Safety of simvastatin and goal attainment for low-density lipoprotein cholesterol in Sultan Qaboos University Hospital

Despite the scientific evidence of reducing cardiac events with HMG Co-A reductase inhibitors [statins] therapy in both primary and secondary preventions, these therapies continue to be underutilized in patients receiving convictional care. Simvastatin, a HMG Co-A inhibitor agent, is the most commonly used statin in Sultan Qaboos University Hospital. The aim of this study is to review the safety and the effectiveness of achieving LDL-C targets with Simvastatin according to the NCEP-ATP3 guidelines in patients with different cardiovascular risk categories at Sultan Qaboos University Hospital. A retrospective chart review was conducted for 160 patients. Patients were identified by outpatient prescriptions provided by pharmacy department from April 2008 to May 2008. 98% of the patients were prescribed simvastatin 20 mg and only 2% received 40 mg. The mean age of patients was 57 years +/- 12. While 49% of the patients were male and 45% had diabetes mellitus, 50% had cardiovascular disease, 2.5% were smokers, 67% were hypertensive, and 3% had positive family history of coronary artery disease. 75% of patients were classified as high risk, 7% moderate risk and 18% low risk for coronary artery disease. Among all lipid profiles, only LDL-C was changed from baseline with simvastatin treatment in all patients [3.60 +/- 1.03 to 3.25 +/- 1.34 mmol/L]. LDL-C level at baseline was higher in the high risk group [4.11 +/- 1.06 mmol/L] compared to low and moderate risk groups [3.68 +/- 0.89, 3.42 +/- 1.15] respectively. Achievement of LDL-C goals was achieved in only 43% for high risk, 50% in moderate risk, and 90% in low risk patients. There was no significant increase in liver enzymes and creatinine kinase. This study identified that more than half of the high risk patients were not at the target LDL-C goals which place them at a continuous risk of coronary heart disease. More appropriate lipid lowering therapy using more potent statins or combination therapy should be optimized to improve achievement of LDL-C goals according to ATP-III guidelines

Genotypes and allele frequencies of angiotensin converting enzyme [ACE] insertion/deletion polymorphism among Omanis

To describe the angiotensin converting enzyme [ACE] genotype frequencies among Omani Arabs. A polymerase chain reaction [PCR] test, based on separation of different size DNA fragments, was developed to test the presence or absence [polymorphism] of a small DNA deletion in the ACE gene. The subjects were 124 Omani Arab students of Sultan Qaboos University, Muscat. The frequency of the I allele was 0.29, while that of the D allele was 0.71. The gene frequency distribution did not deviate from Hardy-Weinberg equilibrium. The frequency of D allele among Omanis is similar to that among other Arabs and Africans, but differs significantly from that among the Japanese and Chinese