ABSTRACT
This paper outlines the position of the Department of Cardiovascular Prevention from the Chilean Society of Cardiology regarding the use of the "polypill". The international and local evidence regarding the benefits of the polypill compared to conventional therapy is reviewed. The benefits and some limitations of the polypill are outlined, along with cost-effective considerations. The increased adherence to treatment and the better clinical results of this strategy are put forward. The used of the polypill in different groups of subjects, especially those recovered from a recent myocardial in-farction, is recommended for individual patients and in Chilean cardiovascular prevention programs from the Ministry of Health.
Subject(s)
Humans , Atherosclerosis/prevention & control , Cardiovascular Agents/administration & dosage , Cardiovascular Diseases/prevention & control , Medication Adherence/statistics & numerical data , Atherosclerosis/epidemiology , Cardiovascular Diseases/epidemiology , Chile/epidemiology , Cost-Benefit Analysis , Risk Factors , Secondary PreventionABSTRACT
Background: Plasma high density lipoproteins (HDL) are involved in reverse cholesterol transport mediated by the scavenger receptor class B type I (SR-BI). Nicotinic acid increases HDL cholesterol levels, even though its specific impact on SR-BI dependent-cellular cholesterol transport remains unknown. Aim: To determine the effect of nicotinic acid on HDL particle functionality in cholesterol efflux and uptake mediated by SR-BI in cultured cells in hypoalphalipoproteinemic patients. Material and Methods: In a pilot study, eight patients with low HDL (≤ 40 mg/dL) were treated with extended release nicotinic acid. HDL cholesterol and phospholipid levels, HDL2 and HDL3 fractions and HDL particle sizes were measured at baseline and post-therapy. Before and after nicotinic acid treatment, HDL particles were used for cholesterol transport studies in cells transfected with SR-BI. Results: Nicotinic acid treatment raised total HDL cholesterol and phospholipids, HDL2 levels as well as HDL particle size. Nicotinic acid significantly increased HDL cholesterol efflux and uptake capacity mediated by SR-BI in cultured cells. Conclusions: Nicotinic acid therapy increases SR-BI-dependent HDL cholesterol transport in cultured cells, establishing a new cellular mechanism by which this lipid-lowering drug appears to modulate HDL metabolism in patients with hypoalphalipoproteinemia.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cholesterol, HDL/metabolism , Hypoalphalipoproteinemias/metabolism , Hypolipidemic Agents/pharmacology , Lipoproteins, HDL/metabolism , Niacin/pharmacology , Biological Transport , Cholesterol, HDL/drug effects , Phospholipids/blood , Pilot Projects , Scavenger Receptors, Class B/metabolismABSTRACT
Se han demostrado efectos beneficiosos de los vasodilatadores arteriales en pacientes con insuficiencia aórtica crónica (IAC). No existen trabajos que estudien el rol de los inhibidores de la ECA en estos pacientes. Con objeto de evaluar el efcto a mediano plazo de enalapril sobre la dilatación y función ventricular izquierda (VI), estudiamos a 20 pacientes con IAC severa y gran dilatación VI (dimensión sistólica ecocardiográfica > de 50 mm). Los pacientes fueron separados en dos grupos: Grupo E (n=10) que recibieron enalapril 20 mg/día por un plazo de seis meses, y grupo C (n=10) que no recibieron la droga. Los pacientes fueron evaluados clínica y ecocardiográficamente al comienzo y 1,3 y 6 meses de ingresados al estudio. Dos pacientes del Grupo E no completaron el estudio, por mala adherencia al tratamiento. Los pacientes del Grupo E presentaron, a los seis meses de tratamiento, una disminución significativa de la dimensión sistólica ecocardiográfica de VI (52,6 ñ 3,1 vs 55,8 ñ 3,2 mm; p<0,05) y de la masa VI(461 ñ 74 vs 527 ñ 73 g; p<0,05), sin cambios significativos en dimensión diastólica y fracción de acortamiento de VI. Los pacientes del Grupo C no presentaron cambios significativos durante el seguimiento. Estos resultados sugieren un efcto beneficioso del enalapril en pacientes con IAC severa y gran dilatación VI, aunque no está bien definido su impacto en la historia natural de estos pacientes