oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Reducing cholesterol to prevent coronary heart disease

Matthew J Sorrentino,

老年心脏病学杂志(英文版) , 2005,
Abstract: Coronary heart disease (CHD) remains the number one killer of men and women in the United States of America despite major advances in interventional technologies for the treatment of coronary artery disease. CHD is rapidly becoming a major cause of morbidity and mortality in developing nations as well and is now recognized as the leading cause of death worldwide. The recognition and treatment of coronary risk factors such as high cholesterol levels, hypertension, smoking, obesity and diabetes has made a positive impact on CHD morbidity and mortality. The most successful treatment has targeted lowering LDL cholesterol with HMG CoA Reductase Inhibitors or the statin class of medications. Recent studies have extended the boundaries of treatment to different risk groups and are reporting significant reductions in coronary events.
Statin-Induced Increase in HDL-C and Renal Function in Coronary Heart Disease Patients
Vasilios G. Athyros, Anna I. Kakafika, Athanasios A. Papageorgiou, Efstathios D. Pagourelias, Savvas D. Savvatianos, Moses Elisaf, Asterios Karagiannis, Konstantinos Tziomalos and Dimitri P. MikhailidisBackground:Methods and Resultspost hocConclusions
The Open Cardiovascular Medicine Journal , 2007, DOI: 10.2174/1874192400701010008]
Abstract: 8-14 Vasilios G. Athyros, Anna I. Kakafika, Athanasios A. Papageorgiou, Efstathios D. Pagourelias, Savvas D. Savvatianos, Moses Elisaf, Asterios Karagiannis, Konstantinos Tziomalos and Dimitri P. Mikhailidis Published Date: (28 June, 2007) Background: Little is known about the potential of statin-induced high-density lipoprotein cholesterol (HDL-C) increase to improve renal function in coronary heart disease (CHD) patients. Methods and Results: In this post hoc analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study we investigated the effect of HDL-C increase after statin treatment on renal function. From a total of 1,600 patients, 880 were on various statins (mainly atorvastatin) and 720 were not. Other secondary prevention therapies were similar in the 2 groups. After a 3 year follow up, the lipid profile was unchanged in the statin untreated group and estimated glomerular filtration rate (eGFR) was reduced by 5.1% compared with baseline (P<0.0001). In contrast, in the statin treated group non-HDL-C was reduced by 43%, HDL-C was increased by 7% and there was a significant increase in eGFR compared with baseline by 9.8% (P<0.0001). In multiple regression analysis, the mean 7% increase in HDL-C in the treated arm during the entire study was associated with a 5.6% increase in eGFR recorded after the 6th week of treatment. The odds ratio of eGFR increase with every 5% statin-induced rise in HDL-C was 1.78 (95% confidence interval 1.19-3.34; P=0.001). Conclusions: Statin treatment significantly improved renal function. Statin-induced HDL-C increase significantly and independently contributed to this improvement. This finding supports the concept that improving lipid variables other than low density lipoprotein cholesterol is also beneficial to preserving renal function.
Benefits of statin therapy and compliance in high risk cardiovascular patients  [cached]
Joel A Lardizabal,Prakash C Deedwania
Vascular Health and Risk Management , 2010,
Abstract: Joel A Lardizabal1, Prakash C Deedwania21Division of Cardiology, Department of Medicine, University of California in San Francisco (Fresno-MEP), Fresno, CA, USA; 2University of California in San Francisco, Chief of Cardiology, Veterans Affairs Central California System, Fresno, CA, USAAbstract: Cardiovascular disease (CVD) remains the top cause of global mortality. There is considerable evidence that supports the mortality and morbidity benefit of statin therapy in coronary heart disease (CHD) and stroke, both in primary and secondary prevention settings. Data also exist pointing to the advantage of statin treatment in other high-risk CVD conditions, such as diabetes, CKD, CHF, and PVD. National and international clinical guidelines in the management of these CVD conditions all advocate for the utilization of statin therapy in appropriate patients. However, overall compliance to statin therapy remains suboptimal. Patient-, physician-, and economic-related factors all play a role. These factors need to be considered in devising approaches to enhance adherence to guideline-based therapies. To fully reap the benefits of statin therapy, interventions which improve long-term treatment compliance in real-world settings should be encouraged.Keywords: cardiovascular disease, statin therapy, coronary heart disease, long-term treatment compliance
Efficacy, safety and tolerability of ongoing statin plus ezetimibe versus doubling the ongoing statin dose in hypercholesterolemic Taiwanese patients: an open-label, randomized clinical trial
Chih-Chieh Yu, Wen-Ter Lai, Kuang-Chung Shih, Tsung-Hsien Lin, Chieh-Hua Lu, Hung-Jen Lai, Mary E Hanson, Juey-Jen Hwang
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-251
Abstract: This was a randomized, open-label, parallel-group comparison study of ezetimibe 10 mg added to ongoing statin compared with doubling the dose of ongoing statin. Adult Taiwanese hypercholesterolemic patients not at optimal LDL-C levels with previous statin treatment were randomized (N = 83) to ongoing statin + ezetimibe (simvastatin, atorvastatin or pravastatin + ezetimibe at doses of 20/10, 10/10 or 20/10 mg) or doubling the dose of ongoing statin (simvastatin 40 mg, atorvastatin 20 mg or pravastatin 40 mg) for 8 weeks. Percent change in total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C) and triglycerides, and specified safety parameters were assessed at 4 and 8 weeks.At 8 weeks, patients treated with statin + ezetimibe experienced significantly greater reductions compared with doubling the statin dose in LDL-C (26.2% vs 17.9%, p = 0.0026) and total cholesterol (20.8% vs 12.2%, p = 0.0003). Percentage of patients achieving treatment goal was greater for statin + ezetimibe (58.6%) vs doubling statin (41.2%), but the difference was not statistically significant (p = 0.1675). The safety and tolerability profiles were similar between treatments.Ezetimibe added to ongoing statin therapy resulted in significantly greater lipid-lowering compared with doubling the dose of statin in Taiwanese patients with hypercholesterolemia. Studies to assess clinical outcome benefit are ongoing.Registered at ClinicalTrials.gov: NCT00652327Chinese populations are perceived to have lower low-density lipoprotein cholesterol (LDL-C) levels and coronary heart disease (CHD) risk than Caucasians [1]. However, as life expectancy and the standard of living improve in Asian countries, an increased risk for cardiovascular disease, high blood pressure, diabetes and dyslipidemia have become more prevalent and are predicted to continue to rise as the population ages [2]. LDL-C is the primary target of cholesterol-lowering therapy. Reducing serum levels of LDL-C is associated with a
Pharmacogenomic insights into treatment and management of statin-induced myopathy
Bas JM Peters, Olaf H Klungel, Frank L Visseren, Anthonius de Boer, Anke-Hilse Maitland-van der Zee
Genome Medicine , 2009, DOI: 10.1186/gm120
Abstract: To reduce the morbidity and mortality associated with heart disease, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) inhibitors (statins) are used by millions of patients worldwide. The primary mechanism by which statins reduce the risk of coronary artery disease (CAD) involves lowering low-density lipoprotein cholesterol (LDLc) in plasma. Although generally well tolerated, the most common adverse drug reaction (ADR) from statin therapy is myopathy, symptoms of which can range from myalgia (mild fatigue and muscle pain without raised creatine kinase (CK) [1]) to life-threatening rhabdomyolysis (muscle symptoms associated with marked CK elevations, typically substantially more than ten times the upper limit of normal [1]). Among 20 randomized trials, the incidence of minor muscle pains was 190 per 100,000 person years, whereas rhabdomyolysis incidence was reported to be 1.6 per 100,000 person years [2]. In the ambulatory setting, the incidence of hospitalized rhabdomyolysis per 100,000 person years for monotherapy with atorvastatin, prava-statin, or simvastatin was shown to be 4.4 [3]. In contrast to the incidence of minor muscle pains in clinical trials, observational studies have reported considerably higher numbers of statin-associated myalgia cases [4,5].Currently, there is no consensus of the exact definition of statin-induced myopathy (SIM) [6]. The mechanism behind SIM is poorly understood, but a number of (arguable) underlying mechanisms have been proposed, including isoprenoid and coenzyme Q10 depletion, low cholesterol content, myocyte skeletal membrane-related instability, and mitochondrial dysfunction. SIM is of great clinical importance because (i) mild ADRs in patients on lifelong statin treatment lower the quality of life, and (ii) patients may discontinue statin therapy because of intolerance.Numerous factors have been proposed that may increase the risk of SIM, including older age, female sex, low body mass index, excessive alcohol use, and drug inte
Statin use is associated with fewer periodontal lesions: A retrospective study
Otso Lindy, Kimmo Suomalainen, Marja M?kel?, Seppo Lindy
BMC Oral Health , 2008, DOI: 10.1186/1472-6831-8-16
Abstract: Periodontal probing pocket depth (PPD) values were collected from dental records of 100 consecutive adult patients referred to a university dental clinic for treatment of advanced chronic periodontitis. A novel index, Periodontal Inflammatory Burden Index (PIBI), was derived from the PPD values to estimate systemic effects of periodontitis.Periodontitis patients taking statins had a 37% lower number of pathological periodontal pockets than those without statin medication (P = 0.00043). PIBI, which combines and unifies the data on PPD, was 40% smaller in statin using patients than in patients without statin (P = 0.00069). PIBI of subjects on simvastatin and atorvastatin both differed significantly from patients without statin and were on the same level. The subjects' number of teeth had no effect on the resultsPatients on statin medication exhibit fewer signs of periodontal inflammatory injury than subjects without the statin regimen. PIBI provides a tool for monitoring inflammatory load of chronic periodontitis. The apparent beneficial effects of statins may in part be mediated by their pleiotropic anti-inflammatory effect on periodontal tissue.Statins are inhibitors of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase. They were developed for the reduction of serum cholesterol levels [1], and have been used successfully in the prevention and treatment of coronary heart disease. [2-4]. Recently, interest has focused on non-cholesterol-dependent, pleiotropic effects of statins [5-7]. Anti-inflammatory pleiotropic effects are supposed to result from the inhibition of isoprene modification of signal transducers of inflammation [7].Inflammatory processes are considered to participate in the development of cardiovascular disease (CVD) [8-11]. In addition to local inflammatory reactions in the arterial wall, chronic inflammatory processes in other tissues have been suggested to impose a systemic burden on the arteries, thus contributing to CVD. This systemic inflammati
Benefits of statin therapy and compliance in high risk cardiovascular patients
Joel A Lardizabal, Prakash C Deedwania
Vascular Health and Risk Management , 2010, DOI: http://dx.doi.org/10.2147/VHRM.S9474
Abstract: enefits of statin therapy and compliance in high risk cardiovascular patients Review (8844) Total Article Views Authors: Joel A Lardizabal, Prakash C Deedwania Published Date September 2010 Volume 2010:6 Pages 843 - 853 DOI: http://dx.doi.org/10.2147/VHRM.S9474 Joel A Lardizabal1, Prakash C Deedwania2 1Division of Cardiology, Department of Medicine, University of California in San Francisco (Fresno-MEP), Fresno, CA, USA; 2University of California in San Francisco, Chief of Cardiology, Veterans Affairs Central California System, Fresno, CA, USA Abstract: Cardiovascular disease (CVD) remains the top cause of global mortality. There is considerable evidence that supports the mortality and morbidity benefit of statin therapy in coronary heart disease (CHD) and stroke, both in primary and secondary prevention settings. Data also exist pointing to the advantage of statin treatment in other high-risk CVD conditions, such as diabetes, CKD, CHF, and PVD. National and international clinical guidelines in the management of these CVD conditions all advocate for the utilization of statin therapy in appropriate patients. However, overall compliance to statin therapy remains suboptimal. Patient-, physician-, and economic-related factors all play a role. These factors need to be considered in devising approaches to enhance adherence to guideline-based therapies. To fully reap the benefits of statin therapy, interventions which improve long-term treatment compliance in real-world settings should be encouraged.
Effect of statin therapy on the progression of coronary atherosclerosis  [cached]
Tian Jinwei,Gu Xia,Sun Yanli,Ban Xiang
BMC Cardiovascular Disorders , 2012, DOI: 10.1186/1471-2261-12-70
Abstract: Background An increasing number of authors employing intravascular ultrasound (IVUS) and virtual histology (VH-IVUS) have investigated the effect of statin use on plaque volume (PV) and plaque composition. However, inconsistent results have been reported. Therefore, we conducted a meta-analysis to determine the appropriate regimen of statins to effectively stabilize vulnerable coronary plaques. Methods Online electronic databases were carefully searched for all relevant studies. We compared mean values of PV and plaque composition between baseline and follow-up in patients receiving statin therapy. We pooled treatment effects and calculated mean differences (MD) with the 95% confidence interval (CI) using a random-effects model. By stratified analyses, we explored the influence of clinical presentation, dose and duration of statin treatment, and low-density lipoprotein-cholesterol (LDL-C) levels on the effects of statins. Results Seventeen studies involving 2,171 patients were analyzed. Statin therapy significantly decreased PV ( 5.3 mm3; 95% CI: –3.3 mm3 to 7.2 mm3; P < 0.001), without heterogeneity. When considering the dose and duration of statins used, only subgroups employing a high dose and long duration demonstrated a significant reduction in PV (p < 0.001). A significant decrease in PV was noted if achieved LDL-C levels were <100 mg/dL (p < 0.001). Statin treatment could induce a twofold decrease in PV in patients with acute coronary syndrome (ACS) compared with that observed in patients with stable angina pectoris (SAP). A regressive trend was seen for necrotic core volume (MD: –2.1 mm3; 95% CI: –4.7 mm3 to 0.5 mm3, P = 0.11). However, statin use did not induce a significant change for fibrotic, fibro-fatty, or dense calcium compositions. Conclusions Our meta-analysis demonstrated that statin therapy (especially that involving a high dose and long duration and achieving <100 mg/dL LDL-C levels) can significantly decrease PV in patients with SAP or ACS. These data suggested that statins can be used to reduce the atheroma burden for secondary prevention by appropriately selecting the statin regimen. No significant change in plaque composition was seen after statin therapy.
Place of pitavastatin in the statin armamentarium: promising evidence for a role in diabetes mellitus  [cached]
Kawai Y,Sato-Ishida R,Motoyama A,Kajinami K
Drug Design, Development and Therapy , 2011,
Abstract: Yasuyuki Kawai, Ryoko Sato-Ishida, Atsushi Motoyama, Kouji KajinamiDepartment of Cardiology, Kanazawa Medical University, Uchinada, JapanAbstract: Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, known as statins, have revolutionized the treatment of hypercholesterolemia and coronary artery disease prevention. However, there are considerable issues regarding statin safety and further development of residual risk control, particularly for diabetic and metabolic syndrome patients. Pitavastatin is a potent statin with low-density lipoprotein (LDL) cholesterol-lowering effects comparable to those of atorvastatin or rosuvastatin. Pitavastatin has a high-density lipoprotein (HDL) cholesterol raising effect, may improve insulin resistance, and has little influence on glucose metabolism. Considering these factors along with its unique pharmacokinetic properties, which suggest minimal drug–drug interaction, pitavastatin could provide an alternative treatment choice, especially in patients with glucose intolerance or diabetes mellitus. Many clinical trials are now underway to test the clinical efficacy of pitavastatin in various settings and are expected to provide further information.Keywords: HMG-CoA reductase inhibitor, pitavastatin, efficacy, safety, diabetes mellitus
Genetic determinants of statin intolerance
Jisun Oh, Matthew R Ban, Brooke A Miskie, Rebecca L Pollex, Robert A Hegele
Lipids in Health and Disease , 2007, DOI: 10.1186/1476-511x-6-7
Abstract: COQ2 genotypes, based on two single nucleotide polymorphisms (SNP1 and SNP2) and a 2-SNP haplotype, all showed significant associations with statin intolerance. Specifically, the odds ratios (with 95% confidence intervals) for increased risk of statin intolerance among homozygotes for the rare alleles were 2.42 (0.99 to 5.89), 2.33 (1.13 to 4.81) and 2.58 (1.26 to 5.28) for SNP1 and SNP2 genotypes, and the 2-SNP haplotype, respectively.These preliminary pharmacogenetic results, if confirmed, are consistent with the idea that statin intolerance which is manifested primarily through muscle symptoms is associated with genomic variation in COQ2 and thus perhaps with the CoQ10 pathway.Large clinical trials over the past two decades have unequivocally established the benefit of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) inhibitors – or "statins" – in the primary and secondary prevention of coronary heart disease (CHD) [1]. Reduction of plasma low-density lipoprotein (LDL) cholesterol with statins has revolutionized clinical cardiology; this family of drugs is generally well-tolerated, easy to administer, and has very good patient acceptance. However, the potential for adverse effects exists. From clinical trials, the statin discontinuation rate due to adverse events ranges between 1 and 5% [1]. Frequently reported adverse effects include gastrointestinal complaints, rashes, dizziness, pruritus and headache [2]. Statin-related skeletal muscle disorders range from benign myalgias – such as non-specific muscle aches or joint pains without elevated serum creatinine kinase (CK) concentration – to true myositis with >10-fold elevation of serum CK [3]. The incidence of muscle aches and pains with statin monotherapy ranges from 1 to 7%, whereas severe myopathy, defined as >10-fold elevation of serum CK with muscle pains, weakness and tenderness, occurs in up to 0.5% of patients [3]. Life-threatening rhabdomyolysis with muscle necrosis and subsequent electrolyte alterations,
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.