Renal dysfunction as an independent predictor of total mortality after acute coronary syndrome: the Thai ACS Registry.

BACKGROUND: Renal insufficiency in the acute coronary syndrome (ACS) is associated with poor cardiac outcome. In Asian populations, there are no data available for these associations. MATERIAL AND METHOD: Data was from the Thai ACS registry, only a new case of ACS. Clinical characteristics, treatment strategies, in-hospital mortality and 1-year mortality were compared for patients with normal or mild renal dysfunction (estimated glomerular filtration rate [eGFR]> 60 ml/minute/1.73 m2, n = 809 [44.5%]), moderate renal dysfunction (eGFR 30-60 ml/minute/1.73 m2, n = 706 [38.9%]), and severe renal dysfunction (eGFR < 30 ml/minute/1.73 m2, n = 301 [16.6%]). RESULTS: Of the 1,816patients with mean follow-up 10.8 months, the mean age was 65 years, and 59.2 percent of the groups were male. Patients with severe renal dysfunction were significantly older, less likely to be male (45.2%, p < 0.001) and had a greater prevalence of diabetes (63.1%, p < 0.001) and hypertension (85.4%, p < 0.001). In-hospital and 1-year mortality were 13.5% and 22.5% respectively. According to discharge diagnosis, unadjusted hazard ratios for overall in-hospital mortality was statistically significant only in ST elevation MI subgroup, hazard ratio was 2.73 (95% CI, 1.72 to 4.34) and 6.27 (95% CI, 3.78 to 10.4) for moderate and severe renal dysfunction group, respectively. The risk of death for all types of ACS at 1-year follow up increased when eGFR decreased below 60 ml/minute/1.73 m2, the adjusted hazard ratio was 1.66 (95% CI,1.22 to 2.23) and 1.91 (95% CI, 1.34 to 2.72) for moderate and severe renal dysfunction group, respectively. CONCLUSION: From Thai ACS registry, renal dysfunction at presentation is an independent predictor for the overall 1-year mortality and appeared to associate with an increase in hospital mortality in the subsets with STEMI

The Atorvastatin Goal Achievement Across Risk Levels: (ATGOAL) study in Thailand.

OBJECTIVE: To evaluate the efficacy and safety of atorvastatin at the starting doses of 10, 20, 40 mg and evaluate the effectiveness of 1 step titrate up regimen. MATERIAL AND METHOD: Two hundred and forty two subjects with dyslipidemia were enrolled and assigned the appropriate dose in relation to their individual cardiovascular risk status and baseline LDL-C levels. If the NCEP targets were not achieved, the doses were titrated up at week 4 and the primary efficacy was evaluated at week 8. RESULTS: A majority of subjects (88.8%) achieved their LDL-C goals at week 8. Almost all of the subject's LDL-C levels reached their goals by week 2 and 4 (81.6% and 87.1%, respectively). Only 10.7% (n = 25) required the sole titration. Each dose provided significant decreases in LDL-C (average -46.4%). Only 36 subjects experienced treatment related adverse events, the majority of these were in the high-risk group (n = 22) with only one subject registering a serious adverse event. CONCLUSION: Atorvastatin is effective and safe for Thai patients with dyslipidemia. The appropriate starting dose has contributed in the achievement of cholesterol reduction.

Efficacy and safety of 12-week treatment with fenofibrate 300 mg in Thai dyslipidemic patients.

BACKGROUND: High levels of low density lipoprotein (LDL) cholesterol is a known major factor in atherosclerosis. In addition to LDL-cholesterol, an increase in the triglycerides-rich lipoprotein and a decrease in HDL-cholesterol increase the risk of coronary artery disease. Fenofibrate, a fibric acid derivative, is highly effective in reducing serum triglycerides and LDL-cholesterol and produces a modest increase in HDL-cholesterol. The present study was done to evaluate the efficacy of fenofibrate at 300 mg daily on serum lipid profiles and to study the drug safety and tolerability of fenofibrate in Thai patients. MATERIAL AND METHOD: Forty patients with elevated serum total cholesterol, LDL cholesterol were recruited for 12 weeks of 300 mg per day of fenofibrate therapy. Blood analysis for lipid profiles, liver function test, creatinine and muscle enzyme were done at the begining and end of the study. RESULTS: The mean baseline total cholesterol, LDL-cholesterol, triglycerides and HDL-cholesterol were 249 mg/dl, 160 mg/dl, 325 mg/dl and 43 mg/dl respectively. Significant changes of all lipid parameters from baseline were observed after 12 weeks of treatment. Reduction of serum total cholesterol, LDL-cholesterol and triglycerides were 16, 23, and 41 percent respectively. Increased serum HDL-cholesterol of 14 percent was also observed. One patient withdrew from the trial due to chest pain. Two asymptomatic elevated transaminase were detected during the study. CONCLUSION: Fenofibrate at 300 mg per day is effective and safe in treating Thai patients with dyslipidemia.

Efficacy and safety of rilmenidine, a selective imidazoline I1 receptor binding ligand, in mild-to-moderate Thai hypertensive patients.

BACKGROUND: Rilmenidine is an antihypertensive agent that selectively binds to imidazoline I1 receptor located in the brainstem and kidney. It acts both centrally by reducing sympathetic overactivity and in the kidney by decreasing water and sodium overload. This dual action leads to the immediate and delayed control of blood pressure caused by this drug. OBJECTIVE: The aim of this study was to assess the efficacy and safety of rilmenidine as monotherapy in mild-to-moderate essential hypertensive patients. METHOD: An 8-week, open-labeled, multicenter study was conducted in Thai patients with mild-to-moderate essential hypertension. Rilmenidine 1 mg/day was given for 8 weeks. The dose could be titrated up to 2 mg/day according to the patient's blood pressure response at week 4. The primary efficacy parameters were the mean reductions in systolic and diastolic blood pressure. The proportions of patients whose blood pressure normalized or responded were evaluated as secondary efficacy parameters. Safety parameters were assessed by the changes in heart rate and reported side effects during the treatment period. RESULTS: 103 subjects (44.7% men) with a mean age of 53 +/- 9.7 years completed the 8-week follow-up. At baseline, 46.6 per cent and 53.4 per cent of the patients were classified with mild and moderate hypertension, respectively. The mean blood pressure was 154/93 mmHg. After the 8-week treatment, there was a significant decrease in blood pressure to 140/86 mmHg (p < 0.001), with mean pressure reduction of 14/7.5 mmHg. The normalization rate was 44 per cent and the response rate was 68 per cent. No significant changes were found for mean heart rate and any laboratory parameters tested. Only 17 patients reported mild and transient side effects such as drowsiness and dryness of the mouth and throat, which required no treatment. CONCLUSION: This study has shown that rilmenidine is an effective and well tolerated monotherapy in Thai patients with mild-to-moderate essential hypertension.

Extracranial internal carotid stenting in Phramongkutklao Hospital.

BACKGROUND: Carotid artery occlusive disease is estimated to be the primary cause in 20-30 per cent of all strokes. This report was to demonstrate the safety and efficacy of the treatment of extracranial stenosis by carotid artery stenting. METHOD: From June 1995 to December 2001, there were 13 patients with internal carotid stenosis > or = 60 per cent who were eligible for carotid stenting. RESULTS: Twelve patients were male. The mean age was 68 years old. Fifty-four per cent had neurological symptoms. The percentage of pre stenting stenosis was 86 +/- 8 and the percentage of post stenting stenosis was 18 +/- 15. There were 3 patients who had complications after the procedure (minor stroke = 2, severe bradycardia = 1). One patient died. There were no new or recurrent neurological events during the 6 to 84 month-follow-up. CONCLUSIONS: Carotid stent implantation may be an alternate treatment for extracranial carotid stenosis.

Efficacy and safety of atorvastatin 10 mg every other day in hypercholesterolemia.

OBJECTIVES: The authors sought to evaluate the safety and efficacy of atorvastatin administered every other day in patients with hypercholesterolemia. BACKGROUND: Statins have efficacy in lowering cholesterol and reducing cardiovascular events but their cost is a major disadvantage. Atorvastatin is the most potent statin and has a long half-life. Therefore, atorvastatin given on alternate days may be reasonable and cost effective, particularly in hypercholesterolemia patients. METHOD AND RESULT: Sixty patients with hypercholesterolemia despite diet therapy were enrolled into the study. They received atorvastatin 10 mg every other day before bedtime. Duration of treatment was 8 weeks. A lipid profile was determined as baseline, at 4 weeks and again at 8 weeks. Atorvastatin every other day significantly reduced total cholesterol (TC), triglyceride (TG), and LDL-c versus baseline. The TC, TG, and LDL-c levels were lower by 23 per cent, 8 per cent, and 30 per cent. Increase in HDL-c level was not statistically significant. Three patients had drug side effects. One patient had increased serum transaminase and one patient had increased serum muscle enzyme. The other one had somnolence. CONCLUSIONS: In hypercholesterolemia patients, atorvastatin 10 mg every other day is safe and effective in lowering TC, TG, with LDL-c and a slight increase in HDL-c.