperglicemiantes, como análogos de GLP-1, permitindo o uso a longo prazo com manutenção de resultados e adicionando benefícios cardiovasculares. A abordagem terapêutica das dislipidemias no paciente obeso é imperativa para a evolução desse perfil de pacientes, nos quais múltiplos fatores fisiológicos, bioquímicos, metabólicos e clínicos, estão interconectados e diretamente relacionados com aumentos substanciais do risco de diabetes, de doença aterosclerótica cardiovascular e mortalidade por todas as causas


Cardiovascular disease has been the no. 1 cause of death in Brazil since the late 1960s, despite the downtrend observed in recent years. Lifestyle changes related to urbanization and globalization, high calorie intake and lower energy expenditure, combined with a rapidly aging population due to increased life expectancy, have led to a greater prevalence of obesity and dyslipidemia, and consequently, cardiovascular and metabolic diseases. Population-based surveys, cohort and case-control studies underline the importance of the growth of risk factors, and regional differences indicate that public policies and medical care must prioritize health interventions in order to prevent and control the most prevalent risk factors in our country. The therapeutic approach to obesity must include not only weight reduction alone, but also in combination with comprehensive metabolic improvement, which is associated with a reduced risk of cardiovascular complications. In general, weight loss is more frequently achieved in the first few months or first year of exposure to medications, and although some drugs are more effective, adverse events are common, limiting treatment options to long-term therapy. The major advances and greater safety seen in recent years were achieved with the use of anti-hyperglycemic agents such as GLP-1 analogues, enabling long-term use with maintenance of results and adding cardiovascular benefits. The therapeutic approach to dyslipidemia in obese patients is imperative for the progress of this patient population, in which multiple physiological, biochemical, metabolic and clinical factors are interlinked and directly related to substantial increases in the risk of diabetes, atherosclerotic cardiovascular disease, and all-cause mortality


Assuntos
Humanos , Masculino , Feminino , Dieta , Dislipidemias/terapia , Obesidade/prevenção & controle , Obesidade/terapia , Fatores de Tempo , Brasil , Doenças Cardiovasculares/mortalidade , Índice de Massa Corporal , Epidemiologia , Prevalência , Fatores de Risco , Aterosclerose , Sobrepeso/complicações , Estilo de Vida
12.
Maturitas ; 124: 93-99, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30910278

RESUMO

The impact of dyslipidaemias on the risk of cardiovascular disease (CVD) is well documented. However, it is often under-estimated and, sometimes, suboptimally managed in the elderly population. The prevalence of dyslipidaemias seems to decline from the 7th decade of life in both genders. The association of dyslipidaemias with CVD weakens after the 7th decade, perhaps due to other age-related comorbidities. Low-density lipoprotein cholesterol remains the main target in the management of CVD risk. Although the evidence is not robust for the elderly, statins are the cornerstone of the management of CVD. Statins do have a potentially beneficial role in elderly individuals with established CVD and/or a history of type 2 diabetes mellitus. Data on their use in other elderly populations are inconsistent. There is no clear evidence for a beneficial effect of other hypolipidaemic drug categories in the elderly, such as ezetimibe, fibrates, niacin, omega-3 fatty acids and the new proprotein convertase subtilisin/kexin type 9 inhibitors. Their use should be balanced against possible adverse effects, such as the increased risk of myopathy with fibrates. Potential drug-drug interactions should be also taken into account. In conclusion, there is a need to establish the most effective lipid-lowering strategy in the elderly population with respect to CVD risk reduction, in future well-designed trials.


Assuntos
Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , LDL-Colesterol/sangue , Dieta , Dislipidemias/sangue , Dislipidemias/terapia , Ezetimiba/uso terapêutico , Ácidos Graxos Ômega-3/uso terapêutico , Ácidos Fíbricos/uso terapêutico , Humanos , Pró-Proteína Convertase 9/antagonistas & inibidores
13.
Ann Clin Biochem ; 56(3): 338-356, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30889974

RESUMO

An elevated low-density lipoprotein cholesterol concentration is a classical risk factor for cardiovascular disease. This has led to pharmacotherapy in patients with atherosclerotic heart disease or high heart disease risk with statins to reduce serum low-density lipoprotein cholesterol. Even in patients in whom the target levels of low-density lipoprotein cholesterol are reached, there remains a significant residual cardiovascular risk; this is due, in part, to a focus on low-density lipoprotein cholesterol alone and neglect of other important aspects of lipoprotein metabolism. A more refined lipoprotein analysis will provide additional information on the accumulation of very low-density lipoproteins, intermediate density lipoproteins, chylomicrons, chylomicron-remnants and Lp(a) concentrations. Instead of measuring the cholesterol and triglyceride content of the lipoproteins, measurement of their apolipoproteins (apos) is more informative. Apos are either specific for a particular lipoprotein or for a group of lipoproteins. In particular measurement of apos in atherogenic particles is more biologically meaningful than the measurement of the cholesterol concentration contained in these particles. Applying apo profiling will not only improve characterization of the lipoprotein abnormality, but will also improve definition of therapeutic targets. Apo profiling aligns with the concept of precision medicine by which an individual patient is not treated as 'average' patient by the average (dose of) therapy. This concept of precision medicine fits the unmet clinical need for stratified cardiovascular medicine. The requirements for clinical application of proteomics, including apo profiling, can now be met using robust mass spectrometry technology which offers desirable analytical performance and standardization.


Assuntos
Apolipoproteínas/metabolismo , Dislipidemias/diagnóstico , Dislipidemias/terapia , Medicina de Precisão/métodos , Aterosclerose/complicações , Aterosclerose/genética , Dislipidemias/complicações , Dislipidemias/metabolismo , Humanos , Medição de Risco
14.
Niger J Clin Pract ; 22(3): 355-360, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30837423

RESUMO

Background: Apolipoprotein B (apo B) has been widely reported to be a better predictor of cardiovascular risk than low-density lipoprotein cholesterol (LDL-C). This is the reason apo B treatment target values based on the equivalence to LDL-C values in healthy population has been advocated using percentiles from population studies. The aim of this study was to determine the apo B values equivalent to currently used medical decision targets for LDL-C concentration in a population of healthy Nigerians and examine for any demographic influence. Materials and Methods: A total of 252 apparently healthy individuals (89 males, 163 females), between the ages of 30 and 65 years were selected from core health workers (medical and nursing staffs) of University College Hospital Ibadan between December 2015 and May 2016. Serum lipids and apo B were measured using enzymatic and immunoturbidimetry method, respectively. Results: The mean apo B of the study population were 94 and 98 mg/dL in men and women, respectively. Mean apo B concentration was significantly higher in the female participants in the age groups above 55 years. LDL-C concentrations of 100, 130, 160, and 190 mg/dL corresponded to the 15th, 55th, 87th, and 95th percentile, respectively. The corresponding apo B concentrations were 73 mg/dL (15th percentile), 95 mg/dL (55th percentile), 124 mg/dL (87th percentile), and 145 mg/dL (95th percentile). The group of participants with LDL-C of <130 mg/dL and the group with equivalent apo B of <95 mg/dL has the same clinical and biochemical characteristics in both men and women. Conclusion: This study has defined apo B targets that may potentially be used to guide the initiation of therapy in persons with dyslipidemia. It has also demonstrated the population level relationship that exists between apo B and LDL-cholesterol and has shown the gender and age-related influence of apo B distribution in the population.


Assuntos
Apolipoproteínas B/sangue , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , LDL-Colesterol/sangue , Dislipidemias/sangue , Dislipidemias/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Fatores de Risco , Fatores Sexuais
15.
Clin Res Cardiol Suppl ; 14(Suppl 1): 33-38, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30838552

RESUMO

BACKGROUND: Lipoprotein(a) (Lp(a)) is a genetic risk factor for cardiovascular disease (CVD) and is associated with the induction and sustaining of atherosclerotic cardiovascular diseases (ASCVD). Since 2008 Lp(a) along with progressive CVD has been approved as an indication for regular lipoprotein apheresis (LA) in Germany. The German Lipoprotein Apheresis Registry (GLAR) has been initiated to provide statistical evidence for the assessment of extracorporeal procedures to treat dyslipidemia for both LDL-cholesterol (LDL-C) and Lp(a). The GLAR now allows prospective investigations over a 5-year period about annual incidence rates of cardiovascular events. Here Lp(a) patients (LDL-C < 100 mg/dl; Lp(a) > 60 mg/dl or >120 nmol/l) showed the same reduction of major coronary (83%) and non-coronary events (63%) as had been formerly shown in the Pro(a)LiFe study. However, Lp(a) is not only an apolipoprotein(a) (apo(a)) and LDL-C containing particle, which is covalently bound to a LDL-C core by a disulphide bridge. The composition of this particle, inter alia containing oxidized phospholipids, gives pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing atherosclerotic processes mainly in the arterial wall. However, recent investigations have shown that a reduction of inflammatory settings without LDL-C or Lp(a) reduction may reduce ASCVD events. Lipoprotein apheresis (LA) could not only reduce LDL-C and Lp(a) in parallel, but also different inflammatory and coagulation parameters. In summary lipoprotein apheresis is not only anti-atherosclerotic, but also anti-inflammatory and anti-thrombotic and therefore an ideal treatment option with respect to the shown reduction of major adverse coronary events (MACE) and major adverse non-coronary events (MANCE) by reducing Lp(a) levels.


Assuntos
Aterosclerose/sangue , Remoção de Componentes Sanguíneos/métodos , Doenças Cardiovasculares/sangue , Lipoproteína(a)/sangue , Aterosclerose/genética , Aterosclerose/terapia , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/terapia , LDL-Colesterol/sangue , Dislipidemias/terapia , Predisposição Genética para Doença , Alemanha , Humanos , Lipoproteína(a)/genética , Sistema de Registros , Fatores de Risco
16.
Circulation ; 139(8): 1025-1035, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30779652

RESUMO

BACKGROUND: Improvements have been made in the treatment and control of some but not all major cardiovascular risk factors in the United States. It remains unclear whether women and men have benefited equally. METHODS: Data from the 2001 to 2002 through the 2015 to 2016 US National Health and Nutrition Examination Survey on adults aged 20 to 79 years were used. We assessed sex differences in temporal trends in the levels of systolic blood pressure, body mass index, smoking status, high-density lipoprotein and total cholesterol, and hemoglobin A1c. Trends in treatment and control rates of hypertension, diabetes mellitus, and dyslipidemia were also assessed. RESULTS: Overall, 35 416 participants (51% women) were included. Trends in systolic blood pressure, smoking status, high-density lipoprotein cholesterol, and hemoglobin A1c were similar between the sexes. Body mass index increased more in women than men ( P=0.006). Mean levels were 28.1 and 29.6 kg/m2 in women and 27.9 and 29.0 kg/m2 in men in 2001 to 2004 and 2013 to 2016, respectively. Total cholesterol decreased more in men than women ( P=0.002): mean levels in 2001 to 2004 and 2013 to 2016, respectively, were 203 and 194 mg/dL in women and 201 and 188 mg/dL in men. Improvements in the control of hypertension, diabetes mellitus, and dyslipidemia were similar between the sexes; however, sex differences persisted. In 2013 to 2016, control rates in women versus men were 30% versus 22% for hypertension, 30% versus 20% for diabetes mellitus, and 51% versus 63% for dyslipidemia. CONCLUSIONS: Temporal trends in cardiovascular risk factor levels were broadly similar between the sexes, except for total cholesterol and body mass index. Sex differences in the control of hypertension, diabetes mellitus, and dyslipidemia persist, and further efforts are required to reduce this differential.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/tendências , Saúde da Mulher/tendências , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Dislipidemias/epidemiologia , Dislipidemias/terapia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade/terapia , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia , Abandono do Hábito de Fumar , Fatores de Tempo , Estados Unidos , Adulto Jovem
17.
Clin Pediatr (Phila) ; 58(5): 502-510, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30793626

RESUMO

Identification and management of dyslipidemia in childhood can reduce future cardiovascular risk. We performed a retrospective cohort study of children ages 2 to 18 years during 2009 to 2013 to evaluate factors that affect screening and treatment of pediatric dyslipidemia related to 2011 National Heart, Lung, and Blood Institute (NHLBI) guidelines. Logistic regression analysis determined the impact of NHLBI-identified factors on odds of being screened, elevated low-density lipoprotein cholesterol (LDL-C), and receiving pharmacotherapy. A total of 1 736 032 children were included; 113 780 (6.6%) were screened for dyslipidemia. Screening in 9 to 11 year olds increased from 2009 to 2012. Of children screened, 18 801 (16.5%) had elevated LDL-C; 425 (2.3%) were treated pharmacologically. Parental dyslipidemia, diabetes mellitus, chronic kidney disease, Kawasaki disease, human immunodeficiency virus infection, nephrotic syndrome, liver, thyroid, and other endocrine disorders increased odds of screening. Older age, nephrotic syndrome, chronic kidney disease, diabetes mellitus, and hypertension increased odds of having elevated LDL-C and receiving treatment. Pediatric dyslipidemia screening rates remain low.


Assuntos
Tomada de Decisão Clínica/métodos , Dislipidemias/diagnóstico , Dislipidemias/terapia , Fidelidade a Diretrizes/tendências , Programas de Rastreamento/tendências , Padrões de Prática Médica/tendências , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Dislipidemias/sangue , Feminino , Humanos , Lipoproteínas LDL/sangue , Modelos Logísticos , Masculino , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estudos Retrospectivos , Medição de Risco , Estados Unidos
18.
Clín. investig. arterioscler. (Ed. impr.) ; 31(1): 26-30, ene.-feb. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182489

RESUMO

La Sociedad Española de Arteriosclerosis tiene homologadas más de 70 unidades de lípidos repartidas por todo el país. Este artículo resume los principales motivos para remitir pacientes a nuestras unidades, agrupados no solo por niveles de lípidos o por el tipo de dislipidemia, sino además por determinadas características clínicas que hagan sospechar dislipidemias primarias, de diagnóstico complejo o de difícil tratamiento, bien por ineficacia, bien por aparición de efectos adversos


The Spanish Arteriosclerosis Society has accredited more than 70 lipid units across the country. The main criteria for patients to be referred to these units are presented. These are not only grouped by the type of dyslipidaemia or the lipid levels, but also on certain clinical characteristics suggesting primary hyperlipidaemia, a complex diagnosis, or difficult management due to inefficacy, or side effects


Assuntos
Humanos , Aterosclerose/terapia , Dislipidemias/terapia , Hiperlipidemias/terapia , Sociedades Médicas/organização & administração , Acreditação , Aterosclerose/diagnóstico , Dislipidemias/diagnóstico , Hiperlipidemias/diagnóstico , Lipídeos/sangue , Encaminhamento e Consulta/organização & administração , Espanha
19.
BMC Womens Health ; 19(1): 11, 2019 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-30651099

RESUMO

BACKGROUND: When untreated, dyslipidemia is a higher risk factor for stroke and stroke-related mortality in men than in women. However, when dyslipidemia is treated the risk reduction is the same, but men benefited from mortality reduction more than women. Whether there is a gender difference in exclusion criteria for the use of recombinant tissue plasminogen activator (rtPA) or thrombolysis therapy in an acute ischemic stroke subpopulation with dyslipidemia is yet to be investigated. METHOD: In a dyslipidemic stroke population obtained from a stroke registry, gender differences in exclusion risk factors were determined using clinical and demographic variables. Univariate analysis compared the recombinant tissue plasminogen activator (rtPA) group and the no rtPA group. Multiple regression analysis was used to determine demographic and clinical factors associated with inclusion and exclusion for rtPA in the total dyslipidemic stroke population and the subsets of the male and female population. The regression model was tested using the Hosmer-Lemeshow test, for the overall correct classification percentage. Significant interactions and multicollinearity between independent variables were examined using variance inflation factors. RESULTS: A total of 769 patients presented with acute ischemic stroke with incidence dyslipidemia; 325 received rtPA while 444 were excluded from rtPA. Of those excluded from rtPA, 54.30% were female and 45.72% were male. In an adjusted analysis, female patients with increased age (OR = 1.024, 95% CI, 1.001-1.047, P < 0.05), with a history of carotid artery stenosis (OR = 7.063, 95% CI, 1.506-33.134, P < 0.05), and previous stroke (OR = 1.978, 95% CI, 1.136-3.442, P < 0.05) were more likely to be excluded from rtPA. Male patients with atrial fibrillation (OR = 2.053, 95% CI, 1.059-3.978, P = 0.033), carotid artery stenosis (OR = 2.400, 95% CI, 1.062-5.424, P = 0.035), and previous stroke (OR = 1.785, 95% CI, 1.063-2.998, P = 0.028) were more likely to be excluded from rtPA. CONCLUSION: Although there are some similarities in the clinical risk factors for exclusion in both male and female stroke patients with incidence of dyslipidemia, there are differences as well. Elderly female stroke patients with incidence of dyslipidemia are more likely to be excluded from rtPA, even after adjustment for the effect of confounding variables. Further research should focus on how identified clinical risk factors can be targeted and managed to improve the use of rtPA in elderly female acute ischemic stroke population with incidence of dyslipidemia.


Assuntos
Dislipidemias/epidemiologia , Dislipidemias/terapia , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/terapia , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Dislipidemias/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/complicações , Terapia Trombolítica/métodos
20.
Hipertens Riesgo Vasc ; 36(1): 21-27, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-29636229

RESUMO

INTRODUCTION: A sedentary lifestyle is indicated in the international literature as one of the main causes for the onset of some cardiovascular risk factors. OBJECTIVE: To assess the effect of a therapeutic physical exercise programme on different clinical indicators related to dyslipidaemia (total cholesterol, HDL and LDL) in sedentary subjects with a cardiovascular risk factor. METHOD: Intervention study with before-and-after evaluation of a sample of 340 patients (132 males and 208 females) referred from the 2 primary care centres of the municipality of Molina de Segura (Murcia), and who participated in a 30-week programme of physical exercise combining muscle-conditioning work circuits with other cardio-respiratory resistance workouts. Regarding the clinical indicators, the health professionals collected in the medical history the health indicators corresponding to the biological evolution of the process for which the subjects studied had started the physical exercise programme. RESULTS: The statistical analyses showed a significant improvement (p<.005) in the LDL indicator and a non-significant improvement in total and HDL cholesterol indicators after a 3-month exercise programme of 3 weekly sessions. CONCLUSIONS: The prescription of physical exercise in dyslipidaemic subjects from primary care centre should be evaluated as a resource for improving the clinical indicators specific to their pathology.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dislipidemias/terapia , Terapia por Exercício/métodos , Comportamento Sedentário , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Colesterol/sangue , HDL-Colesterol/sangue , Estudos Controlados Antes e Depois , Dislipidemias/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Fatores de Risco
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