Rosuvastatin reduces nonalcoholic fatty liver disease in patients with chronic hepatitis C treated with alpha-interferon and ribavirin

Nonalcoholic fatty liver disease develops in patients with chronic hepatitis C. Interferon and ribavirin combination therapy is the standard treatment for chronic hepatitis C, but if present, NAFLD can reduce the virological response to anti-HCV therapies. We determined whether the addition of rosuvastatin to interferon and ribavirin improves the sustained virological response [SVR] and reduces steatosis. This study was a prospective, randomized, open-label trial. Between January 2004 and December 2007, 65 patients with chronic hepatitis [27 women and 38 men, mean age 48 years] aged 32-63 years [median 46 years] were consecutively enrolled. Patients were randomly assigned to receive leukocyte interferon alpha [3 MIU 3 times per week] plus ribavirin [1200 mg per day] for 12 months or interferon alpha and ribavirin at the same dosages plus rosuvastatin [5 mg per day]. The primary endpoints were measurements in SVR, liver enzyme, cholesterol, triglyceride, CRP, glucose, and insulin levels; and Homa-IR, fibrosis, and steatosis scores. After 12 months of treatment, we observed a significant improvement in SVR in 51% of patients who received interferon plus ribavirin plus rosuvastatin compared with 18% of relapsers [OR 1.52; 95% CI= 0.41-5.64; RR 1.13]. There were 23 responders [69%] and 10 nonresponders [30%] [OR 1.38; 95% CI= 0.49-16.5; RR 1.11]. When comparing interferon plus ribavirin group vs interferon plus ribavirin and rosuvastatin group after 12 months, we observed a significant difference in AST [85.70 vs.106.5.00 IU/ml] [OR 1.2; 95% CI= 0.29-4.94; RR 1.04; p<0.001], ALT [81.80 vs. 126.2 IU/ml] [OR 1.2; 95% CI= 0.29-4.94; RR 1.04; p<0.001], LDL-cholesterol [0.01 vs. 0.60 mmol/l] [OR 14; 95% CI= 3.98-49.16; p RR 2.96; <0.001], triglycerides [0.17 vs. 0.2 mmol/l] [OR 20; 95% CI= 4.94-80.89; RR 5.38; p<0.05], and Viremia [1.8 vs. 2.48 UI/ml, p<0.05]. Mean fibrosis score decreased 0.10 vs. 0.50 [OR 4.5; 95% CI= 0.89-22.66; RR 1.5; p<0.05], and mean steatosis score declined 0.30 vs. 0.50 [OR 11.2; CI= 2.88-43.53; RR 2.75; p<0.001]. In HCV patients with NAFLD, the addition of rosuvastatin to interferon and ribavirin significantly reduces viremia, steatosis, and fibrosis without causing side effects

Efficacy and limits of sildenafil citrate in patients with arterial erectile dysfunction: role of peripheral arterial disease and cardiovascular comorbidities / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction (ED) was related to their peak systolic velocity (PSV), peripheral atherosclerosis, cardiovascular risk factors (RF) and/or comorbidities at low cardiovascular risk.</p><p><b>METHODS</b>We enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone (group A, n = 27), ED plus atherosclerotic carotid artery (group B, n = 23), ED plus lower limb artery abnormalities (group C, n = 25), and ED plus carotid and lower limb artery abnormalities (group D, n = 22). Sildenafil efficacy (100 mg twice a week for 12 weeks) was also examined in patients with =or>3 RF, peripheral atherosclerosis and no cardiovascular comorbidities (group E, n = 20).</p><p><b>RESULTS</b>Median PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients (77.8%), intermediate in groups B and C (65.2% and 56%) and lowest in groups D (45.4%) and E (50%), and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was negatively influenced by: =or>3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidities was positively related to atherosclerosis localization or extension (25, 35, 38 and 47 in groups A, B, C and D, respectively).</p><p><b>CONCLUSION</b>Low sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.</p>