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J Stroke Cerebrovasc Dis ; 30(4): 105655, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33571878


OBJECTIVE: To evaluate the effect of very low levels of LDL-C (< 55 mg/dl) achieved with lipid-lowering therapy on hemorrhagic stroke incidence. METHODS: We performed a meta-analysis including randomized trials that achieved LDL-C levels under 55 mg/dl in more intensive lipid-lowering arms, regardless of the lipid-lowering drug used. A fixed-effects model was used. This meta-analysis was performed according to PRISMA guidelines. RESULTS: Eight eligible trials including 122.802 patients, were identified and considered eligible for the analyses. A total of 62.526 subjects were allocated to receive more intensive lipid-lowering therapy while 60.276 subjects were allocated to the respective control arms. There were no differences in the incidence of hemorrhagic stroke between the group that received a more intensive lipid-lowering therapy (achieved LDL-C level <55 mg/dl), and the group that received a less intense scheme (OR, 1.05; 95%CI, 0.85-1.31). The statistical heterogeneity was low (I2 = 2%). The sensitivity analysis showed that the results were robust. CONCLUSIONS: The use of more intensive lipid-lowering therapy that achieved an LDL-C level lower than 55 mg/dl in patients with high cardiovascular risk, is not associated with an increased risk of hemorrhagic stroke. Considering the cardiovascular benefit and safety observed with the achievement of very low LDL-C values, the challenging lipid goals recommended by the new guidelines seem consistent.

LDL-Colesterol/sangue , Dislipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Biomarcadores/sangue , Regulação para Baixo , Dislipidemias/sangue , Dislipidemias/epidemiologia , Humanos , Hipolipemiantes/efeitos adversos , Incidência , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Resultado do Tratamento
Arch Cardiovasc Dis ; 114(2): 132-139, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33546998


Low-density lipoprotein cholesterol is a well-known causal factor for atherosclerotic cardiovascular disease, and is the primary target of lipid-lowering therapy. There is, however, still a substantial risk of atherosclerotic cardiovascular disease events despite intensive statin therapy, and data from clinical trials suggest that an elevated concentration of triglycerides is a marker of residual cardiovascular risk on low-density lipoprotein-lowering therapy. Serum triglycerides are a biomarker for triglyceride-rich lipoproteins, and several lines of evidence indicate that triglyceride-rich lipoproteins and their cholesterol-enriched remnant particles are associated with atherogenesis. Moreover, genetic data in humans strongly suggest that the remnants of triglyceride-rich lipoproteins are a causal cardiovascular risk factor. Although lifestyle changes remain the cornerstone of management of hypertriglyceridaemia, a recent trial with high doses of the omega-3 fatty acid icosapent ethyl showed a significant reduction in cardiovascular events that was not explained by the reduction in triglycerides alone. In patients with elevated triglycerides, several novel drugs are in development to reduce the residual risk on statin therapy linked to an excess of atherogenic triglyceride-rich lipoproteins. In this review, we provide an update on the biology, epidemiology and genetics of triglycerides, and the risk of atherosclerotic cardiovascular disease.

Aterosclerose/sangue , Dislipidemias/sangue , Triglicerídeos/sangue , Animais , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Aterosclerose/prevenção & controle , Biomarcadores/sangue , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Dislipidemias/terapia , Humanos , Hipolipemiantes/uso terapêutico , Prognóstico , Medição de Risco , Comportamento de Redução do Risco
Medicine (Baltimore) ; 100(6): e24345, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578530


BACKGROUND: Hypertension combined with hyperlipidemia (HTN-HLP), as a common clinical chronic disease combination, will increase the incidence of cardiovascular and cerebrovascular diseases, increase the occurrence of sudden death and other adverse events. At present, the commonly used therapeutic drugs are mainly combined with antihypertensive drugs and lipid-lowering drugs, which not only have poor compliance, but also have adverse reactions. Currently, traditional Chinese medicine, as a traditional medicine in China, has been applied in clinical practice for thousands of years and has rich clinical experience in treating HTN-HLP. However, there is no systematic evaluation of the efficacy, safety and improvement of patients' quality of life. This systematic review and meta-analysis will assess studies of the effects and safety of Chinese herbal medicine (CHM) for HTN-HLP patients. METHODS: We will search PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science (ISI), China National Knowledge Infrastructure, Wan fang Database, Chinese Scientific Journals Full-Text Database (VIP) and China Biological Medicine Database from the time when databases were established to 01, February 2021. After a series of screening, randomized controlled trials (RCTs) will be included related to CHM for HTN-HLP. Two researchers will assess the RCTs through the Cochrane bias risk assessment tool. And the evidence grade of the results will be evaluated by GRADEprofiler software. RESULTS: This study will provide a reliable evidence for the efficiency of antihypertensive and reducing blood lipids of CHM for HTN-HLP. CONCLUSION: We will summarize the methods and provide sufficient evidence to confirm the efficacy and safety of CHM for HTN-HLP. INPLASY REGISTRATION NUMBER: INPLASY2020110144.

Medicamentos de Ervas Chinesas/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Hipolipemiantes/uso terapêutico
BMC Infect Dis ; 21(1): 150, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546621


BACKGROUND: In people living with HIV (PLWH), statins may be disproportionately effective but remain underutilized. A large prospective trial in patients with low to moderate cardiovascular (ASCVD) risk will reveal whether they should be considered in all PLWH. But its effect size may not apply to real-world PLWH with higher ASCVD and mortality risk. Also, the clinical role of non-statin lipid-lowering therapy (LLT) and LLT adherence in this population is unknown. METHODS: Comparative multi-level marginal structural model for all-cause mortality examining four time-updated exposure levels to LLT, antihypertensives, and aspirin in a virtual cohort of older PLWH. Incident coronary, cerebrovascular, and overall ASCVD events, serious infections, and new cancer diagnoses served as explanatory outcomes. RESULTS: In 23,276 HIV-infected US-veterans who were followed for a median of 5.2 years after virologic suppression overall mortality was 33/1000 patient years: > 3 times higher than in the US population. Use of antihypertensives or aspirin was associated with increased mortality. Past LLT use (> 1 year ago) had no effect on mortality. LLT exposure in the past year was associated with a reduced hazard ratio (HR) of death: 0.59, 95% confidence interval (CI) 0.51-0.69, p < 0.0001 for statin containing LLT and 0.71 (CI: 0.54-0.93), p = 0.03 for statin-free LLT. For consistent LLT use (> 11/12 past months) the HR of death was 0.48 (CI: 0.35-0.66) for statin-only LLT, 0.34 (CI: 0.23-0.52) for combination LLT, and 0.27 (CI: 0.15-0.48) for statin-free LLT (p < 0.0001 for all). The ASCVD risk in these patients was reduced in similar fashion. Use of statin containing LLT was also associated with reduced infection and cancer risk. Multiple contrasting subgroup analyses yielded comparable results. Confounding is unlikely to be a major contributor to our findings. CONCLUSIONS: In PLWH, ongoing LLT use may lead to substantially lower mortality, but consistent long-term adherence may be required to reduce ASCVD risk. Consistent non-statin LLT may be highly effective and should be studied prospectively.

Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Hipolipemiantes/uso terapêutico , Feminino , Sobreviventes de Longo Prazo ao HIV , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Estados Unidos/epidemiologia , Veteranos
J Stroke Cerebrovasc Dis ; 30(4): 105629, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33497937


BACKGROUND: Limb Shaking Syndrome (LSS) is usually associated with internal carotid occlusion. There are few reported-cases in context of middle cerebral artery stenosis. METHODS: We presented LSS in a patient with middle cerebral artery stenosis disease. RESULTS: The patient was a 62-year-old man, smoker, with high blood pressure who suffered left hemifacial and limbs myoclonus. He was initially diagnosed with focal seizures and he started antiepileptic treatment. However, he repeated the episodes. The electroencephalogram showed no abnormalities, and a vascular study with ultrasounds and angio-MRI evidenced severe middle cerebral stenosis. Finally, a diagnosis of Limb Shaking Syndrome was established and he started antiplatelet and high dose lipid-lowering treatment. CONCLUSION: Not all abnormal movements are due to epileptic seizures. When we evaluate a patient with vascular risk factors it is important to perform a complete vascular study to discard not only critical carotid stenosis but also intracranial disease.

Infarto da Artéria Cerebral Média/complicações , Ataque Isquêmico Transitório/complicações , Tremor/etiologia , Erros de Diagnóstico , Epilepsia/diagnóstico , Epilepsia/fisiopatologia , Humanos , Hipolipemiantes/uso terapêutico , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/tratamento farmacológico , Infarto da Artéria Cerebral Média/fisiopatologia , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/tratamento farmacológico , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Síndrome , Resultado do Tratamento , Tremor/diagnóstico , Tremor/fisiopatologia
Rev. esp. cardiol. Supl. (Ed. impresa) ; 20(supl.D): 21-26, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199127


Desde 2016 se han publicado importantes ensayos clínicos, como los estudios FOURIER y ODYSSEY OUTCOMES, asi como otro tipo de estudios clínicos, que han llevado a la actualizacion de la guía de práctica clínica para el paciente con dislipemia, publicada en 2019. Además de mejorar la Estratificación del riesgo cardiovascular incluyendo pruebas de imagen cardiovascular no invasivas, como el calcio coronario, la ecografia carotidea o femoral y la angiografia mediante tomografia computarizada, asi como marcadores biologicos, principalmente la lipoproteína (a), las principales novedades son los objetivos terapéuticos de cLDL mucho más estrictos, y las nuevas recomendaciones sobre ezetimiba y los inhibidores del PCSK9, anadidos a las estatinas, que han pasado a ser recomendacion de clase I. Por otra parte, el consenso de la Sociedad Española de Cardiología para mejorar el control lipídico en prevención secundaria permite de una manera práctica y sencilla la optimizacion del tratamiento hipolipemiante

The publication of pivotal clínical trials, such as the FOURIER and ODYSSEY OUTCOMES trials, and of other types of clínical study since 2016 has resulted in changes in the clínical practice guidelines for patients with dyslipidemias, which were updated in 2019. Cardiovascular risk stratification has been improved by the use of: (I) noninvasive cardiovascular imaging, involving for example the coronary calcium score, carotid or femoral artery ultrasonography, and coronary CT angiography; and (II) biomarkers, particularly lipoprotein(a). However, the principle novelties were much stricter low-density lipoprotein cholesterol treatment targets and new recommendations on ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, added to statins, which have now become class-I treatment recommendations. Furthermore, the Spanish Society of Cardiology's consensus on improving lipid control in secondary prevención provides a simple and practical way of optimizing lipid-lowering therapy

Humanos , Medicina Baseada em Evidências , Hipolipemiantes/uso terapêutico , Dislipidemias , Sociedades Médicas
Medicine (Baltimore) ; 99(51): e23367, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371067


BACKGROUND: Recent experimental and clinical studies have suggested that Hwangryunhaedok-tang (HHT), an herbal formula, could improve the lipid profiles in patients with dyslipidemia. This systematic review aimed to evaluate the effectiveness and safety of HHT monotherapy or adjunctive HHT therapy with conventional lipid-lowering drugs in managing dyslipidemia. METHODS: Twelve English, Korean, Chinese, and Japanese databases were comprehensively searched from their inception to January 2020. Randomized controlled trials (RCTs) using HHT monotherapy or adjunctive HHT therapy for dyslipidemic patients were included. The primary outcome was the low-density lipoprotein cholesterol (LDL-C) level. Descriptive analyses of participant details, interventions, and outcomes were conducted and where appropriate data were available, a meta-analysis was performed and presented as a risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs). The risk of bias was assessed using the Cochrane risk of bias tool and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Nine RCTs with 536 participants were included. In comparison with lipid-lowering drugs alone, HHT as an adjunctive therapy to lipid-lowering drugs or as a monotherapy showed significantly superior (MD -1.15 mmol/L, 95% CI -1.25 to -1.05) or inferior results (MD 0.23 mmol/L, 95% CI 0.09 to 0.38), respectively, for LDL-C levels. The incidence of adverse events was significantly lower when HHT was used in addition to lipid-lowering drugs, in comparison to that with lipid-lowering drugs alone. No serious adverse events were reported in the HHT group. Most included studies showed a high risk of performance bias and the quality of evidence was rated generally "low" because of the high risk of bias and inconsistency or imprecision of the meta-analysis results. CONCLUSION: Current evidence suggests that HHT may be beneficial for patients with dyslipidemia and may reduce the adverse events associated with lipid-lowering drugs. However, due to the high risk of bias of the included studies and low quality of evidence for the main findings, no definitive conclusion could be reached. Further rigorous, high-quality, and placebo-controlled RCTs should be conducted to assess the efficacy of HHT. TRIAL REGISTRATION NUMBER: PROSPERO CRD42020164563.

Medicamentos de Ervas Chinesas/uso terapêutico , Dislipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Extratos Vegetais/uso terapêutico , Glicemia , Pressão Sanguínea , LDL-Colesterol/efeitos dos fármacos , Comorbidade , Quimioterapia Combinada , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Hipolipemiantes/administração & dosagem , Hipolipemiantes/efeitos adversos , Extratos Vegetais/administração & dosagem , Extratos Vegetais/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
Atherosclerosis ; 313: 126-136, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33045618


The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus Disease 2019 (COVID-19) has resulted in a pandemic. SARS-CoV-2 is highly contagious and its severity highly variable. The fatality rate is unpredictable but is amplified by several factors including advancing age, atherosclerotic cardiovascular disease, diabetes mellitus, hypertension and obesity. A large proportion of patients with these conditions are treated with lipid lowering medication and questions regarding the safety of continuing lipid-lowering medication in patients infected with COVID-19 have arisen. Some have suggested they may exacerbate their condition. It is important to consider known interactions with lipid-lowering agents and with specific therapies for COVID-19. This statement aims to collate current evidence surrounding the safety of lipid-lowering medications in patients who have COVID-19. We offer a consensus view based on current knowledge and we rated the strength and level of evidence for these recommendations. Pubmed, Google scholar and Web of Science were searched extensively for articles using search terms: SARS-CoV-2, COVID-19, coronavirus, Lipids, Statin, Fibrates, Ezetimibe, PCSK9 monoclonal antibodies, nicotinic acid, bile acid sequestrants, nutraceuticals, red yeast rice, Omega-3-Fatty acids, Lomitapide, hypercholesterolaemia, dyslipidaemia and Volanesorsen. There is no evidence currently that lipid lowering therapy is unsafe in patients with COVID-19 infection. Lipid-lowering therapy should not be interrupted because of the pandemic or in patients at increased risk of COVID-19 infection. In patients with confirmed COVID-19, care should be taken to avoid drug interactions, between lipid-lowering medications and drugs that may be used to treat COVID-19, especially in patients with abnormalities in liver function tests.

Betacoronavirus , Infecções por Coronavirus/complicações , Hiperlipidemias/complicações , Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Pneumonia Viral/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Hiperlipidemias/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Reino Unido
BMJ ; 371: m3109, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046451


Hypertriglyceridemia is one of the most common lipid abnormalities encountered in clinical practice. Many monogenic disorders causing severe hypertriglyceridemia have been identified, but in most patients triglyceride elevations result from a combination of multiple genetic variations with small effects and environmental factors. Common secondary causes include obesity, uncontrolled diabetes, alcohol misuse, and various commonly used drugs. Correcting these factors and optimizing lifestyle choices, including dietary modification, is important before starting drug treatment. The goal of drug treatment is to reduce the risk of pancreatitis in patients with severe hypertriglyceridemia and cardiovascular disease in those with moderate hypertriglyceridemia. This review discusses the various genetic and acquired causes of hypertriglyceridemia, as well as current management strategies. Evidence supporting the different drug and non-drug approaches to treating hypertriglyceridemia is examined, and an easy to adopt step-by-step management strategy is presented.

Gerenciamento Clínico , Hipertrigliceridemia/terapia , Adulto , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Hipertrigliceridemia/complicações , Hipertrigliceridemia/genética , Hipolipemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pancreatite/etiologia , Pancreatite/prevenção & controle , Fatores de Risco , Triglicerídeos/sangue
Medicine (Baltimore) ; 99(43): e22887, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120833


Hyperlipemia is a well-established etiology of acute pancreatitis. However, few data are available in the medical literature about the management of triglyceride levels in the outpatient setting in patients with hypertriglyceridemic acute pancreatitis (HTG-AP). We evaluated the blood triglyceride levels and followed the triglyceride management of patients with HTG-AP.This retrospective study enrolled patients with HTG-AP from January 2013 to March 2019 in the Affiliated Hospital of Southwest Medical of University. By reviewing the hospitalization records and the follow-up data, the clinical features, blood triglyceride levels, use of lipid-lowering medications and rate of blood triglyceride levels monitoring after hospital discharge were analyzed.A total of 133 patients (46 women, 87 men; median age at presentation 37.4 years) diagnosed with HTG-AP were enrolled in the study. Thirty-two patients (24.1%) presented with recurrent acute pancreatitis (RAP). Patients who had RAP were younger and had higher blood triglyceride levels than those with a single attack (P < .05). No difference in serum amylase levels, hospitalization duration or mortality rate were observed between non-recurrent acute pancreatitis and RAP patients. Lipid monitoring was only observed in 12.8% of patients and 10 patients (7.5%) took medications to control their blood triglyceride levels after hospital discharge. The follow-up of triglyceride levels in the outpatient setting were higher in RAP patients than in patients with non-recurrent acute pancreatitis (P < .05). Among the patients who measured their triglyceride levels after discharge, 83.3% of patients with RAP had at least 1 follow-up triglyceride level that was higher than 500 mg/dL, while no patients had an HTG-AP attack with a triglyceride level higher than 500 mg/dL.Triglyceride levels after hospital discharge higher than 500 mg/dL may be associated with an increased risk of relapse of clinical acute pancreatitis events. Inappropriate management for triglyceride control in the outpatient setting may be associated with an increased risk of relapse of clinical HTG-AP events.

Hiperlipidemias/complicações , Hipertrigliceridemia/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Pancreatite/etiologia , Adulto , Amilases/sangue , Estudos de Casos e Controles , China/epidemiologia , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Hipertrigliceridemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Pacientes Ambulatoriais/estatística & dados numéricos , Pancreatite/diagnóstico , Alta do Paciente , Recidiva , Estudos Retrospectivos , Triglicerídeos/sangue
J Stroke Cerebrovasc Dis ; 29(11): 105139, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066880
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(7): 497-502, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192622


ANTECEDENTES Y OBJETIVOS: La pandemia por COVID-19 ha puesto de manifiesto que las enfermedades cardiovasculares conllevan mayor riesgo de mortalidad. Han surgido dudas en cuanto a la terapia lipídica en estos pacientes. Nuestro objetivo en esta revisión es analizar la eficacia y la seguridad de la terapia hipolipemiante en los pacientes con COVID-19. MATERIAL Y MÉTODOS: Se realizó una revisión de la literatura científica en PubMed, informes CDC, NIH y NCBI SARS-CoV-2 utilizando las palabras clave: COVID-19, statins, ezetimibe, PCSK9 inhibitors, hypercholesterolemia and hypolipidemic drugs. RESULTADOS: Las estatinas se deben seguir utilizando en los pacientes con COVID-19 en base a su eficacia, seguridad, efectos inmunosupresores, antiinflamatorios, disponibilidad y accesibilidad. En función de los niveles de riesgo cardiovascular de estos pacientes puede ser necesario el empleo de estatinas de alta potencia y/o ezetimiba y/o inhibidores de la proproteína convertasa subtilisina (iPCSK9) en pacientes de alto y muy alto riesgo cardiovascular. Los pacientes tratados con iPCSK9 deben seguir con el tratamiento por sus efectos beneficiosos sobre la prevención de la enfermedad cardiovascular. Los pacientes con hipercolesterolemia familiar y COVID-19 son especialmente vulnerables a la enfermedad cardiovascular precoz y deben seguir recibiendo el tratamiento hipolipemiante intensivo. CONCLUSIONES: En los pacientes con COVID-19 la mayoría de las enfermedades cardiovasculares basales son de origen aterosclerótico, con peor pronóstico para los pacientes con alto riesgo y muy alto riesgo de enfermedad cardiovascular. En estos pacientes el tratamiento intensivo con estatinas y/o combinación fija con ezetimiba y/o iPCSK9 juega un papel fundamental

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has shown that cardiovascular diseases carry a higher risk of mortality. Doubts have been raised regarding lipid therapy in these patients. The objectives are to analyze the efficacy and safety of lipid lowering therapy in patients with COVID-19. MATERIAL AND METHODS: A review of the scientific literature was conducted in PubMed, CDC Reports, NIH, and NCBI SARS-CoV-2 using the keywords: COVID-2, statins, ezetimibe, PCSK9 inhibitors, hypercholesterolemia, and hypolipidemic drugs. RESULTS: The statins should continue to use patients with COVID-19 based on their efficacy, safety, immunosuppressive effects, anti-inflammatory availability and accessibility. Depending on the cardiovascular risk levels of these patients, the use of high potency statins and/or ezetimibe and/or iPCSK9 may be necessary in patients with high and very high cardiovascular risk. Patients treated with iPCSK9 should continue treatment for its beneficial effects in preventing cardiovascular disease. Patients with familial hypercholesterolemia and COVID-19 are especially vulnerable to cardiovascular disease and should continue to receive severe lipid lowering therapy. CONCLUSIONS: In patients with COVID-19, the majority of baseline CVDs are of atherosclerotic origin, with the worst prediction for patients with high risk and very high risk of CVD. In these patients, intensive treatment with statins and/or fixed combination with ezetimibe and/or iPCSK9 plays a fundamental role

Humanos , Infecções por Coronavirus/tratamento farmacológico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Vírus da SARS/patogenicidade , Hipolipemiantes/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Pandemias , Atenção Primária à Saúde/organização & administração , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Ezetimiba/administração & dosagem
Clín. investig. arterioscler. (Ed. impr.) ; 32(5): 209-218, sept.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196745


En general, las guías de práctica clínica tanto europeas con americanas han abordado el control de la dislipidemia aterogénica de forma poco convincente e incluso superficial, en gran medida por las limitaciones terapéuticas disponibles. En consecuencia, esta dislipidemia está infradiagnosticada, infratratada e infracontrolada. Dada la reciente aparición de la guía 2019 de la European Atherosclerosis Society y de la European Society of Cardiology sobre el control de las dislipidemias, parece oportuno examinar su posicionamiento con respecto a la dislipidemia aterogénica y/o sus principales componentes, el aumento en las lipoproteínas ricas en triglicéridos y la disminución del colesterol de las lipoproteínas de alta densidad

In general, both European and American clinical guidelines have addressed the management of atherogenic dyslipidaemia in an unconvincing and even superficial way, largely because of the available therapeutic limitations. Consequently, this type of dyslipidaemia is underdiagnosed, under-treated, and under-controlled. Given the recent presentation of the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology on the management of dyslipidaemias, it seems appropriate to examine its position with respect to atherogenic dyslipidaemia and/or its main components, the increase in triglyceride-rich lipoproteins, and the decrease of high-density lipoprotein cholesterol

Humanos , Dislipidemias/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Doenças Cardiovasculares/prevenção & controle , Triglicerídeos/normas , HDL-Colesterol/análise , Lipoproteínas HDL/normas , Apolipoproteínas B/normas , Aterosclerose/prevenção & controle , Hipolipemiantes/uso terapêutico , Hipertrigliceridemia/tratamento farmacológico , Hipertrigliceridemia/genética
Biomed Khim ; 66(4): 326-331, 2020 Jul.
Artigo em Russo | MEDLINE | ID: mdl-32893822


The tested drug cramizol exhibits lipid-lowering and anti-atherogenic effects. Cramizol reduces blood cholesterol and triglycerides. It also increases HDL and reduces the atherogenic index in rats with the chronic dyslipidemia model induced by a hypercholesterol diet. Cramizol is effective as a hypolipidemic agent and its efficiency is comparable with the reference drug, phenofibrate. Cramizol increases expression of the ApoA1 and ApoC2 genes, and also reduces expression of the Scarb1 gene in rats with experimentally induced hyperlipidemia. These mechanisms could be the basis of its hypolipidemic and anti-atherogenic actions.

Dislipidemias , Fenofibrato , Hiperlipidemias , Animais , HDL-Colesterol , Dislipidemias/tratamento farmacológico , Dislipidemias/genética , Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/farmacologia , Hipolipemiantes/uso terapêutico , Ratos , Triglicerídeos/metabolismo
Hipertens. riesgo vasc ; 37(3): 108-114, jul.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193519


INTRODUCCIÓN Y OBJETIVOS: Las alteraciones del sistema nervioso autónomo fueron propuestas como precursoras en la génesis y perpetuación de la aterosclerosis hace ya mucho tiempo. Nuestro objetivo fue determinar si existe asociación entre la presencia de aterosclerosis carotídea y la función autonómica evaluada mediante la variabilidad de la frecuencia cardíaca. MÉTODOS: A través de un estudio prospectivo de casos y controles investigamos la variabilidad de la frecuencia cardíaca en 5 min y la presencia de aterosclerosis carotídea mediante ultrasonografía en 54 pacientes que dividimos en 2 grupos según la presencia (+) o ausencia (−) de placas ateroscleróticas en carótidas (ATE). Se analizó la variabilidad de frecuencia cardíaca en dominio de frecuencia en el espectro de alta frecuencia, baja frecuencia, cociente alta/baja frecuencia y potencia espectral total. RESULTADOS: Sobre una población de 54 individuos sin enfermedad cardiovascular establecida evaluados en forma consecutiva, se detectaron 26 individuos (48%) portadores de ATE+. Se observó una reducción en la variabilidad de la frecuencia cardíaca en el grupo ATE+ representada por el espectro de baja frecuencia (LF) (p < 0,0001). La actividad parasimpática específicamente representada por el componente espectral de alta frecuencia también resultó menor en el grupo ATE+en análisis univariado (p < 0,0001) al igual que la potencia espectral total (p < 0,0001), un índice de regulación autonómica integral. No se encontraron diferencias significativas cuando se analizó el balance autonómico de baja y alta frecuencia (LF/HF) (p = 0,1598). En un modelo de regresión logística solo la presión arterial sistólica y el poder espectral total resultaron predictores independientes de ATE+. CONCLUSIÓN: Verificamos una disminución en la variabilidad de la frecuencia cardíaca en sujetos con aterosclerosis carotídea, que se estableció tanto a través de sus componentes espectrales como de la potencia espectral total, no así a través de la valoración del balance autonómico. La potencia espectral total, en principio, sería un método correcto de evaluación autonómica en este grupo de pacientes

INTRODUCTION AND OBJECTIVES: Alterations of the sympathetic and parasympathetic nervous system have been proposed as precursors of the genesis and perpetuation of atherosclerosis for a long time. The objective of this study is to determine if there is an association between the presence of carotid atherosclerosis and the reduction in heart rate variability. METHODS: Using a prospective case-control design, the heart rate variability and the presence of carotid atherosclerosis was investigated in 54 patients, divided into 2 groups according to the presence or absence of carotid atherosclerosis. An analysis was made of the heart rate variability variables of the frequency (spectral) domain in high frequency band, low frequency band, parasympathetic autonomic balance, and the total spectral band. RESULTS: Of the 54 individuals evaluated without previous cardiovascular disease consecutively, 26 of them (48%) presented with subclinical carotid atherosclerosis (ATE+). A reduction in heart rate variability was observed in the ATE+group represented by the low frequency (LF) spectrum (P < .0001). The parasympathetic activity specifically represented in the high frequency (HF) band was also lower in the ATE+group in the univariate analysis (P < .0001), same as the total spectral power (P < .0001), an index of integral autonomic regulation. No significant differences were found in the LF/HF analysis (P = .1598). After analysing variables with significant differences in the univariate analysis with a logistic regression model, only systolic blood preassure and the total spectral power were shown to be independent predictors of ATE+. CONCLUSION: A reduction in heart rate variability was found in subjects with carotid atherosclerosis. Some spectral components of heart rate variability, like low frequency or total spectral power, were better predictors of carotid atherosclerosis than the parasympathetic autonomic balance. In this study it seems that total spectral power is an adequate measurement for analysing autonomic function

Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiopatologia , Frequência Cardíaca , Aterosclerose/diagnóstico por imagem , Estudos de Viabilidade , Estudos Prospectivos , Modelos Logísticos , Pressão Sanguínea , Estudos de Casos e Controles , Antropometria , Hipolipemiantes/uso terapêutico , Índice de Massa Corporal , Hipertensão/terapia , Fatores de Risco
Med Hypotheses ; 143: 110127, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32759008


Fenofibrate, which is a PPAR-alfpha agonist, increases the level of sulfatide. In this letter we hypothesize on the background of various findings that this is beneficial against COVID-19. Fenofibrate has been used for decades against hypercholesterolemia and has no serious side effects. Therefore, a trial giving fenofibrate to patients with corona virus infection is recommended.

Betacoronavirus/fisiologia , Infecções por Coronavirus/tratamento farmacológico , Fenofibrato/farmacologia , Hipolipemiantes/farmacologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Sulfoglicoesfingolipídeos/sangue , Adulto , Envelhecimento/sangue , Criança , Reposicionamento de Medicamentos , Fenofibrato/uso terapêutico , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/complicações , Hipertensão/sangue , Hipertensão/complicações , Hipolipemiantes/uso terapêutico , PPAR alfa/antagonistas & inibidores , Internalização do Vírus
Clín. investig. arterioscler. (Ed. impr.) ; 32(4): 175-182, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-194698


El accidente cerebrovascular es la segunda causa de mortalidad después del infarto de miocardio y la principal causa de discapacidad adquirida. Los pacientes con ictus isquémico tienen un elevado riesgo de posteriores episodios vasculares, incluyendo ictus recurrente, infarto de miocardio y muerte de causa vascular. Los primeros estudios epidemiológicos mostraron una relación débil o inexistente entre la colesterolemia y el ictus. Posteriormente, los estudios de intervención con estatinas revelaron una reducción del riesgo de recurrencia de episodios cerebrovasculares. El Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), primer ensayo clínico diseñado para analizar los efectos de la terapia con estatinas en la prevención secundaria del ictus, demostró que el tratamiento con atorvastatina 80mg/día reducía la recurrencia de ictus en pacientes con un accidente cerebrovascular isquémico reciente establecido o transitorio, con un modesto aumento en la tasa de ictus hemorrágico. Estudios posteriores han recabado los beneficios de la terapia de estatinas, con ezetimiba o inhibidores de PCSK9 tanto en la prevención primaria como secundaria del accidente cerebrovascular isquémico. Dado que el 80% de los episodios cerebrovasculares recurrentes pueden prevenirse, hemos considerado de interés realizar una revisión narrativa de los beneficios de la terapia hipolipemiante en la prevención secundaria de la enfermedad cerebrovascular isquémica

Stroke is the second cause of death after myocardial infarction, and the main cause of acquired disability. Patients with ischaemic stroke have a higher risk of future vascular events, including recurrent stroke, myocardial infarction, and death by vascular cause. The initial epidemiological studies demonstrated a weak or non-existent relationship between cholesterolaemia and stroke. Subsequently, statin intervention trials showed a reduction in the risk of recurrence of cerebrovascular events. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), the first clinical trial designed to assess effects of statin therapy in secondary stroke prevention, highlighted the reduction of stroke recurrence with atorvastatin 80mg/daily in patients with a recent ischaemic established or transient stroke, with a modest increase in the rate of haemorrhagic stroke. Successive studies have also reported the benefits of statin therapy combined with ezetimibe or PCSK9 inhibitors in primary and secondary ischaemic stroke prevention. Since 80% of recurrent cerebrovascular events could be prevented, it is considered of interest to carry out a narrative review of the benefits of lipid-lowering therapy in the secondary prevention of ischaemic cerebrovascular disease

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Encefalopatias/tratamento farmacológico , Encefalopatias/prevenção & controle , Isquemia Encefálica/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pressão Arterial , Hemorragias Intracranianas/tratamento farmacológico , Medicina Baseada em Evidências/métodos , Terapia Combinada