Tratamiento posterior a un ataque cerebrovascular con estatinas y metas de colesterol de baja densidad / Statin treatment and low density cholesterol targets in patients post stroke

RESUMEN INTRODUCCIÓN: El ACV es uno de los eventos cardiovasculares más prevalentes en el mundo, en Colombia es la segunda causa de muerte y la primera de discapacidad. Uno de los factores de riesgo más importantes para tener en cuenta es el control del colesterol, la reducción de los niveles de C-LDL, principalmente por medio del tratamiento con estatinas y otros fármacos hipolipemiantes. MATERIALES Y MÉTODOS: En esta revisión narrativa de la literatura se ha recogido la información más relevante sobre el uso y los beneficios de este tratamiento y algunas consideraciones adicionales. CONCLUSIÓN: Los hallazgos de esta revisión demuestran el efecto protector de esta terapia cuando se consiguen reducir los niveles de C-LDL y colesterol, además, las otras terapias como ezetimiba o inhibidores de PSCK9. Por otro lado, los estudios mencionan posibles efectos beneficiosos en el contexto de ACV pero se requieren más ensayos clínicos.

ABSTRACT INTRODUCTION: Stroke is one of the most prevalent cardiovascular events in the world, in Colombia it is the second cause of death and first in disability. One of the most important risk factors to consider is cholesterol control, the reduction of LDL-C and cholesterol levels, mainly through treatment with statins and other lipid-lowering drugs. MATERIALS AND METHODS: The most relevant information on the use and benefits of this treatment and some additional considerations have been collected in this narrative review of the literature. CONCLUSION: The results of this narrative review show the protective effect of this therapy when it is possible to reduce LDL-C and cholesterol levels, in addition to other therapies such as ezetimibe or PSCK9 inhibitors. On the other hand, studies mention possible beneficial effects in the context of stroke but more clinical trials are required.

Lipid-lowering drug prescriptions in a group of Colombian patients / Patrones de prescripción de hipolipemiantes en pacientes de Colombia

Introduction. Lipid-lowering drugs, especially statins, have shown great relevance in preventing and treating cardiovascular diseases. Objective. To determine the prescription patterns of lipid-lowering drugs and the variables associated with their use in a Colombian population. Materials and methods. This is a cross-sectional descriptive study. From a drugdispensing database of approximately 4.5 million Colombian health system affiliates, patients of all ages and both sexes treated with lipid-lowering agents (statins, fibrates, ezetimibe) were identified between January and March, 2017. Demographic, pharmacological and co-medication variables were included. Results. In total, 103,624 patients were identified as being treated with lipid-lowering agents. The average age was 67.5 years, and 49.8% were 65 years or older. Women comprised 58.0% of the patients. Statins were the most used (n=96,910; 93.5%), and atorvastatin (n=80,812; 78.0%) and lovastatin (n=12,621; 12.2%) were the most frequent. The mean atorvastatin dose was 30.3 mg/day, and 49.9% of its users received presentations of 40 mg or more. A total of 9,258 (8.9%) patients received fibrates, and only 780 (0.8%) were taking ezetimibe. Of this population, 94.9% were treated with lipid-lowering monotherapy, and 97.3% (n=100,813) had co-medication for their comorbidities, with the most frequent being antihypertensive (89.1%), antiplatelet (57.8%), antidiabetic (31.5%) and antiulcerative agents (34.2%). Conclusions. Atorvastatin is currently the most frequently used lipid-lowering drug in this group of Colombian patients, especially in monotherapy and at doses close to the defined daily dose. Only half received high-intensity doses. New studies are required to verify the efficacy of these therapies.

Introducción. Los fármacos hipolipemiantes, especialmente las estatinas, han demostrado gran relevancia para la prevención y el tratamiento de las enfermedades cardiovasculares. Objetivo. Determinar los patrones de prescripción de los fármacos hipolipemiantes y las variables asociadas con su uso en una población de Colombia. Materiales y métodos. Se trata de un estudio descriptivo y transversal. A partir de una base de datos de dispensación de medicamentos de 4,5 millones de afiliados al sistema de salud de Colombia, se identificaron los pacientes de cualquier edad y sexo en tratamiento con hipolipemiantes (estatinas, fibratos, ezetimibe), entre enero y marzo de 2017. Se incluyeron variables demográficas, farmacológicas y de comedicaciones. Resultados. Se identificaron 103.624 pacientes en tratamiento con hipolipemiantes. La edad promedio fue de 67,5 años y el 49,8 % tenía 65 o más años. El 58,0 % eran mujeres. Las estatinas fueron los más utilizados (n=96.910; 93,5 %), siendo la atorvastatina (n=80.812; 78,0 %) y la lovastatina (n=12.621; 12,2 %) las más frecuentes. La dosis promedio de atorvastatina fue de 30,3 mg/día y el 49,9 % de sus usuarios recibía presentaciones de 40 mg o más. Un total de 9.258 (8,9 %) pacientes recibían fibratos y solo 780 (0,8 %) tomaban ezetimibe. El 94,9 % de casos recibió tratamiento en monoterapia hipolipemiante y el 97,3 % (n=100.813) tenía comedicaciones para comorbilidades, siendo las más frecuentes antihipertensivos (89,1 %), antiagregantes plaquetarios (57,8 %), antidiabéticos (31,5 %) y antiulcerosos (34,2 %). Conclusiones. La atorvastatina es actualmente el medicamento hipolipemiante más utilizado en este grupo de pacientes de Colombia, especialmente en monoterapia y a dosis cercanas a las definidas, aunque solo la mitad recibían dosis recibían dosis de alta intensidad. Se requieren nuevos estudios que verifiquen la efectividad de estos tratamientos.

Experiencia en la utilización de hipolipemiantes en una cohorte de pacientes en 12 ciudades colombianas / Experience in the use of oral lipid-lowering medicines in a group of patients followed in 12 colombian cities

Resumen Introducción: Los estudios de utilización de medicamentos sirven para evaluar la efectividad y seguridad de los fármacos en la práctica real, diferente al contexto del estudio clínico controlado. Los hipolipemiantes actúan sobre el perfil lipídico disminuyendo el riesgo de enfermedades cardiovasculares. Objetivo: Describir el desempeño clínico y seguridad de la utilización de medicamentos hipolipemiantes en la práctica médica real en una cohorte de pacientes con diagnóstico de dislipidemia. Metodología: Estudio observacional de cohorte. Se siguió una cohorte de pacientes con indicación de hipolipemiantes durante 6 meses, en 12 ciudades de Colombia pertenecientes a un registro biomédico de seguimiento de pacientes tratados con medicamentos del portafolio de Abbott. Se midieron variables demográficas y clínicas basales, de seguridad y de desempeño clínico de los medicamentos sobre el perfil lipídico a los 3 y 6 meses. Resultados: Se siguieron 501 pacientes en tratamiento con hipolipemiantes. Las estatinas solas disminuyeron el colesterol de baja densidad de 249 mg/ dL (RIQ=226-268) en la medición basal a 190 (177.6-210) y 170 (108-170) en la segunda y tercera medición, respectivamente. Para estatina + ezetimibe, de 167 mg/dL (RIQ=139-184) a 132 (110-150) y 128.5 (101.5-128.5). El fenofibrato disminuyó los triglicéridos de 275 mg/dL (RIQ=21çj-346) a 201 (172-239) y 150.5 (140-150.5). Conclusiones: la administración de estatinas sola o en combinación disminuyó los niveles de LDL y colesterol total, mientras que el fenofibrato demostró su efectividad al disminuir los triglicéridos. No se reportaron efectos adversos. Hubo una adherencia parcial del médico tratante a la guía de práctica clínica para dislipidemias. MÉD.UIS.2019;32(1):13-20.

Abstract Introduction: Drug use studies are important to evaluate the effectiveness and safety of drugs in daily practice, outside the controlled clinical study. Lipid-lowering drugs act on the lipid profile, decreasing the risk of cardiovascular diseases. Objective: To describe the clinical performance and safety of the use of lipid-lowering drugs in real practice in a group of patients diagnosed with dyslipidemia. Methods: An observational, descriptive cohort study. A cohort of patients with hypolipidemic indication for 6 months was followed in 12 cities of Colombia that belong to the biomedical registry of follow-up of patients treated with medicines from the Abbott portfolio. Baseline demographic and clinical variables, safety and efectivity of the drugs were measured on the lipid profile at 3 and 6 months. Results: 501 patients received lipid-lowering agents. Statins alone decreased the low density (LDL) cholesterol of 249 mg / dL (RIQ = 226-268) at baseline to 190 (177.6-210) and 170 (108-170) at the second and third measurements, respectively. For statin + ezetimibe, from 167 mg / dL (RIQ = 139-184) to 132 (110-150) and 128.5 (101.5-128.5). Fenofibrate decreased triglycerides from 275 mg / dL (RIQ = 219-346) to 201 (172-239) and 150.5 (140-150.5). Conclusions: The administration of statins alone or in combination decreased LDL and total cholesterol levels, while fenofibrate demonstrated its effectiveness in lowering triglycerides. No adverse effects were reported. There was partial adherence of the treating physician to GPC for dyslipidemias. There were no adverse events. MÉD.UIS.2019;32(1):13-20.

Estatinas en enfermedad renal crónica / Statins in chronic kidney disease

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)

A atorvastatina e o alendronato interferem na movimentação dentária induzida em ratos viaredução das atividades inflamatória e reabsortiva e aumento do anabolismo ósseo

A movimentação dentária induzida (MDI) envolve processos inflamatórios e de remodelação óssea nos sítios de compressão e tração. Durante o tratamento ortodôntico, fármacos podem modular a taxa de movimentação.Nesse contexto, investigou-se a atorvastatina (ATV), o alendronato (ALD) ou sua combinação (ATV+ALD) na MDI em ratos. Inicialmente, grupos de 6 animais com MDI foram eutanasiados na 6ª h e nos dias 1, 4, 7, 11, 14 e 21, e tiveram suas hemimaxilas analisadas quanto a distância entre molares e incisivos, histomorfometria do ligamento periodontal (LP) das raízes distovestibular, distolingual e intermediária, e atividade de mieloperoxidase (MPO; Ux103/mg de gengiva). Para a abordagem farmacológica, os animais durante 28 d receberam por gavagem água destilada (H2Od; 2 ml/kg/d), ATV (1, 3 e 9 mg/kg/d), ALD (1 e 7 mg/kg/sem) ou combinação de suas menores doses (ATV+ALD), sendo 11 d antes da eutanásia, submetidos à MDI. Foram avaliados além da distância entre molares e incisivos, a histomorfometria e MPO, os níveis de IL-1β(pg/mg de gengiva), imunomarcações para RANKL, OPG e TRAP, e níveis séricos de fosfatase alcalina óssea (FAO; U/l); (Comissão de Ética em Pesquisa Animal-UFC nº 21/14)...

The induced tooth movement (MDI) depends oninflammatoryand bone remodelingprocesses in sites of compression and traction. During orthodontic treatment, drugs canmodulatethe movement ́s rate.In this context, we investigated the influence of atorvastatin (ATV), alendronate (ALD), or combination of these drugs (ATV+ALD) on MDI in rats.First, groups of animals (n=6/group) were euthanized at the 6thhour, and on the 1st, 4st, 7st, 11st, 14stand 21stdays, and they had their hemimaxillas analyzed for the distance between molars and incisors, histomorphometry of periodontal ligament (PL) of distobuccal, intermediate and distolingualroots, and myeloperoxidase activity (MPO; x 103U/mg of tissue). For pharmacological approach, the animals received by gavage during 28 d distilled water (H2Od, 2 ml/kg/d), ATV (1, 3 and 9 mg/kg/d), ALD (1 and 7 mg/kg/wk), or thecombination of lower doses of these drugs (ATV+ALD). Then, the rats weresubmitted to MDI 11 days prior to euthanasia. The distance between molars and incisors, histomorphometry, MPO, IL-1β levels (pg/mg of tissue), immunostaining for RANKL, OPG and TRAP, and serum levels of bone alkaline phosphatase (BALP; U/l)were evaluated. This study was approved by the Ethical aspects: Ethics Committee on Animal Research-UFC No. 21/14...

Dislipidemia em pacientes com doença renal crônica / Dyslipidemia in patients with chronic kidney disease

JUSTIFICATIVA E OBJETIVOS: Identificar o perfil lipídico dos pacientes renais crônicos e analisar a prevalência das alterações lipídicas nesses pacientes. MÉTODOS: Realizado um estudo retrospectivo em 136 pacientes portadores de doença renal crônica (DRC) não dialítica atendidos em um único ambulatório. Foram coletados os seguintes dados: sexo, idade, comorbidades, medicações em uso, exame físico e exames laboratoriais. Calculou-se a prevalência das principais dislipidemias e as variáveis foram analisadas por meio das estatísticas descritivas: média aritmética e mediana. Foram utilizados os testes t de Student, Mann-Whitney, qui-quadrado e Exato de Fisher. As variáveis foram comparadas entre os grupos com e sem dislipidemia. RESULTADOS: A prevalência de dislipidemias foi de 75,7%, sendo a média dos valores de colesterol total (CT) de 179,6±41,0mg/dl, HDL-colesterol de 46,1±12,6mg/dl,LDL-colesterol de 101,7±34,5mg/dl e de triglicerídeos de 160,0±87,2mg/dl. O grupo com dislipidemia apresentou níveis superiores de triglicerídeos e inferiores de HDL-colesterol. CONCLUSÕES: Observamos elevada prevalência de dislipidemia neste estudo.

BACKGROUND AND OBJECTIVES: Identify the lipid profile of chronic renal patients and the prevalence of lipid disorders in these patients. METHODS: A retrospective study was performed in 136 patients with chronic kidney diseases (CKD) not dialytic, treated in a unique clinic. The following data were collected: gender, age, comorbidities, medications in use, physical examination and laboratory tests. It has been estimated the prevalence of dyslipidemias and main variables were analyzed through descriptive statistics: arithmetic mean and median. The Student's t-tests, Mann-Whitney, chi-squareand Fisher exact were used. Variables were compared between groups with and without dyslipidemia. RESULTS: The prevalence of dyslipidemias was 75.7%, with an average of the total cholesterol of 179.6±41.0mg/dl, HDL-cholesterol of 46.1±12.6mg/dl, LDL cholesterol of 101.7±34.5mg/dl and triglyceride levels of 160.0±87.2mg/dl. The group with dyslipidemia showed increased levels of triglycerides and lower HDL cholesterol. CONCLUSIONS: We observed a high prevalence of dyslipidemia in this study.

Associação entre perfil lipídico, estado nutricional e consumo alimentar em idosos atendido sem unidades de saúde, Londrina, PR / Association of lipid profile, nutritional status and dietary intake in elderly primary care health units in Londrina, PR

Introdução: as dislipidemias, a obesidade, os hábitos alimentares, o estilo de vida e as características genéticas são fatores de riscos para doenças cardiovasculares. Objetivo: investigar a associação do, perfil lipídico ao estado nutricional e ao consumo alimentar em idosos. Métodos: participaram do estudo 469 idosos. Foi avaliado o estado nutricional pelo IMC, o consumo alimentar pelo recordatório de 24 horas, o perfil lipídico por método enzimático automatizado e o uso de medicação hipolipemiante. Resultados: houve alta prevalência de excesso de peso (mulheres: 51,1%; homens: 32,5%). Somente 23,2% das mulheres e 49,4% dos homens não apresentaram dislipidemias. As mulheres apresentaram valores superiores de colesterol total, LDL-c e triglicerídeos (p < 0,05) quando comparadas aos homens, mesmo no subgrupo de pacientes medicados. A dieta caracterizou-se como hiperproteica, hiperlipídica e com baixo consumo de hortaliças e frutas. Considerações finais: os resultados reforçam a importância da promoção da alimentação saudável no âmbito da atenção básica, independente do uso de medicação hipolipemiante, pois as alterações no perfil lipídico e no estado nutricional persistem, indicando risco aumentado para doenças cardiovasculares.

Introduction: dyslipidemia, obesity, unbalanced diet, life style and genetic background are risk factors for cardiovascular diseases. Objective: this study aimed to evaluate the association of lipid profi le, nutritional status and dietary intake in elderly. Methods: the studied population was composed by 469 individuals. Nutritional status was assessed by BMI, dietary intake by 24-Hour Dietary Recall, the lipid profi le by enzymatic method and use of antilipidaemic medication. Results: a high prevalence of overweight was observed (women: 51.1%; men: 32.5%). Only 23.2% of women and 49.4% of men did not have dyslipidemia. The women showed higher values of total cholesterol, LDL-c and triglycerides compared to men, even in patients using antilipidaemic medication (p < 0.05). Diet was hyperlipidemic, hyperproteic and with low vegetables consumption. Final remarks: these results reinforce the signifi cance of healthy diet in primary attention despite the use of antilipidemic medication, since changes in the lipid profi le and nutritional status are sustained indicating an increased risk for cardiovascular diseases.

Evaluación del potencial hipolipemiante de dos plantas medicinales en un modelo de hiperlipidemia crónica / Evaluation of the hypolipidemic potential of two medicinal plants using a chronic hyperlipidemia model

Introducción: la presencia de metabolitos antioxidantes en las especies Cymbopogon citratus (DC.) Stapf. (Caña Santa) y Plectranthus amboinicus (Lour.) Spreng. (Orégano), permite la obtención de evidencia que facilita la ejecución de investigaciones biomédicas. Objetivo: evaluar el efecto hipolipemiante de las especies Plectranthus amboinicus (orégano) y Cymbopogon citratus (caña santa) mediante un modelo de hiperlipidemia crónica. Métodos: se evaluó el efecto hipolipemiante de los extractos hidroalcohólicos de las partes aéreas secas de P. amboinicus y C. citratus aplicando el modelo crónico de hiperlipidemia donde se suministró por un período de 60 días, dieta hipercalórica, consistente en grasa de cerdo y azúcar refino. Se emplearon ratones machos Balb/C, conformando 5 grupos, uno control (grupo I) y cuatro de tratamiento, se administraron dosis orales de 200 mg/kg y 400 mg/kg de los extractos blandos de P. amboinicus (grupos II y III) y C. citratus (grupos IV y V) respectivamente. Se realizó la caracterización fitoquímica de ambos extractos y evaluaron las concentraciones plasmáticas de colesterol total, triacilglicéridos (TAG) y lipoproteínas de muy baja densidad (VLDL). Resultados: el tamizaje fitoquímico corroboró la presencia de compuestos reductores, alcaloides, flavonoides, triterpenos en los extractos hidroalcohólicos de ambas plantas, observándose mayor cantidad de estos compuestos en el extracto de Caña santa. Las variables colesterol, TAG y VLDL en los grupos IV y V, mostraron una disminución estadísticamente significativa, mientras los grupos II y III presentaron un comportamiento similar respecto al grupo control (I). Conclusiones: el extracto blando de Cymbopogon citratus a las dosis de estudio posee actividad hipolipemiante a diferencia del extracto hidroalcohólico de Plectranthus amboinicus.

Introduction: the presence of antioxidant metabolites in the species Cymbopogon citratus (DC.) Stapf. (lemongrass) and Plectranthus amboinicus (Lour.) Spreng. (oregano) is a source of evidence for biomedical research. Objective: evaluate the hypolipidemic effect of the species Plectranthus amboinicus (oregano) and Cymbopogon citratus (lemongrass) using a chronic hyperlipidemia model. Methods: an evaluation was performed of the hypolipidemic effect of hydroalcoholic extracts from dry aerial parts of P. amboinicus and C. citratus using a chronic hyperlipidemia model in which a hypercaloric diet of pork fat and refined sugar was provided for 60 days. Male Balb/C mice were used which were divided into one control group (Group I) and four treatment groups. Oral doses of 200 mg/kg and 400 mg/kg were administered of soft extracts of P. amboinicus (Groups II and III) and C. citratus (Groups IV and V), respectively. Phytochemical characterization was conducted of both extracts, evaluating plasma concentrations of total cholesterol, triacylglycerides (TAG) and very low density lipoproteins (VLDL). Results: phytochemical screening confirmed the presence of reducing compounds, alkaloids, flavonoids and triterpenes in alcoholic extracts of both plants, more abundantly in the lemongrass extract. The variables cholesterol, TAG and VLDL showed a statistically significant reduction in Groups IV and V, whereas the values for Groups II and III were similar to those in Group I (control). Conclusions: the soft extract of Cymbopogon citratus displayed hypolipidemic activity at the study doses, whereas the hydroalcoholic extract of Plectranthus amboinicus did not.

Medicamentos de ação metabólica: Estatinas, fibratos e antidiabéticos orais / Drugs of metabolic action: Statins, fibrates and oral antidiabetics

A polifarmácia na prática clínica atualmente é necessária paraa obtenção de metas de tratamento mais rigorosas impostas porestudos que vêm demonstrando seus benefícios. O pacienteque apresenta alterações metabólicas está mais suscetível aouso de medicamentos hipolipemiantes e antidiabéticos orais.A interação medicamentosa entre esses e outros fármacosfaz com que devamos nos atentar aos mecanismos de ação,metabolização e excreção dessas drogas...

Multiple drugs used in clinical practice are required to obtain morestrict treatment goals determined by studies that have demonstratedtheir benefits. Metabolic alterations in patients are more likelyto be treated with lipid lowering drugs and oral antidiabetics.We should pay close attention to their rnechanisms of action,metabolism and excretion, due to their interaction with otherdrugs...

Hipolipemiantes e câncer / Lipid-lowering drugs and cancer

Os hipolipemiantes são medicamentos de eficácia comprovada no tratamento dos distúrbios do metabolismo dos lipídeos. Essas drogas reduzem a morbidade e a mortalidde em eventos cardiovasculares de forma notória. A suspeita de que esses agentes podem aumentar o risco de câncer tem sido questionada desde o início de seu uso, gerando intensos debates e reanálises de ensaios clínicos sobre o assunto. Recentemente, os resultados do estudo Sinvastatin and Ezetimibe in Aortic Stenosis (SEAS) despertaram novo interesse por esse tema, pois os pacientes submetidos a terapia hipolipemiante intensiva tiveram número aumentado de câncer em comparação com o grupo controle. Este artigo visa a revisar os estudos em busca de evidência sobre associação do uso de hipolipemiantes e baixos níveis de colesterol com incidência de câncer. Até o momento não há evidências concretas de meta-análises, seja com estatinas ou, mais recentemente, com ezetimiba, que indiquem que esses medicamentos induzam o aparecimento de neoplasias ou que elevem o risco de mortalidade pelo câncer.

The efficacy of lipid-lowering agents in the treatment of lipid metabolism disorders is well established. These drugs markedly reduce morbidity and mortality in cardiovascular events. The hypothesis that lipid-lowering drugs might increase the risk of cancer has been questioned from the very beginning of their use and has been subject of intense debate and several attempts to reanalyze clinical trial data. Recently, the results of the Simvastatin and Ezetimibe in Aortic Stenosis Study (SEAS) has sparked new interest on this issue, since patients undergoing intense lipid-lowering therapy had a higher rate of cancer than the control group. This article gives an overview of the clinical evidence on the association of lipid-lowering drugs and low cholesterol levels with the incidence of cancer. So far there are no clear evidences from metanalyses, whether with statins or more recently with ezetimibe, indicating that these drugs induce the development of cancer or increase the risk of mortality due to cancer.

Cumplimiento de las metas con reductores del colesterol en pacientes mexicanos: El estudio COMETA México / Cholesterol goal Attainment with Lipid Lowering Drugs: The COMETA Mexico Trial

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.

Efecto del germinado de maíz sobre el perfil lipídico, la hemoglobina y la uricemia / Effect of clorophilic juice from germinateo corn on seric lipids, hemoglobin, ano uric acid

Se investigó el efecto del jugo clorofílico de germinado de maíz, con una dosis de 30 ml diarios durante dos meses, sobre el perfil lipídico, la glicemia, la uricemia, la hemoglobina y el hematocrito, en nueve adultos con edad promedio de 44 años y que presentaban hipertrigliceridemia como trastorno principal. Las concentraciones promedio iniciales en mgl dl que eran de 6.9 (ácido úrico), 259 (triglicéridos) y 199 (colesterol total) descendieron en forma progresiva y significativa a los 30, 45 y 60 días de tratamiento hasta valores respectivos de 5.0, 171 y 169 (p = 0.010,0.015 y 0.034 respectivamente). La hemoglobina ascendió de manera progresiva y significativa (p = 0.008) durante el experimento. Este tratamiento natural podría ser útil en la regulación de los lípidos sanguíneos y otros factores biológicos de riesgo para el desarrollo de ateromatosis coronaría, sin los efectos tóxicos que se han demostrado con algunas drogas hipolipemiantes.

The effect was studied of clorophilic juice from germinated corn on blood seric lipids, uric acid, glucose, hemoglobine and hematocrite. Nine adults with average age 44 years and who presented hypertriglyceridemia received daily 30 ml doses of the juice during 2 months. Initial average concentrations in mg/dl were 6.9 (uric acid), 259 (triglycerides) and 199 (total cholesterol); they decreased progressively and significantly at 30, 45 and 60 days of treatment reaching values of 5.0, 171 and 169 respectively (p:0.01 0,0.015 and 0.034). Hemoglobin increased significantly (p:0.008). This natural treatment could be useful in regulating blood lipids and other biologic risk factors for coronary arteriosclerosis, without the toxic efects shown by some lipid control drugs.