Effects of intensive versus mild lipid lowering by statins in patients with ischemic congestive heart failure: Korean Pitavastatin Heart Failure (SAPHIRE) study

BACKGROUND/AIMS: This study was designed to evaluate the dose-effect relationship of statins in patients with ischemic congestive heart failure (CHF), since the role of statins in CHF remains unclear. METHODS: The South koreAn Pitavastatin Heart FaIluRE (SAPHIRE) study was designed to randomize patients with ischemic CHF into daily treatments of 10 mg pravastatin or 4 mg pitavastatin. RESULTS: The low density lipoprotein cholesterol level decreased by 30% in the pitavastatin group compared with 12% in the pravastatin (p < 0.05) group. Left ventricular systolic dimensions decreased significantly by 9% in the pitavastatin group and by 5% in the pravastatin group. Left ventricular ejection fraction (EF) improved significantly from 37% to 42% in the pitavastatin group and from 35% to 39% in the pravastatin group. Although the extent of the EF change was greater in the pitavastatin group (16% vs. 11%) than that in the pravastatin group, no significant difference was observed between the groups (p = 0.386). Exercise capacity, evaluated by the 6-min walking test, improved significantly in the pravastatin group (p < 0.001), but no change was observed in the pitavastatin group (p = 0.371). CONCLUSIONS: Very low dose/low potency pravastatin and high dose/high potency pitavastatin had a beneficial effect on cardiac reverse remodeling and improved systolic function in patients with ischemic CHF. However, only pravastatin significantly improved exercise capacity. These findings suggest that lowering cholesterol too much may not be beneficial for patients with CHF.

The Seroepidemiologic Study for Human T-cell Lymphotropic Virus Type I(HTLV-I) Infection in Residents of Cheju-Do / 감염

BACKGROUND: Human T-cell lymphotropic virus type I (HTLV-I) is a retrovirus that has been identified as a cause of adult T-cell leukemia/lymphoma and tropical spastic paraparesis. HTLV-I infection is highly endemic in the southwestern islands of Japan, Caribbean basin, South America, and Africa. In 1993, we showed that the seroprevalence of antibodies to HTLV-I was 0.13% among blood donors in Korea, but surprisingly, 0.80% in Cheju-Do adjacent to endemic areas of Japan. So this study was designed to reevaluate the seroprevalence of antibodies to HTLV-I among residents in Cheju-Do. METHODS: Total 2,372 residents in Cheju-Do were tested from December 1995 to March 1996. Anti-HTLV-I antibodies were detected by the microtiter particle agglutination test. RESULTS: Among total 2,372 residents, 19 were anti-HTLV-I positive. So the overall positive rate of anti-HTLV-I antibodies was 0.80%. The positive rate in females was higher than in males (0.82% vs 0.78%). The positive rate was 1.45% in the age group of 20-29 years, 1.41% in 40-49 years, 0.91% in 0-9 years, 0.70% in 30-39 years, and 0.54% in 50-59 years. The mean age of seropositive cases is 35.2 in males and 35.4 in females, with a mean of 35.3. Geographically, high positive rate was observed in Sogwipo-City (1.37%) and Namcheju-Gun (0.83%) compared to those of Pukcheju-Gun (0.64%) and Cheju-City (0.61%), which showed high seroprevalence in districts adjacent to endemic areas of Japan. Any specific risk factors or associated disorders of HTLV-I infection could not be found among the seropositive cases. CONCLUSION: The seroprevalence of antibodies to HTLV-I in Cheju-Do was noted to be very high by the microtiter particle agglutination test. So henceforth serosurvey by confirmative laboratory tests is needed, and if high seroprevalence is showed from it, screening of blood donors for HTLV-I in Cheju-Do should be considered to prevent transfusion-associated HTLV-I infection.