Application of the MCDA method for assessing new technologies for familial hypercholesterolaemia treatment / Aplicação do método MCDA para avaliar novas tecnologias para o tratamento da hipercolesterolemia familiar

Objective: Familial hypercholesterolaemia is a hereditary disease characterized by very high levels of low-density lipoprotein cholesterol and an elevated risk of early-onset cardiovascular disorders. New drugs provide alternatives for the treatment of patients with homozygous familial hypercholesterolaemia. The study aims to explore a practical application of multiple-criteria decision analysis on prioritization of new and emerging technologies for familial hypercholesterolaemia. Methods: The decision model was constructed using the MACBETH method. There were three stages: structuring the problem, measuring the performance of alternatives, and building the model. The weights for alternatives and levels were obtained by indirect comparisons, which evaluated the attractiveness of the performance levels of the criteria using the swing weights technique. Results: The drugs lomitapide, ezetimibe, evolocumab, and mipomersen were selected as alternatives for decision-making. "Cardiovascular Death", "Stroke" and "Acute Myocardial Infarction" had the three most significant weights. The criteria with the lowest weights were "Comfort" and "LDL-C Reduction". The top-ranked technology was evolocumab, with an overall score of 59.87, followed by ezetimibe, with a score of 37.21. Conclusion: How to apply the result of a higher score in the actual decisionmaking process still requires further studies. The case in question showed that evolocumab has more performance benefits than other drugs but with a cost approximately 50 times higher

Objetivo: A hipercolesterolemia familiar é uma doença hereditária caracterizada por níveis muito elevados de lipoproteína de baixa densidade (LDL-colesterol) e um risco elevado de doenças cardiovasculares de início precoce. Novos medicamentos oferecem alternativas para o tratamento de pacientes com hipercolesterolemia familiar homozigótica. Esse estudo tem como objetivo explorar uma aplicação prática da análise de decisão multicritério na priorização de tecnologias novas e emergentes para hipercolesterolemia familiar. Métodos: O modelo de decisão foi construído usando o método MACBETH. Três etapas foram criadas: estruturação do problema, mensuração do desempenho das alternativas e construção do modelo. Os pesos para alternativas e níveis foram obtidos por comparações indiretas, que avaliaram a atratividade dos níveis de desempenho dos critérios usando a técnica de pesos de balanço. Resultados: Os medicamentos lomitapida, ezetimiba, evolocumabe e mipomersen foram selecionados como alternativas para a tomada de decisão. "Morte Cardiovascular", "Acidente vascular cerebral" e "Infarto Agudo do Miocárdio" tiveram os três pesos mais significativos. Os critérios com os menores pesos foram "Conforto" e "Redução do LDL-C". A tecnologia mais bem avaliada foi o evolocumabe, com pontuação geral de 59,87, seguido da ezetimiba, com pontuação de 37,21. Conclusão: Ainda são necessários estudos para determinar como aplicar o resultado de uma pontuação mais alta no processo de tomada de decisão. O caso em questão demonstrou que o evolocumabe tem benefícios mais significativos em relação aos outros medicamentos, mas com um custo cerca de 50 vezes maior

A successful pregnancy outcome of homozygous familial hypercholesterolaemia patient on statin therapy

@#Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disorder of lipoprotein metabolism mainly due to mutation of the low-density lipoprotein (LDL)-receptor gene (LDLR). It is a life-threatening disease that causes accelerated, multi-vessel atherosclerosis presented in early childhood. Pregnancy in HoFH may pose early coronary morbidity and mortality to both the foetus and mother. The combination of HoFH and pregnancy can be a fatal condition. While statins are very effective in lowering low-density lipoprotein cholesterol (LDL-C) levels, they are generally contraindicated during pregnancy, thus their use during pregnancy is uncommon. On the other hand, lipid apheresis (LA) has turned into an effective treatment to control cholesterol level amid pregnancy. However, the procedure is not widely available in our region. To date, there are scarcely documented case reports of HoFH in pregnancy in which the majority of them underwent LA to keep LDL-C at a low level. We report a rare case of successful pregnancy outcome of HoFH patient treated with lipid-lowering drugs including statin without LA therapy. Apart from that, we also discussed the genetic findings of the proband and all screened family members in which to the best of our knowledge, the first study using the whole-exome sequencing technique to identify the causative gene mutations for familial hypercholesterolaemia among the Malaysian population.

Therapeutic effects of anthocyanin-rich Hibiscus sabdariffa L. extract on body mass index, lipid profile and fatty liver in obese-hypercholesterolaemic rat model

Background: Hibiscus sabdariffa L. or Roselle, is one of the most common flower plants cultivated worldwide. Traditionally, it is claimed to reduce weight and cholesterol level. The aim of this study was to evaluate the effects of anthocyanin-rich Roselle aqueous extract on the physical, biochemical and histological changes in obese-hypercholesterolaemic rat model.Methods: Thirty Sprague-Dawley male rats were divided into five groups (n=6 per group). Group 1 is normal control (NC) rat that was fed with normal diet. The remaining rats (Group 2-5) were fed with commercial high-fat diet (HFD) for 6 weeks to induce obese-hypercholesterolaemic (OH) rat. After induction, the OH rats were divided into 4 groups: OH-Untreated group, OH-ARTE; OH treated with 300 mg/kg Roselle aqueous (anthocyanin-rich) and 1% trifluoroacetic acid extract (ARTE), OH-Orlistat; OH treated with 37 mg/kg orlistat and OH-Atorvastatin; OH treated with 10 mg/kg atorvastatin. After the 3 weeks intervention period, all rats were sacrificed. Body mass index, lipid profile and liver enzymes were evaluated. The liver section was subjected to hematoxylin and eosin staining for histopathological evaluation.Results: This study showed that 3 weeks administration of ARTE significantly reduced BMI, improved levels of lipid profile and liver enzymes, and histopathological changes of liver when compared to OH-untreated rats. The results were also comparable to the standard drugs.Conclusions: This study suggested that Roselle extract constitutes an effective and safe alternate treatment for obesity and hyperlipidaemia.

Evaluation of Reference Genes for Quantitative PCR in Four Tissues from Rabbits with Hypercholesterolaemia

Abstract Rabbit with hypercholesterolaemia is an important model for studying cholesterol metabolism disease. This study aimed to evaluate the expression stability of nine reference genes for quantitative PCR (qPCR) analysis in adrenal gland, liver, spleen, and kidney tissue from rabbits with hypercholesterolaemia. In total, 30 male Harbin Large White (HLW) rabbits were fed a normal feed (n = 15) or a high cholesterol feed (n = 15) for 8 weeks to induce hypercholesterolaemia. Nine reference genes were verified by qPCR using cDNA extracted from rabbit tissue samples. For qPCR analysis, reference genes were evaluated using the RefFinder and GeNorm algorithms. Overall, seven rabbits with hypercholesterolaemia were identified based on body weight and total cholesterol measurements. Combining the results of the RefFinder and GeNorm algorithms, the most stable reference genes were hypoxanthine phosphoribosyltransferase 1 (Hprt1) and eukaryotic translation elongation factor 1 alpha 1 (Eef1a1) in the adrenal gland, β-2-microglobulin (B2m) and glyceraldehyde-3-phosphate dehydrogenase (Gapdh) in the liver, tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein zeta (Ywhaz) and Gapdh in the spleen, and peptidylprolyl isomerase (Ppia), β-actin (Actb), succinate dehydrogenase complex subunit A flavoprotein (Sdha), and B2m in the kidney. Taken together, our results confirmed that Hprt1 and Eef1a1, B2m and Gapdh, Ywhaz and Gapdh, and Ppia, Actb, Sdha, and B2m were the best reference genes for qPCR analyses in adrenal gland, liver, spleen, and kidney tissue, respectively, of rabbits with hypercholesterolaemia.

Increased trunk fat along with decreased peripheral fat as an important predictor of hypertriglyceridaemia & hypercholesterolaemia in Indians with HIV infection

Background & objectives: Dyslipidaemia is a major contributor to cardiovascular morbidity, which is increased in HIV. Data on dyslipidaemia in Indians with HIV are scant. This study was undertaken to determine the predictors of dyslipidaemia and lipoatrophy in Indians with HIV infection and their relation with body composition parameters. Methods: A total of 382 consecutive patients with HIV infection were screened, of whom 257 clinically stable patients, without any acute comorbidity, having at least one year follow up underwent biochemical and DEXA analysis. Results: The most common dyslipidaemia was hypertriglyceridaemia (47.08%), followed by hypercholesterolaemia [total cholesterol (TC)] (38.91%) and low high-density lipoprotein (HDL) cholesterol (38.52%), in patients having median age 37 (32-42) yr and HIV duration 57 (33-101) months. Patients with at least one dyslipidaemia (78.99%) had significantly higher insulin resistance (IR), per cent body fat, per cent trunk fat (PTF) and trunk limb fat ratio (TLFR). Baseline CD4 count and delta CD4 count (change in CD4 count 6-12 months following ART) had significant inverse correlation with triglycerides and TC. Patients with highest triglycerides and cholesterol quartiles had significantly higher immune reconstitution, metabolic syndrome, IR, trunk fat mass (FM), PTF and TLFR, with comparable total FM. Logistic regression revealed that body mass index, HIV duration and PTF were independent predictors of hypertriglyceridaemia, with only PTF being significant predictor of hypercholesterolaemia. Every unit increase in PTF was associated with 13 and 4.1 per cent increased hypertriglyceridaemia and hypercholesterolaemia. Lipoatrophy was present in 8.57 per cent patients and was a poor predictor of dyslipidaemia. Interpretation & conclusions: High occurrence of dyslipidaemia was observed in patients with HIV on anti retroviral therapy. Central adiposity (TFM) was the most important predictor of dyslipidaemia in these patients.

Updates in the management of Dyslipidaemia in the high and very high risk individual for CV risk reduction

mortality and an important cause of morbidity in Malaysiafor several years. To reduce global cardiovascular (CV) riskin the population, primary preventive strategies need to beimplemented. Hypercholesterolaemia is one of the majorrisk factors for CVD. This paper is an expert review on themanagement of hypercholesterolemia focusing on high andvery high risk individuals. In low and Intermediate riskindividuals, therapeutic lifestyle changes (TLC) and ahealthy lifestyle alone may suffice. In high and very high riskindividuals, drug therapy in conjunction with TLC arenecessary to achieve the target LDL-C levels which havebeen shown to slow down progression and sometimes evenresult in regression of atherosclerotic plaques. Statins arefirst-line drugs because they have been shown in numerousrandomized controlled trials to be effective in reducing CVevents and to be safe. In some high risk individuals, despitemaximally tolerated statin therapy, target Low DensityLipoprotein Cholesterol (LDL-C) levels are not achieved.These include those with familial hypercholesterolaemia andstatin intolerance. This paper discusses non-statintherapies, such as ezetimibe and the newer Proproteinconvertase subtilisin/kexin type 9 Inhibitors (PCSK9-i).

Hipercolesterolemia familiar heterocigota en manejo con anti-PCSK9 / Heterozygous familial hypercholesterolaemia being managed with anti-PCSK9

Resumen Introducción: la hipercolesterolemia familiar representa un factor de riesgo sustancial para padecer enfermedad coronaria prematura, arterial periférica y valvular. Se han descrito dos formas según su alteración genética y cigocidad, así como tres mutaciones genéticas asociadas. Pese a que el tratamiento con estatinas se considera la primera línea, algunos pacientes no alcanzan metas, de modo que se han utilizado los inhibidores del PCSK9 como nueva estrategia. Métodos y materiales: se expone el caso de una paciente de 42 años con hipercolesterolemia familiar heterocigota tratada con inhibidores del PCSK9. Se describen los criterios y estudiosgenéticos utilizados para realizar el diagnóstico, la cronología de tratamientos que recibió y los exámenes de laboratorio anteriores y posteriores al inicio del evolocumab. Adicionalmente se hace una revisión de tema acerca de la hipercolesterolemia familiar y su tratamiento con inhibidores del PCSK9. Conclusiones: la hipercolesterolemia familiar es una enfermedad que ocasiona graves consecuencias cardiovasculares. Los inhibidores del PCSK9 se han convertido en una alternativa prometedora para aquellos que no responden a las terapias convencionales. Se requieren estudios que corroboren o contradigan los beneficios y eventos adversos encontrados hasta el momento en que los pacientes se someten a estas nuevas terapias para así ofrecer un tratamiento ideal y oportuno.

Abstract Introduction: Familial hypercholesterolaemia is a substantial risk factor for suffering premature coronary, peripheral arterial, and valular disease. There are two forms described, depending on their genetics and zygosity, as well as three associated genetic mutations. Although treatment with statins is considered first line, some patients do not reach targets, as such that that PCSK9 inhibitors have been used as a new strategy. Materials and method: A case is presented of a 42 year-old patient with heterozygous familial hypercholesterolaemia treated with PCSK9 inhibitors. The criteria and genetic studies used to make a diagnosis are described, as well as the chronology of the treatments that have been received and the laboratory results before and after starting with evolocumab. A review has also been made of the subject of familial hypercholesterolaemia and its treatment with PCSK9 inhibitors. Conclusions: Familial hypercholesterolaemia is a diseases that may have serious cardiovascular consequences. PCSK9 inhibitors have become a promising alternative for those who do not respond to conventional therapies. Studies are required that can corroborate or contradict the benefits and adverse effects found up until now in patients subjected to these new therapies in order to offer an ideal and appropriate treatment.

Anti-hypercholesterolemic and anti-hyperglycaemic effects of conventional and supercritical extracts of black cumin (Nigella sativa)

Objective:To explore the hypoglycaemic and hypocholesterolemic potential of conventional and supercritical extracts of black cumin.Methods:Purposely,rat modelling was carried out for 2 months by designing three studies i.e.study Ⅰ (normal rats),study Ⅱ (hyperglycaemic rats) and study Ⅲ (hypercholesterolemic rots).Each study was further divided into three groups based on diet i.e.control,functional diet (contained extract of black cumin prepared by using conventional solvent) and nutraceutical diet (contained extract of black cumin prepared by supercritical fluid extraction system).Results:During whole trial,an abating trend was observed in the level of serum cholesterol with maximum reduction (12.8％) in nutraceutical group of study Ⅲ.Low density lipoprotein and triglyceride level was also lowered maximum in study Ⅲ as 17.1％ and 11.6％,respectively.Whereas,highest decline in glucose level was in nutraceutical group of study Ⅱ as 11.2％.Conclusions:Inclusion of black cumin extracts in diet significantly lowers the occurrence of hyperglycaemia and hypercholesterolaemia.Furthermore,hypoglycaemic and hypocholesterolemic potential of nutraceutical diet is more prominent as compared to functional diet.

Anti-hypercholesterolemic and anti-hyperglycaemic effects of conventional and supercritical extracts of black cumin (Nigella sativa)

Objective To explore the hypoglycaemic and hypocholesterolemic potential of conventional and supercritical extracts of black cumin. Methods Purposely, rat modelling was carried out for 2 months by designing three studies i.e. study I (normal rats), study II (hyperglycaemic rats) and study III (hypercholesterolemic rats). Each study was further divided into three groups based on diet i.e. control, functional diet (contained extract of black cumin prepared by using conventional solvent) and nutraceutical diet (contained extract of black cumin prepared by supercritical fluid extraction system). Results During whole trial, an abating trend was observed in the level of serum cholesterol with maximum reduction (12.8%) in nutraceutical group of study III. Low density lipoprotein and triglyceride level was also lowered maximum in study III as 17.1% and 11.6%, respectively. Whereas, highest decline in glucose level was in nutraceutical group of study II as 11.2%. Conclusions Inclusion of black cumin extracts in diet significantly lowers the occurrence of hyperglycaemia and hypercholesterolaemia. Furthermore, hypoglycaemic and hypocholesterolemic potential of nutraceutical diet is more prominent as compared to functional diet.

Prevalence of hypercholesterolaemia among adults aged over 30 years in a rural area of north Kerala, India: a cross-sectional study.

to reduce the burden of the disease, it is important to know the level of modifiable risk factors in the population. The aim of this study was to estimate the prevalence of hypercholesterolaemia and associated factors among the population aged over 30 years in a rural area in north Kerala, India. Methods: A cross-sectional study was carried out to find the prevalence of hypercholesterolaemia among 533 residents of Kulappuram village. The fasting blood glucose level, total serum cholesterol level, blood pressure and body mass index of the residents were also assessed. The significance of association of hypercholesterolaemia with age, sex, body mass index and blood pressure was tested using the chi-squared test. Logistic regression was carried out to estimate the adjusted odds ratios (OR). Results: The prevalence of hypercholesterolaemia was 63.8%. It was more prevalent in women (adjusted OR: 1.56; 95% confidence interval [CI]: 1.07–2.27), in those with body mass index in the range 23.0–24.9 kg/m2 (adjusted OR: 1.78; 95% CI: 1.04–3.02) and in those with blood pressure ≥140/90 mmHg (adjusted OR: 1.62; 95% CI: 1.1–2.38). Conclusion: The prevalence of hypercholesterolaemia is high in the study population.

Effects of adding tocotrienol-tocopherol mixed fraction and vitamin C supplementation on coronary risk biomarkers in patients with hypercholesterolaemia with moderate coronary risk.

This study was a prospective clinical trial to investigate the effects of adding combined tocotrienol-tocopherol mixed fraction (TTMF) and vitamin C (TTMF+C) supplementation on coronary biomarkers in non-statin and statin treated patients with hypercholesterolaemia (HC) with moderate coronary risk. A total of 35 patients were randomised at baseline into one of two groups, (G1) TTMF+C (320mg TTMF plus 500mg vitamin C) alone daily and (G2) TTMF+C (320mg TTMF plus 500mg vitamin C) plus atorvastatin 10 mg daily. The entire supplementation were taken for 12 months. Fasting serum samples were taken at baseline, 2weeks, 3months, 6months and 12months post-randomisation and analysed for inflammatory biomarkers; high sensitivity C- reactive protein (hsCRP) and interleukin-6 (IL6). Combination of TTMF and vitamin C supplementation leads to neutral effects on lipid profiles and inflammation; with no added benefit in statin-treated HC patients with moderate coronary risk. This neutral effects may be attributed to the tocopherol composition in TTMF which could possibly attenuate any potential beneficial effects of tocotrienols. Clinical studies using pure tocotrienols in the absence of tocopherols would further confirm this.

Traditional and Complementary Medicine (TCM) among Study Population with Cardiovascular Risk; use and Substitution for Conventional Medicine in Pahang, Malaysia

Introduction: Cardiovascular diseases are the main cause of morbidity and mortality in Malaysia. There is evidence of high traditional and complementary medicine (TCM) use among population with cardiovascular risk and there have been anecdotal reports about substitution of conventional medicines with TCM. We investigated the prevalence of TCM use, treatment preference and substitution of conventional medicines in study population with cardiovascular risk factors in Pahang, Malaysia. Methods: A cross-sectional survey was conducted using an interviewer-administered questionnaire in five districts of Pahang. A total of 1250 households were chosen through proportionate and systematic sampling. Respondents aged 18 years and above were selected. Results: The study population with cardiovascular risk factors who used TCM was higher than the general population (31.7% versus 25.9%). There were no clear preferences in using TCM by gender, age groups, educational level and income even though other bumiputeras showed a slight inclination towards TCM use. Among the study population with cardiovascular risk factors who consumed TCM, 20-30% of them were using TCM as a substitute for their conventional medications. Respondents from the younger age group (18-40 years) (57.1%), highest educational level (43.2%), other bumiputeras (38.4%) and highest income group (31.4%) preferred the combination of both conventional and traditional medicine. Conclusion: TCM use among population with cardiovascular risk factors is high. The high preference for combination therapy of TCM and conventional medications among young adults and the use of TCM to substitute conventional medications show that much research is needed to provide proven TCM therapies to avoid self-mismanagement of cardiovascular risk in Malaysia.

Homozygous Familial Hypercholesterolaemia with Valvular Aortic Stenosis and Significant Coronary Artery Disease: A Case Report.

Homozygous Familial Hypercholesterolaemia is a genetic disorder which usually presents with early cardiovascular disease ranging from premature ischaemic disease, including myocardial infarction to aortic root stenosis. A 21 year old Bangladeshi male presented with exertional chest pain and breathlessness. He was diagnosed as a case of Homozygous Familial Hypercholesterolaemia. His angina symptoms were due to underlying valvular aortic stenosis which is a rare presentation of Homozygous Familial Hypercholesterolaemia.

Relación entre ll metabolismo de los triglicérios y aterosclerosis en la hiperrcolesterolemia familarr / Relationsip betwween the triglycerides metabolism and athrosclerosis in familial hypercholesterolemia

La hipercolesterolemia familiar (HF) es un desorden genético, que afecta en la forma heterocigota a uno de cada 500 nacimientos. Está asociado a aterosclerosis, debido a la elevación de las concentraciones de Lipoproteínas de Baja Densidad (LDL), además se han reportado niveles elevados de triglicéridos, e hipertrigliciridemia postprandrial, como posible factor de riesgo independiente para aterosclerosis. En el presente artículo de revisión, se analizó la literatura disponible en la base de datos, al igual que artículos históricos, textos y referencias citadas en trabajos públicos, buscando analizar la relación entre el metabolismo de los triglicéridos en la hipercolesterolemia familiar y la aterosclerosis. La información obtenida se organizó teniendo en cuenta: metabolismo de triglicéridos, metabolismo de triglicéridos en la hipercolesterolemia familiar y aterosclerosis. Dentro de las conclusiones obtenidas se encontró que los niveles elevados de triglicéridos se asocian con un alto riesgo de enfermedad cardiaca coronaria prematura en pacientes con HF.

Familial hypercholesterolaemia (FH) is a genetic disorder, with the heterozygous form affecting one in 500 deliveries. FH is associated with atherosclerosis due to elevated LDL concentrations but also, triglyceride levels and postprandial hypertriglyceridemia have been reported as possible independent risk factors for atherosclerosis. In the present review article available literature in the data basesinformation from database PubMed as well as historical articles, texts and references cited in public published papers to date were analyzed, searching a possible relationship between triglyceride metabolism in FH and atherosclerosis. The information obtained was organizedPertinent information related with the objectives proposed in the present review was found and analyzed. It was then divided into three sections as follows: triglyceride metabolism, triglyceride metabolism in familiar hypercholesterolaemia, triglycerides in familiar hypercholesterolaemia and atherosclerosis. Among the conclusions iIt was found that can be concluded that high levels of triglycerides are associated to with high risk of early coronary heart disease in FH patients.

An update on the burden of cardiovascular disease risk factors in Jamaica: findings from the Jamaica Health and Lifestyle Survey 2007-2008 / Actualización acerca de la carga de los factores de riesgo de la enfermedad cardiovascular en Jamaica: hallazgos de la Encuesta sobre Salud y Estilo de Vida, Jamaica, 2007-2008

BACKGROUND: Previous studies have documented a high burden of cardiovascular disease (CVD) risk factors in Jamaica and suggest that mortality from CVD may be increasing. This paper provides an update on the burden of CVD risk factors in Jamaica using data from the most recent national health survey and evaluates the impact of obesity and physical activity on other CVD risk factors. METHODS: The Jamaica Health and Lifestyle Survey 2007-2008 (JHLS-2) recruited a nationally representative sample of 2848 Jamaicans, 15-74 years old between November 2007 and March 2008. An interviewer administered questionnaire was used to obtain data on demographic characteristics, medical history and health behaviour. Blood pressure and anthropometric measurements were made using standardized protocols and capillary blood samples were obtained to measure fasting glucose and total cholesterol. Prevalence estimates for the various CVD risk factors were obtained within and across sex and other demographic categories. Data were weighted for the complex survey design, non-response to questionnaire items or failure to complete some segments of the evaluation. RESULTS: Prevalence estimates for traditional CVD risk factors were: hypertension, 25%; diabetes, 8%; hypercholesterolaemia, 12%; obesity, 25%; smoking 15%. In addition, 35% of Jamaicans had prehypertension, 3% had impaired fasting glucose and 27% were overweight. A higher proportion of women had diabetes, obesity and hypercholesterolaemia while the prevalence of prehypertension and cigarette smoking was higher in men. Approximately 50% of persons with hypertension, 25% of persons with diabetes and 86% of persons with hypercholesterolaemia were unaware of their risk status. In multivariate analysis, obesity was associated with increased odds of hypertension, diabetes and hypercholesterolaemia while physical inactivity was associated with higher odds of diabetes. CONCLUSION: The burden of CVD risk factors in Jamaica remains very high and warrants interventions to reduce CVD risk.

ANTECEDENTES: Estudios previos han documentado la existencia de una alta carga de factores de riesgo de la enfermedad cardiovascular (ECV), y sugieren que la mortalidad a consecuencia de la ECV puede estar aumentando. Este trabajo ofrece una actualización sobre la carga que los factores de riesgo de la ECV representan para Jamaica, para lo cual recurre a los datos de la más recientes encuesta nacional de salud. El trabajo también evalúa el impacto de la obesidad y la actividad física sobre otros factores de riesgo de la ECV. MÉTODO: La encuesta sobre salud y estilo de vida en Jamaica, 2007-2008 (JHLS-2) reclutó una muestra nacionalmente representativa de 2848 jamaicanos, de 15-74 años de edad, entre noviembre 2007 y marzo 2008. Se uso un cuestionario aplicado por el entrevistador con el propósito de obtener datos acerca de las características demográficas, la historia médica y el comportamiento respecto a la salud. Se hicieron mediciones de la presión sanguínea así como mediciones antropométricas, usando protocolos estandarizados, y se obtuvieron muestras de sangre capilar para medir la glucosa en ayuno y el colesterol total. Se obtuvieron estimados de prevalencia para varios factores de riesgo de ECV dentro y fuera del género, así como otras categorías demográficas. Se sopesaron los datos para el diseño complejo de encuestas, la no respuesta a los ítems de los cuestionarios, o el dejar de responder algunos segmentos de la evaluación. RESULTADOS: Los estimados de la prevalencia para los factores de riesgo tradicionales de la ECV fueron: la hipertensión, 25%; la diabetes, 8%; la hipercolesterolemia, 12%; la obesidad, 25%; el hábito de fumar 15%. Además, el 35% de los jamaicanos padecen de prehipertensión, el 3% muestran glucosa alterada en ayuno, y el 27% tienen sobrepeso. Una proporción más alta de mujeres tenía diabetes, obesidad e hipercolesterolemia, mientras que la prevalencia de la prehipertensión y el hábito de fumar fue más alta entre los hombres. Aproximadamente el 50% de las personas con hipertensión, el 25% de las personas con diabetes, y el 86% de las personas con hipercolesterolemia, no tenían conciencia del estado de riesgo en que se hallaban. En el análisis multivariado, la obesidad estuvo asociada con un aumento de las probabilidades de hipertensión, diabetes e hipercolesterolemia, en tanto que la inactividad física se hallaba asociado con una probabilidad más alta de diabetes. CONCLUSIÓN: La carga de factores de riesgo de ECV en Jamaica sigue siendo muy alta y justifica las intervenciones para reducir el riesgo de ECV.

Hypolipidemic effects of aqueous extract of Acalypha capitata leaves in rats fed on high cholesterol diet

Objective:To evaluate the hypolipidemic effects of aqueous extract of Acalypha capitata (A. capitata) leaves in rats fed on high cholesterol diet. Methods:Cholesterol diet was administered to Wistar rats at a dose of 40 mg per 0.2 mL 3 times daily for 14 days while the control received distilled water. These animals were treated with extract of A. capitata at doses of 100 and 200 mg/kg. Lipid profiles were observed and compared. Results:Administration of A. capitata caused significant decrease in cholesterol, triglyceride and low density lipoprotein-cholesterol when compared with the control (P<0.05) which was dose dependent. Also, it was observed that high density lipoprotein-cholesterol was significantly increased when compared with the control. Conclusions:This observation suggests that the leaf extract of A. capitata could probably serve as a potential natural product for treatment of hyperlipidaemia.

A Preliminary Study on the Prevalence of Cardiovascular Disease Risk Factors in Selected Rural Communities in Samarahan and Kuching Division, Sarawak, Malaysia

Background: It is important to understand the prevalence of risk factors for cardiovascular disease, especially in a rural setting. Methods: A cross-sectional study was carried out in 238 rural households located in the Kuching and Samarahan divisions of Sarawak among individuals aged 16 years and above. Anthropometric measurements, blood levels of glucose and cholesterol, and blood pressure were collected. Results: Prevalence of blood pressure in the hypertensive range was 43.1%. The highest rates of blood pressure in the hypertensive range were found in individuals aged above 60 years (38.6%) and 50–59 years old (31.8%). Age was one factor found to be significantly associated with blood pressure in the hypertensive range (P < 0.001). Prevalence of obesity was 49.0%. The highest prevalence of obesity was found among those aged 40–49 years (41.9%) and 50–59 years (29.9%). Gender was significantly associated with obesity (P = 0.004). The prevalence of blood cholesterol at risk was 21.6%, and the highest rate was found in the 40–49 years age group (34.0%). Fifty percent of respondents were found to have hyperglycaemia, with the highest prevalence in the 50–59 years age group (37.5%). A significant association was found between obesity, blood pressure in the hypertensive range and blood glucose level. When compared with non-obese individuals, those who were obese were more likely to have blood pressure in the hypertensive range and hyperglycaemia. Conclusion: The risk of developing lifestyle-related diseases is no longer based on geographical or socio-economic factors.

Abnormal Microvascular Reactivity with Hypercholesterolaemia in Pregnancy

Background: Post-occlusive skin reactive hyperaemia (PORH) is a model used to assess microvascular reactivity. This study aims to compare PORH response among pregnant hypercholesterolaemic patients with age and gestational age-matched controls. Methods: This cross sectional study involved 17 hypercholesterolaemic, pregnant women and 20 pregnant controls entering their early third trimester. Laser Doppler fluximetry (LDF) was used to measure skin perfusion. The process of PORH was performed by occluding the upper arm with an occlusion cuff at 200 mmHg for 3 minutes. Skin perfusion was recorded before, during, and after occlusion release. Baseline perfusion, time to achieve peak perfusion (Tp), peak perfusion after occlusion release (PORHpeak), and maximum change in perfusion due to occlusion (PORHmax) were recorded. Results: Serum total cholesterol (TC) was significantly different (P < 0.001) between the 2 groups: 7.25 (SEM 0.18) mmol/L for hypercholesterolaemic women and 5.54 (SEM 0.15) mmol/L for the control group. There were no significant differences in their baseline, PORHpeak, and PORHmax. However, Tp in the hypercholesterolaemic group was significantly increased (P = 0.024) compared with the controls at 14.9 (SEM 0.6) seconds and 13.1 (SEM 0.5) seconds, respectively. Conclusion: Pregnant hypercholesterolaemic patients showed an abnormal microvascular reactivity response. Tp with ischemia was significantly increased compared with normocholesterolaemic controls.