An Update on Pharmacotherapy of Dyslipidemia for Adults

Dyslipidemia is an important cause of atherosclerotic cardiovascular disease (ASCVD) worldwide that leads to increased risk of morbidity and mortality; treating dyslipidemia to goal reduces the risks. This article reviews the pharmacological therapy of dyslipidemiawhich is often required in addition to life style intervention to achieve target lipid levels.Currently, there are seven types of approvedlipid modifying drugs which are effective in treating dyslipidemiawhen used singly or in combination. Statins are considered as first line drug and havebeen used extensively in the primary and secondary prevention of ASCVD. Ezetimibe is used as a first line add-on drug for patients already on a statin who have not reached their low density lipoprotein (LDL-C) goals;however,ezetimibe can be used as initial drug in statin intolerant patients. Bile acid sequestrants are a useful alternative to statins or ezetimibe in pregnant women or patients with liver disease. They also lower blood glucose and are useful in diabetes mellitus (DM). The PCSK9 inhibitors are powerful lipid modifying drugs, are expensive, needinjection for delivery, and are used when statin in maximum doses with other drugs cannot lower the LDL-C level to targets in patients with very high CV risk. Fibrates have recently shown to slow the progression of microvascular diseases and are found beneficial for DM with hypertriglyceridemia and microvascular complications. Currently, niacin use is markedly decreased due to development of more effective alternative drugs for managing dyslipidemia andbecause of the adverse effects related to niacin use.Recent trials reveal that, ω-3 fatty acids, when added in pharmacological doses to statin therapy (after controlling LDL-C), are effective in reducing CV events in patientshaving moderate hypertriglyceridemia with high or very high CV risks

Treating Dyslipidemia in Adults: An Update

Dyslipidemia is an important risk for the promotion of atherosclerosis and the development of cardiovascular disease (CVD). Currently available drugs can effectively lower the increased levels of blood cholesterol in most patients and prevent the development and progression of CVD. This paper focuses on the adverse cardiovascular effects produced by high blood cholesterols and the overall management of dyslipidemia in adults. Relevant guidelines and research papers published mainly after the year 2000 on the management of dyslipidemia were reviewed. High levels of low density lipoprotein cholesterol (LDL-C), or low levels of high density lipoprotein cholesterol (HDL-C), combined or independently are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). Apolipoprotein B (ApoB), an atherogenic lipoprotein has emerged recently as the key factor in the pathogenesis of atherosclerosis. High triglyceride (TG) levels are associated with acute and recurrent pancreatitis. The purpose of treating lipid disorders is to prevent the development of ASCVD and pancreatitis. The treatment of dyslipidemia includes multifactorial life style intervention and pharmacotherapy with lipid modifying drugs. Reduction of LDL-C is substantially associated withreduction of risk of ASCVD and evidences show that “lower is better” for LDL-C reduction.

The Coronavirus Disease 2019 (COVID-19): A Review

Many details of the emergence of 2019 novel coronavirus infection such as its origin, spread, epidemiology, full spectrum of clinical illness, treatment and mortality rate has not been clearly defined. This review focuses the epidemiological evidences, clinical manifestations, investigations and treatment provided to the admitted cases of the 2019 novel coronavirus pneumonia in various hospitals of Wuhan city and other regions in China. Information have been gathered mainly from relevant researches and papers that were published recently. Clinical manifestations included fever, non-productive cough, dyspnoea, myalgia, fatigue, radiographic manifestations of pneumonia and detection of the novel virus by RT-PCR method. Some patients rapidly developed acute respiratory distress syndrome, acute respiratory failure, and other serious complications with fatal outcomes. There are neither vaccines nor effective treatments for the disease caused by the virus, but efforts are typically confined to symptomatic and supportive management. Antivirals and corticosteroids were used in severe illness but had no effective outcome

Dietary and Blood Lipids in Cardiovascular Disease

Blood lipids are essential for life; at the same time, elevated or reduced levels of some of the components of lipid are related to risk of atherosclerotic cardiovascular disease (ASCVD).This article provides a review on dietary and blood lipids with their impact on cardiovascular health. The role of apolipoprotein B (ApoB), Lipoprotein(a) ((Lp(a))and other lipoprotein particles in the development of ASCVD has been reviewed. There are newevidences that ApoB the structural protein of most of the lipoprotein particles (carrier of blood lipids), in addition to low density lipoprotein-cholesterol (LDL-C), plays a central role in the pathogenesis of atherosclerosis with increased risk for ASCVD. Elevated levels of Lp(a) concentrations are associated with an increased risk of ASCVD, but it appears to be a weaker risk factor than ApoB or LDL-C

Factors Precipitating Hypokalemia in Diabetic Patients: A Cross Sectional Study.

Background: Hypokalemia is a very common electrolyte imbalance in diabetic patients which leads to substantial morbidity and mortality. Severe hypokalemia is associated with lifethreatening arrhythmias and sudden cardiac death. There are no adequate studies regarding the incidence and factors precipitating hypokalemia in Bangladeshi diabetic subjects. Objective: The objective of this study was to find out the factors precipitaing hypokalemia in diabetic patients. Materials and Methods: A total 95 admitted diabetic patients with hypokalemia were studied. Specimens were collected from all adult diabetic patients with serum potassium level <3.5 mmol/L irrespective of cause of admission. Informations were obtained in a semistructured data collection form and analyzed. Results: Most of the subjects (61.1%) belonged to the age group of 60 years and above, 31.5% to the age group 40–59 years and 7.4% belonged to the age group of 20–39 years. Sixty one (64.2%) patients were females and 34 (35.8%) were males. In 63.2% cases, vomiting was found as a factor causing hypokalemia in the diabetic patients. Other common factors precipitaing hypokalemia were diarrhea (42.1%), inadequate diet (9.5%), severe hyperglycemia (3,2%), diabetic ketoacidosis (6.3%) and drugs especially diuretics (18.9%), bronchodilators (6.3%) and steroids (5.3%). The commonest comorbidity associated with diabetes was hypertension. Conclusion: In this study the commonest precipitating factor causing hypokalemia was vomiting. Majority of hypokalemic patients were female and of older age group. When hypokalemia is identified, the underlying precipitating factor should be sought and the disorder treated. Diuretics should be used with caution in the elderly patients having hypertension, a common comorbid condition of diabetes, as these patients are susceptible to develop hypokalemia.

Treatment and Prevention of Common Complications of Chronic Kidney Disease.

Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence and prevalence. Outcomes of CKD include not only complications of decreased kidney function and cardiovascular disease but also kidney failure causing increased morbidity and mortality. Unfortunately, CKD is often undetected and undertreated because of its insidious onset, variable progression, and length of time to overt kidney failure. Diabetes is now the leading cause of CKD requiring renal replacement therapy in many parts of the world, and its prevalence is increasing disproportionately in the developing countries. This review article outlines the current recommendations from various clinical guidelines and research studies for treatment, prevention and delaying the progression of both CKD and its common complications such as hypertension, anemia, renal osteodystrophy, electrolyte and acid-base imbalance, and hyperlipidemia. Recommendations for nutrition in CKD and measures adopted for early diabetic kidney disease to prevent further progression have also been reviewed. There is strong evidence that early detection and management of CKD can prevent or reduce disease progression, decrease complications and improve outcomes. Evidence supports that achieving optimal glucose control, blood pressure, reduction in albuminuria with a multifactorial intervention slows the progression of CKD. Angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists are most effective because of their unique ability to decrease proteinuria, a factor important for the progression of CKD.