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The main clinical manifestation of dyslipidemia is hyperlipidemia， which is an important risk factor leading to the occurrence of cardiovascular and cerebrovascular diseases such as atherosclerosis， coronary heart disease and stroke. In clinical practice， lipid-lowering drugs are mainly used for treatment， but there are issues such as individual differences and genetic effects. Therefore， it is necessary to perform gene detection on patients， so as to guide individualized application of lipid-lowering drugs. This review mainly previews the definition of gene detection and the individualized treatment of lipid-lowering drugs， and introduces the application of gene detection in the individualized treatment of lipid-lowering drugs （statins， fibrates， nicotinic acid and ezetimibe）. Among them， the gene polymorphisms of APOE， SLCO1B1 and CYP450 family play a key role in the efficacy and safety of statins； the gene polymorphisms of APOA/B/C family have a significant impact on the efficacy of fenofibrate； the gene polymorphisms of HCAR2 and DGAT2 have an important impact on the efficacy of niacin； the gene polymorphisms of NPC1L1 have a significant impact on the efficacy of ezetimibe. It is suggested to conduct genotype detection for patients with dyslipidemia to select appropriate treatment strategies， so as to provide individualized medication guidance.
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Comprehensive clinical evaluation of drugs is an important technical tool to promote the return of drugs to clinical value. Under the background of normalization and institutionalization of centralized drug volume-based procurement ，it is very crucial to actively organize and carry out comprehensive clinical evaluation of drugs. As of March 2022，there are 5 lipid-lowing drugs that have been included in the centralized drug volume-based procurement of the state and Shandong Province. In order to actively promote the medical institutions to develop the comprehensive clinical evaluation of lipid-lowing drugs standardly ，led by the Shandong Provincial Hospital Affiliated to Shandong First Medical University ，supported by Shandong Hospital Association ，and 19 third grade class A hospitals in Shandong Province jointly participated ，Using Delphi method ，through three rounds of expert opinion investigation and extensive discussion ，Expert Consensus on the Comprehensive Clinical Evaluation of Lipid-lowering Drugs under the Centralized Drug Volume-based Procurement Policy in Shandong Province was developed. The expert consensus adopted the percentage system for quantitative evaluation. The comprehensive clinical evaluation on 15 lipid-lowing drugs involved in centralized drug volume-based procurement in Shandong Province was implemented from eight dimensions including pharmaceutical characteristics ，effectiveness，safety，economy，suitability，accessibility，innovation and other attributes ，and different recommendation levels were formed according to the scores. The development of this consensus will help medical institutions to reasonably allocate and use lipid-lowering drugs in the context of centralized drug volume-based procurement ，so as to better satisfy the national policy needs and continuously improve the quality of pharmaceutical services.
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Objective: To assess the trend of statin application for in-hospital acute myocardial infarction (AMI) patients with its impact factors in eastern urban China from 2001 to 2011. Methods: A 2-stage random sampling design was performed to extract representative AMI sample patients. In the ifrst stage, a simple random-sampling was used to identify participating hospitals. In the second stage, a systematic sampling was conducted in 2001, 2006 and 2011 to select the cases from participating hospitals, to take medical records and clinical information for calculating the in-hospital statin application rate. The impact factors for statin application was assessed by multi Logistic regression model with generalized estimating equations. Results: A total of 5940 AMI records from 32 hospitals were enrolled. From 2001 to 2011, the in-hospital statin use rate increased from 46.0% in 2001 to 82.2% in 2006 and to 93.7% in 2011,P3.37 mmol/L were more likely to receive statin therapy than those with LDL-C<1.81 mmol/L (OR=1.59, 95% CI 1.10-2.30,P=0.013); the patients with chest pain at admission (OR=1.82, 95% CI 1.14-2.91, P=0.012), combining hypertension (OR=1.44, 95% CI 1.02-2.03,P=0.038), with in-hospital PCI (OR=2.99, 95% CI 1.71-5.23, P<0.001) were also more likely to receive statin therapy. The application rate of statin was reduced by reduced LDL-C level accordingly and the patients without LDL-C examination, accounting for 21.3%, had the lowest statin application rate. Conclusion: Statin therapy for in-hospital AMI patients was dramatically increased from 2001 to 2011 in eastern urban China and the guideline was rapidly popularized in clinical practice. However, the improvement has been needed especially in patients without LDL-C examination or with low LDL-C levels; we emphasize that AMI patients should receive statin therapy regardless their LDL-C levels.
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La enfermedad renal crónica constituye una patología de prevalencia e impacto creciente en la población mundial por sus múltiples complicaciones, incluyendo un riesgo cardiovascular aumentado, que representa la principal causa de morbimortalidad en pacientes nefrópatas crónicos. Sin embargo, la relevancia de las dislipidemias, especialmente, la hipercolesterolemia LDL, en el deterioro de la función renal y desarrollo de ateroesclerosis en sujetos con daño renal crónico no ha sido claramente establecida. Esta situación ha generado controversia sobre el beneficio real del uso de hipolipemiantes en estos pacientes. En base a la evidencia disponible, incluyendo estudios clínicos recientes, la recomendación más apropiada sugiere que el uso de terapia hipolipemiante basada en estatinas (con o sin ezetimiba) es beneficioso desde un punto de vista cardiovascular en nefrópatas crónicos con insuficiencia renal leve a moderada antes de la diálisis. Por otro lado, no existe evidencia definitiva para apoyar el uso rutinario de este tipo de hipolipemiantes en el manejo del deterioro de la filtración glomerular y/o la proteinuria. Basándose en la evidencia analizada en esta revisión, las futuras guías clínicas para el manejo del daño renal crónico deberán incorporar el uso de estatinas y/o ezetimiba como un elemento más dentro del armamento terapéutico de este tipo de pacientes.(AU)
Chronic kidney disease is a condition of increasing prevalence and impact on the world population by its many complications, including increased cardiovascular risk that represents the leading cause of morbidity and mortality in chronic nephropathy patients. However, the relevance of dyslipidemia, especially high LDL cholesterol, in the impairment of renal function and development of atherosclerosis in subjects with chronic kidney disease has not been clearly established. This situation has generated controversy regarding the real benefit of use of lipid-lowering therapy in these patients. Based on available evidence, including recent clinical studies, the most appropriate recommendation suggests that the use of lipid-lowering therapy based on statins (with or without ezetimibe) is beneficial from a cardiovascular standpoint in chronic nephropathy with mild to moderate renal failure before dialysis. On the other hand, there is no definitive evidence to support the routine use of lipid lowering drugs in the management of impaired glomerular filtration and/or proteinuria. Based on the evidence discussed in this review, future clinical guidelines for management of chronic renal damage should incorporate the use of statins and/or ezetimibe as a key element in the therapeutic armamentarium to be applied in these patients.(AU)
Subject(s)
Humans , Male , Female , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Renal Insufficiency, Chronic , Dialysis , Hypolipidemic AgentsABSTRACT
OBJECTIVE:To investigate the situation of pharmacoeconomic researches about lipid-lowering drugs in China, and to seek the regimen with good cost-effectiveness in order to provide reference for rational drug use in the clinic. METHODS:Retrieved from CNKI and Wanfang database,pharmacoeconomic literatures about lipid-lowering drugs,published in domestic jour-nals during 2011-2015,were included to discuss the problems of pharmacoeconomic researches about lipid-lowering drugs and put forward related suggestions. RESULTS:Rosuvastatin and other medicines showed good cost-effectiveness,while there were many problems of domestic published pharmacoeconomic researches about lipid-lowering drugs,such as different research methods,dif-ferent treatment courses,different methods of cost calculation,single effect index and absence of ADR. On the whole,the research-es were low in quality,which led the difficulty of accurately obtaining the drugs with best cost-effectiveness. CONCLUSIONS:In the future,related researches should confirm research duration and health output index,effect index and evaluation method accord-ing to disease types and research objectives;enhance the unity of research and design methods;pay attention to cost discount;in addition,strengthen pharmacoeconomic researches about lipid-lowering TCM and compare it with chemical drugs.
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OBJECTIVE:To evaluate the utilization of blood lipid-lowering drugs in Haikou area.METHODS:The consumption sum,DDDs and DDC of blood lipid-lowering drugs in 2 hospitals of Haikou area from 2007 to 2009 were analyzed retrospectively.RESULTS:The consumption sum of blood lipid-lowering drugs in Haikou area increased year by year,up by 41.25% in 2008 than in 2007 and 28.96% in 2009 than in 2008.Blood lipid-lowering drugs were mainly atorvastatin,pravastatin,fluvastatin,simvastatin,bezafibrate.Atorvastatin took up the first place of the list of consumption sum and DDDs in past 3 years.CONCLUSION:Statins occupy the predominate place among blood lipid-lowering drugs and show potential in the market.
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Objective To evaluate the effect of probucol on endothelium-dependent vasodilatation(i,e.flow- mediated dilation,FMD) function of the old patients with isolated systolic hypertension.Methods In this single- blind study,a total of 64 old pariems with isolated systolic hypertension were randomized to receive conventional an- tihypertensive therapy and probucol (0.5g twice daily,group A,n=33) or receive conventional antihyperrensive therapy(group B,n=31) for 12 weeks.The levels of blood lipid were measured and vascular endothelial function was assessed in the brachial artery by high-resolution ultrasound technique in form of endothelium-dependent vasodi- latation before and after treatment.Results After 12-week treatment,the levels of TC,LDL-C and HDL-C in group A were significantly reduced compared with those before treatment(all P0.05).Flow-mediated dilatation parameters in both groups were obviously improved compared with those before treatment( P
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OBJECTIVE:To evaluate the status quo and tendency of the utilization of lipid-lowering drugs in our hospital.METHODS:The utilization of lipid-lowering drugs in our hospital between 2005 and 2008 was analyzed statistically by ranking consumption sum and DDDs.RESULTS:The consumption sum of lipid-lowering drugs had a sharp increase during 2007～2008 as compared with 2005～2006,its proportion in the drugs for cardiovascular diseases increased to some degree.During 2007～2008,Statins took the first two places on the annual consumption list,its use gained popularity and its DDDs increased.The application of Fibrates also took an upward trend.CONCLUSION:The use of lipid-lowering drugs in our hospital had been on the rise,with Statins and Fibrates took the predominant places,which is in line with the requirement of evidence-based medicine.
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En un estudio retrospectivo para determinar el porcentaje de pacientes que alcanzan las metas terapéuticas de C-LDL con hipolipemiantes, se seleccionaron 20 especialistas y médicos generales, quienes trabajaron con 120 pacientes y les midieron los lípidos después de por lo menos 12 semanas de tratamiento. Fueron agrupados en tres categorías: grupo A (riesgo absoluto de cardiopatía coronaria a 10 años <10%); grupo B, con riesgo entre 10 y 20%, y grupo C, con riesgo >20%. Los valores meta del C-LDL fueron: <160 mg/dl para el grupo A, <130 para el B y <100 para el C. La edad fue 57 ± 12 años, 59% fueron hombres y 51% del grupo C. De éstos 83% recibió estatinas, 12% fibratos solos y 5% combinaciones. Atorvastatina y Simvastatina fueron los fármacos más utilizados, a dosis promedio moderadas (12 y 27 mg/día). El C-LDL se redujo 25%. En 22% se ajustó la dosis. Alcanzó las metas de C-LDL con la primera dosis (29%) y al final del estudio (42%). Las metas se alcanzaron mejor en los grupos de menor riesgo. No hubo diferencias entre los distintos tipos de médicos. Los datos indican pobre apego a las recomendaciones internacionales e insuficiente alcance de las metas terapéuticas.
In a retrospective study to determine rate of patients attaining therapeutic LDL-C goal values with lipid-lowering drugs, 20 specialists and general practitioners were selected who enrolled 120 patients whose lipids were measured after at least 12 weeks of treatment. They were grouped in three categories: group A (absolute risk of CHD in 10 years <10%); group B, with 10-20% risk, and group C, with >20% risk. Goal LDL-C values were < 160 mg/dL for group A, < 130 for group B, and < 100 for group C Mean age was 57 ± 12 years, 59% were males, and 51% were in group C; 83% took statins, 12% fibrates alone, and 5%, combinations. Atorvastatin and simvastatin were the most used drugs, at medium doses (mean 12 and 27 mg/day). LDL-C was reduced 25%; overall, 22% of patient doses were adjusted. Therapeutic goals were attained in 29% with initial doses and 42% at the end of study. Goalvalues were better attained in groups with lower risk. No differences were noticed among distinct physician categories. Data show poor compliance with international guidelines and insufficient attainment of therapeutic goals.
Subject(s)
Female , Humans , Male , Middle Aged , Anticholesteremic Agents/therapeutic use , Hyperlipidemias/drug therapy , Patient Compliance , Medicine , Mexico , Retrospective Studies , SpecializationABSTRACT
Nonalcoholic fatty liver disease(NAFLD)is the Clinicopathological syndrome characterized by diffuse hepatic steatosis from excessive use of alcohol and other specific factors that cause liver damage including simple steatosis,and nonalcoholic steatohepatitis.The pathogenesis of NAFLD is closely related to Insulin resistance and genetic susceptibility.Presently the major treatment of NAFLD is diet control to reduce weight.On the basis of the treatment with dyslipidemia and hypoglycemic drugs or application of weight loss for more than one month,are there still mixed hyperlipidemia or hyperlipidemia with two or more risk factors,need to add Lipid-lowering drugs such as fibrates,statins or Probucol should be considered.The prevention and treatment with lipid-lowering drugs in NAFLD will be summarized in this article.