Manejo de la hipercolesterolemia desde dos ángulos diferentes / Hypercholesterolemia management from two different points of view

RESUMEN La cardiopatía isquémica y los accidentes cerebrovasculares son la primera causa de muerte en el mundo. La enfermedad cardiovascular de origen ateroesclerótico es un problema internacional de salud, que constituye una carga social, sanitaria y económica. Se realizó un análisis de las principales guías internacionales sobre dislipoproteinemias y su manejo, como las de la Sociedad Europea de Cardiología y las del Colegio Americano de Cardiología/Asociación Americana del Corazón. También, de los principales artículos publicados en los últimos cinco años sobre el manejo de la hipercolesterolemia, de los cuales se tomaron 20 publicaciones en Medline, Google Académico y SciELO. Las mencionadas guías reúnen las recomendaciones de sus respectivas organizaciones y las combinan con nuevas. Ambas mantienen el uso de scores de riesgo y discrepan sobre la imagenología en la determinación del tratamiento, al igual que en el uso de drogas no estatinas. Se plantea que la mejor intervención para prevenir la enfermedad cardiovascular es la promoción de un estilo de vida saludable (AU).

ABSTRACT Ischemic cardiomyopathy and cerebrovascular stroke are the first causes of death in the world. Cardiovascular disease of atherosclerotic origins is an international health problem that is also a social, sanitary and economic burden. The authors analyzed the main international guidelines on dyslipoproteinemia, like the ones from the European Society of Cardiology and the American College of Cardiology/American Heart Association. They also considered the main articles published in the last five years on the management of hypercholesterolemia and chose 20 of them available in Medline, Google Scholar and SciELO. The before-mentioned guidelines gather the recommendations of their own organizations, and combine them with new ones. They both keep using risk scores on and differ on medical imaging determining the treatment, and also in the use of non-statin drugs. It is stated that the better intervention to prevent cardiovascular disease is the promotion of a healthy lifestyle (AU).

Estimated costs of hospitalization due to coronary artery disease attributable to familial hypercholesterolemia in the Brazilian public health system

ABSTRACT Objective: Cardiovascular diseases are the leading cause of death in Brazil, imposing substantial economic burden on the health care system. Familial hypercholesterolemia (FH) is known to greatly increase the risk of premature coronary artery disease (CAD). This study aimed to estimate the economic impact of hospitalizations due to CAD attributable to FH in the Brazilian Unified Health Care System (SUS). Subjects and methods: Retrospective, cross-sectional study of data obtained from the Hospital Information System of the SUS (SIHSUS). We selected all adults (≥ 20 years of age) hospitalized from 2012­-2014 with primary diagnoses related to CAD (ICD-10 I20 to I25). Attributable risk methodology estimated the contribution of FH in the outcomes of interest, using international data for prevalence (0.4% and 0.73%) and relative risk for events (RR = 8.56). Results: Assuming an international prevalence of FH of 0.4% and 0.73%, of the 245,981 CAD admissions/year in Brazil, approximately 7,249 and 12,915, respectively, would be attributable to an underlying diagnosis ­­of FH. The total cost due to CAD per year, considering both sexes and all adults, was R$ 985,919,064, of which R$ 29,053,500 and R$ 51,764,175, respectively, were estimated to be attributable to FH. The average cost per FH-related CAD event was R$ 4,008. Conclusion: Based on estimated costs of hospitalization for CAD, we estimated that 2.9-5.3% are directed to FH patients. FH can require early specific therapies to lower risk in families. It is mandatory to determine the prevalence of FH and institute appropriate treatment to minimize the clinical and economic impact of this disease in Brazil.

Exposição aos níveis de colesterol ao longo da vida e doença coronariana / Lifetime exposure to cholesterol evels and coronarysrtery disease disease

A doença aterosclerótica compreende amplo espectro de entidades clínicas com envolvimento genético e ambiental. A exposição ao longo da vida a níveis elevados de colesterol e de sua fração LDL determinam um limiar a partir do qual a doença aterosclerótica se desenvolve. Assim, nas formas genéticas de dislipidemias, como a hipercolesterolemia familiar, a idade do aparecimento da doença aterosclerótica vai depender da carga cumulativa de exposição aos níveis de LDL-colesterol, sendo tanto mais precoce quanto maiores os níveis de LDL-colesterol e a presença de fatores de risco adicionais, e mais tardia na ausência destes, e no sexo feminino. A prevenção ao longo da vida parece ser extremamente efetiva, e a avaliação individual com a implementação de medidas preventivas precoces e terapêuticas deve ser estimulada. Assim, parece lógico que reduções de colesterol, por mudanças no estilo de vida ou pelo uso de fármacos na adolescência e ao longo da vida apresentem inestimável benefício para a redução dos desfechos cardiovasculares na vida adulta

The atherosclerotic process comprises a broad spectrum of clinical entities, with genetic and environmental involvement. Lifetime exposure to high levels of cholesterol and LDL-cholesterol determine a trigger that can lead to the development of atherosclerotic disease. Therefore, in genetic forms of dyslipidemia, such as familial hypercholesterolemia, the age of onset of atherosclerotic disease will depend on the cumulative burden of exposure to LDL-cholesterol levels, being earlier with higher levels of LDL-cholesterol, the presence of other risk factors and later, in the absence of risk factors, and in females. Prevention throughout life appears to be extremely effective, and individual assessment, with the implementation of early preventive measures, should be encouraged. Thus, it seems logical that cholesterol reductions, changes in lifestyle, or the use of specific medications in adolescence and throughout life present inestimable benefit in reducing cardiovascular outcomes in adulthood

Guatteria gaumeri, Malmea depressa o Yumel, una revisión sobre su historia, sus propiedades y su uso en la homeopatía / Guatteria gaumeri, Malmea depressa or yumel, a review of its history, its properties and its use in homeopathy

El elemuy, Guatteria gaumeri o Malmea depressa es un árbol que habita en México y Centroamérica, y que debido a las propiedades medicinales de su corteza y su raíz ha sido aprovechado desde la época prehispánica para atender afecciones renales, diabetes mellitus tipo II e hipercolesterolemia, entre otras enfermedades. A principios del siglo XX llamó la atención del médico homeópata mexicano Manuel A. Lizama, quien probó su uso durante una década y registró sus observaciones en el Prontuario de materia médica, publicado en 1913. Desde entonces se han realizado diversas investigaciones dentro y fuera del ámbito homeopático que han confirmado y precisado cuál es la acción medicamentosa de la alfa-asarona y otros componentes del elemuy, pero también han sugerido nuevos atributos que sería conveniente comprobar o descartar a través de estudios científicos. El presente texto hace un recorrido por algunos de los artículos representativos que se han generado sobre la Guatteria gaumeri o Malmea depressa, con la finali ad de que médicos, estudiantes e investigadores actualicen o mejoren sus conocimientos...

The Elemuy, Guatteria gaumeri or Malmea depressa is a tree that grows in Mexico and Central America, and because of the medicinal properties of his bark and roots, it has been used since pre-hispanic times to treat kidney disease, type II diabetes mellitus and hypercholesterolemia, among other diseases. In the early twentieth century it drew the attention of Dr. Manuel A. López a Mexican homeopath, who proved it´s use for a decade and recorded his observations at the Prontuario de Materia Medica, published in 1913. Since then there have been performed several research works into, and out of the homeopathic field that have confirmed and specified the pharmacological action of the alpha-asarone among other components of the Elemuy, but also, new pharmacological properties have been suggested that it would be important to test through scientific works. This text takes us through some representative articles that have been generated on the Guatteria gaumeri or Malmea depressa, in order that doctors, students and researchers update or improve their knowledge about this theme...

Hypocholesterolemic effects of Kluyveromyces marxianus M3 isolated from Tibetan mushrooms on diet-induced hypercholesterolemia in rat

To investigate the effects of Kluyveromyces marxianus M3 isolated from Tibetan mushrooms on diet-induced hypercholesterolemia in rats, female Wistar rats were fed a high-cholesterol diet (HCD) for 28 d to generate hyperlipidemic models. Hyperlipidemic rats were assigned to four groups, which were individually treated with three different dosages of K. marxianus M3+HCD or physiological saline+HCD via oral gavage for 28 d. The total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels in the serum and liver of the rats were measured using commercially available enzyme kits. In addition, the liver morphology was also examined using hematoxylin and eosin staining and optical microscopy. According to our results, the serum and liver TC, TG, LDL-C levels and atherogenic index (AI) were significantly decreased in rats orally administered K. marxianus M3 (p <0.01), and the HDL-C levels and anti atherogenic index (AAI) were significantly increased (p <0.01) compared to the control group. Moreover, K. marxianus M3 treatment also reduced the build-up of lipid droplets in the liver and exhibited normal hepatocytes, suggesting a protective effect of K. marxianus M3 in hyperlipidemic rats.

Treatment of Hypercholesterolaemia in Patients with Diabetes Mellitus

Numerous studies have shown that statins reduce cardiovascular events; including stroke and mortality in diabetics. The American Diabetes Association 2013 guidelines recommend that diabetics at high risk for cardiovascular events should have their serum low-density lipoprotein (LDL) cholesterol reduced to 70 mg/dl (1.8 mmol/l) with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to 100 mg/dl (2.6 mmol/l). The 2013 American College of Cardiology/American Heart Association lipid guidelines recommend giving high-dose statins to adult diabetics aged ? 75 years with atherosclerotic vascular disease (ASCVD) unless contraindicated with a class I indication and moderate-dose or high-dose statins to diabetics with ASCVD ? 75 years with a class IIa indication. Diabetics ? 21 years with a serum LDL cholesterol of ? 190 mg/dl (4.9 mmol/l) should be treated with high-dose statins with a class I indication. For primary prevention in diabetics aged 40 to 75 years and serum LDL cholesterol between 70 and 189 mg/dl (1.8 and 4.9 mmol/l); moderate-dose statins should be given with a class I indication. For primary prevention in diabetics aged 40 to 75 years; a serum LDL cholesterol between 70 and189 mg/dl (1.8 and 4.9 mmol/l); and a 10-year risk of ASCVD of ? 7.5 calculated from the Pooled Heart Equation; high-dose statins should be given with a class IIa indication. For primary prevention in diabetics aged 21 to 39 years or older than 75 years and a serum LDL cholesterol between 70 and 189 mg/dl (1.8 and 4.9 mmol/l); moderate-dose statins or high-dose statins should be given with a class IIa indication. There is no additional ASCVD reduction from adding non-statin therapy to further lower non-high-density lipoprotein (HDL) cholesterol once an LDL cholesterol goal has been reached. Clinical trials have found no lowering of cardiovascular events or mortality in diabetics treated with statins with the addition of nicotinic acid; fibric acid derivatives; ezetemibe; or drugs that raise serum HDL cholesterol

Respuestas metabólicas inducidas por ejercicio físico de alta intensidad en mujeres sedentarias con glicemia basal alterada e hipercolesterolemia / Metabolic response to high intensity exercise training in sedentary hyperglycemic and hypercholesterolemic women

Background: High intensity training could be an effective way of improving health on individuals at high metabolic risk. Aim: To investigate the effects of a high intensity training intervention on metabolic-related markers in sedentary women at high metabolic risk. Material and Methods: Forty six sedentary women with a body mass index (BMI) over 25 kg/m² were assigned to four groups, according to their metabolic profile; hyperglycemia (H, n = 12), hyperglycemia/hypercholesterolemia (HH, n = 13), normoglycemia (N, n = 10) and normoglycemia/hypercholesterolemia (NH, n = 11). For 12 weeks and five days per week, subjects performed seven intervals of high intensity training (20 to 30 seconds) during a training session of 20 minutes. Anthropometric (body weight, body mass index (BMI), waist circumference) and metabolic variables (glucose, total cholesterol, LDL, HDL and TG) were measured at baseline, at 6 and 12 weeks of intervention. Results: BMI and waist circumference decreased significantly after 12 weeks of intervention. Similarly, glucose decreased significantly after 12 weeks of intervention in all groups. The reduction was of higher magnitude in those groups with hyperglycemia (H = -16%, HH = -22%, N = -7,5%, NH = -9,6%). However, lipid profile (TG, total cholesterol, LDL and HDL) improved significantly only in the hypercholesterolemic groups. Conclusions: Physical activity programs incorporating high intensity training can improve glucose and lipid profile in women with metabolic disorders. Moreover, this benefit is greatest in those individuals with highest metabolic burden.

Raised serum cholesterol; evaluation of hypocholesterolemic effect of green tea [Camillia sinensis]

Hypercholestrolemia has a strong association with Atherosclerosis and coronary artery disease [CAD]. It is a major worldwide health problem and the incidence is rising in Pakistan. Hypocholesterolemic effect of green tea [GT] has been proven in various research studies in the world. Present study aims to evaluate this effect in Pakistani population in the context of specific dietary and social habits prevailing here. The university of Lahore. Sixty subjects were included in the study comprising of thirty healthy subjects and thirty hypercholesterolemic individuals who were not taking any medication to control their serum cholesterol. They were all given GT in a dose of 3 gm twice daily for sixty days. Serum cholesterol levels were estimated at day 1 and then every 2nd week till the 60th day. Significant lowering of serum cholesterol was observed [p<0.001] in hypercholesterolemic individuals after 60 days. There were no side effects reported of GT intake. Our results suggest that GT can safely reduce the raised serum cholesterol level in Pakistani population

Efecto del bypass gástrico a largo plazo (7 a 10 años) en pacientes con obesidad severa y mórbida sobre el peso corporal, diabetes, dislipidemia y desarrollo de anemia / Results of gastric bypass for morbid obesity after a follow up of seven to 10 years

weight and complications of obesity, seven to 10 years after gastric bypass surgery. Material and Methods: One hundred eighteen subjects with morbid obesity, aged 15 to 66years (103 women), were followed for a mean of 94 months after surgery. Body weight, fasting blood glucose, total cholesterol, triglycerides and hemoglobin were measured before surgery and during follow up. Results: At 24 months of follow up, all patients lost weight and there was a mild weight increase at 94 months, that paralleled the preo-perative body mass index. Diabetes, hypercholesterolemia and hypertriglyceridemia subsided in 95, 87 and 94% of cases, respectively. Twenty percent of patients had mild anemia and 11% moderate or severe anemia. No patient recovered the preoperative weight. Conclusions: Weight reducing effects of gastric bypass are maintained after 94 months of follow up with the expected health benefits.

Hipercolesterolemias graves en pediatría: Presentación de dos casos / Severe hypercholesterolemia in children: Presentation of two cases and update of the literature

La hipercolesterolemia familiar es uno de los trastornos genéticos más comunes y aporta información sustancial sobre papel etiológico que el colesterol LDL tiene para el desarrollo de la ateroesclerosis. Se presentan dos pacientes con hipercolesterolemia grave. Se remarca la importancia del diagnóstico y tratamiento temprano para evitar o demorar la enfermedad ateromatosa y la enfermedad coronaria precoz.

Familial hypercholesterolemia is one of the most common genetic disorders and it provides the best evidence on the etiologic role of LDL-colesterol for arteroesclerosis development. Two patients with severe hypercholesterolemia had been presented. Importance of early diagnosis and treatment has been stated to avoid or delay atherosclerosis and coronary heart disease.

Dislipidemias / Dyslipidemia

O conhecimento da abordagem diagnóstica e terapêutica das dislipidemias é de fundamental importância não apenas para o cardiologista, visto que as dislipidemias são achados frequentes em sua forma isolada ou associada a outros distúrbios metabólicos (tireoideanos, hepáticos, renais ou associados ao diabetes mellitus), em consequência do emprego de medicamentos como diuréticos, beta-bloqueadores, imunossupressores, antirretrovirais, corticosteroides e, ainda, nas formas genéticas.As dislipidemias podem ter sua expressão fenotípica na infância ou, mais tardiamente, desencadeadas pelo estilo de vida inapropriado, especialmente sedentarismo, dieta inadequada, resistência à insulina e outros fatores relacionados ao estilo de vida. Podem ou não apresentar sinais clínicos característicos e associar-se a complicações como doença aterosclerótica ou pancreatite. A abordagem desses pacientes deve visar mudanças do estilo de vida e o emprego de tratamento medicamentoso, por tempo prolongado, em geral ao longo da vida. As indicações para o uso de fármacos hipolipemiantes e as metas a serem atingidas estão bem definidas por diretrizes.O uso de hipolipemiantes requer o conhecimento de suas características farmacodinâmicas e farmacocinéticas, perfil de segurança e eventos adversos, interações com outros fármacos e presença de comorbidades.A clara associação entre os fatores de risco e a aterosclerose norteou a elaboração de algoritmos para a estratificação do risco cardiovascular, os ensaios clínicos randomizados forneceram a base de evidências para a utilização dos hipolipemiantes na prevenção primária e secundária da doença cardiovascular e em muitas outras situações clínicas, de acordo com as estimativas de risco.

Evaluation the effect of dill [Anethum graveolens L .] and coriander [sativum L.] on lipid profile, liver and kidney functions in hypercholesterolaemic rats

Cardiovascular disease is the most important adult health problem in the world. Epidemiological studies and laboratory experiments have shown that fruit and vegetable consumption has protective effects against cardiovascular disease. So that, the aim of this study is to investigate, the hypocholesterolaemic effects of Dill [Anethum graveolens L.] and Coriander [Coriandrum sativum L.] in two levels 5 and 10% for 6 weeks in hypercholesterolemic rats and their effects on liver and kidney functions. Thirty six rats were divided into six groups, [each of 6 rats] as follow, first group [control negative] fed on basal diet only, second group [control positive] fed on hypercholesterolemic diet [basal diet, 1% cholesterol, 0.25% bile salt and 15% beef tallow], third groups fed on hypercholesterolemic diet supplemented with 5% coriander, fourth groups fed on hypercholesterolemic diet supplemented with 10% coriander, fifth group fed on hypercholesterolemic diet supplemented with 5% dill, and the sixth group fed on hypercholesterolemic diet supplemented with 10% dill. At the end of the experimental period [6 weeks] blood was collected then lipid profile and liver and kidney functions were determined in the serum. The results indicated that, consumption of dill or coriander with 5% or 10% significantly [P<0.05] decreased the mean value of serum total cholesterol, triglycerides, LDL-C and VLDL-C and significantly increased serum HDL-C as compared to control positive group. Also both dill and coriander significantly [P<0.05] improved liver and kidney functions. It was observed that no significant differences between the two tested levels and also between dill or coriander, It is concluded that dill and coriander have a significant lipid lowering effects and are promising hypocholesterolemic agents. Further scientific efforts are certainly required to establish the exact mechanism of action using the purified active components of them

Hypocholesterolemic effects of bitter and sweet lupin seeds in male rats

This study was designed to test bitter and sweet lupin seeds as lipid-lowering and their antioxidative activities on hypercholesterolemic rats. The levels of plasma lipid, malondialdehyde [MDA] and whole blood reduced glutathione [GSH], as well as the activities of transaminases [ALT and AST], lactate dehydrogenase [LDH] in plasma, superoxide dismutase [SOD], glutathione peroxidase [GPx] in erythrocytes and plasma glutathione reductase [OR], glutathione-S-transferase [OST] and catalase [CAT] were examined. The hypercholesterolemia-induced diet was manifested in the elevation of total lipids [TL], total cholesterol [TC], triglycerides [TO], LDL-C and MDA levels, ALT, AST, LDH activities and depletion of OSH and enzymic antioxidants. Supplementation of hypercholesterolemia-indUced diet with bitter and sweet lupin seeds significantly lowered the plasma levels of TL, TC, TG and LDL-C. ALT, AST and LDH activities slightly decreased in treated groups compared with hypercholesterolemic group [HC]. Furthermore, the content of GSH significantly increased while MDA significantly decreased in treated groups compared with HC group. In addition, bitter lupin seeds group improved enzymic antioxidants compared with HC group. In general, the results indicated that, the bitter lupin seeds supplements are better than sweet lupin seeds. These results suggested that the hypocholesterolemic effect of bitter and sweet lupin seeds supplements might be due to their abilities to lower plasma cholesterol level as well as to slow down the lipid peroxidation process and to enhance the antioxidant enzyme activity

Therapeutic evaluation of the concurrent administration of nigella sativa and vitamin E in treatment of rats suffering from induced diabetes and hypercholesterolemia

The present study is conducted to investigate the effect of Nigella sativa and vitamin E in treatment of rats suffering from alloxan-induced diabetes and hypercholesterolemia. The experiment was carried out on 42 male Albino rats weighing [115 +/- 5 gm]. The rats were divided into 6 equal groups; each of 7 rats; as follows: 1st group fed on basal diet and kept as a control negative group. Rats in the other five groups fed two weeks on basal diet containing cholesterol [1.5%] and bile salts [0.25%] to induce hypercholesterolemia also rats in the five groups were all injected subcutaneously with 150 mg/kg body weight of alloxan after fasting overnight to induce hyperglycemic diabetes, then those rats were subdivided into a group that remained as induced diabetic and hypercholesterolemic 'control positive' [2nd group], a group that fed on basal diet + Nigella sativa 2% [NS2%] [3rd group]; a group that fed on basal diet + Nigella sativa 5% [NS5%] [4th group]; a group that fed on basal diet + Nigella sativa 2% + 150mg vitamin E [NS2%+Vit. E150 mg] [5th group], and a group that fed on basal diet + dietary supplemented with Nigella sativa 5%+ Vitamin E 300mg [NS5%+Vit. E300 mg] [6th group]. The results showed that, glucose, total cholesterol and triglycerides decreased significantly when rats fed on basal diet containing high doses of Nigella sativa [5%] with vitamin E compared to low doses [2%] without vitamin E. Also, the mean values of serum HDL-c of all treated rats with different dosages were increased significantly, as compared to [control +] group. The mean values of uric acid was decreased gradually with increased the amount of Nigella sativa, and the best treated group which decreased urea nitrogen was nigella sativa 5% when compared with [control +] or the other treated groups, while Nigella sativa 5% with vitamin E considered the best treated group to decrease serum creatinine. Also., data showed that serum AST level were decreased in all treated groups that fed on Nigella sativa 2% or 5% with vitamin E compared with the [control +]. The study recommended the fortification of diets and bakery products and other suitable food which offered to diabetic patients with Nigella sativa 5% + vitamin E 300 mg in order to decline the symptoms of diabetes and protect against its related complications. Also, from the obtained results it can be concluded that, Nigella sativa 5% supplementation gave the best results in modification of lipid profile in hypercholesterolemic rats

Effect of pomegranate fruit juice and seed oil on serum lipid levels and atherosclerosis development in hypercholesterolemic rabbits

Pomegranate [Punica granatum L.] is a drought tolerant fruit-bearing deciduous shrub native to Iran. It is widely cultivated in dry areas of Iran. Pomegranate fruit juice contains a wide range of polyphenolic metabolites, especially punicalagins with powerful antioxidative properties. Pomegranate seed oil is a unique natural product and a rich source of conjugated fatty acids. The aim of this study was to investigate the pharmacological effects of fruit juice and seed oil of pomegranate on serum lipid levels of hypercholesterolemic rabbits and development of atherosclerosis on their aortas. Fourthly two males and six months aged white New Zealand rabbits [1.7 -2 kg] were randomly assigned to six equal groups and caged in the same environmental condition. One group was fed on regular animal house rabbit chew. Five other groups fed with high cholesterol diet [1% cholesterol]. One group kept as control and other 4 groups fed on same diet supplemented with 1% and 2% doses of pomegranate fruit juice or seed oil. The whole experiment lasted 2 months. At the end of the study [after 2 months] the biochemical analysis of serum lipids and pathological evaluation of atherosclerotic plaque of aortas were performed. Results of biochemical analyses showed that administration of fruit juice and seed oil at both doses did not significantly affect the level of serum lipids profile of hypercholesterolemic rabbits. Pathological data analysis showed that treatments of rabbits with fruit juice and seed oil at both doses significantly reduced aortic atherosclerotic plaque formation. Pomegranate fruit juice and seed oil administration inhibited atherosclerosis development in hypercholesterolemic rabbit's aortas without any significant effects on lipid profile

[ effect of hydroalcoholic extracts of Hypericum perforatum and Amaranthus caudatus on rabbits with hypercholesterolemia]

Atherosclerosis is one of the most common causes of death throughout the world. In this study, anti-atherosclerotic effect of combination extracts of Hypericum and Amaranth on hypercholesterolemic rabbits was compared with that of lovastatin. Twenty adult male Newzeland rabbits were randomly divided into four groups of five and were fed for 60 days as follows: basic diet, high cholesterol, high cholesterol along with combination Hypericum and Amaranth [HA] extract [75 mg/kg] and high cholesterol along with lovastatin [10 mg/kg]. Blood samples were taken at the beginning, one month later and at the end of the study in order to measure their serum factors. Data were analyzed using ANOVA and Danken tests. The extract and lovastatin decreased the levels malondialdehyde [MDA] and apolipoprotein B [apoB], apoB/apoA and increased the levels apolipoprotein A [apoA] in rabbits compared to high cholesterol group [P<0.05]. The extract by decreasing cardiovascular risk factors especially apoB that is one of the most important risk factors of cardiovascular diseases, prevent progression of atherosclerosis. The extract is more effective in decreasing the level of cardiovascular risk factors than Lovastatin in hypercholesterolemic rabbits

Manejo de las dislipidemias en niños y adolescentes: [revisión] / Management of dyslipidemias in children and adolescents: [review]

Evidencia reciente confirma que la enfermedad cardiovascular se inicia en la infancia, y la dislipidemia es uno de los principales factores de riesgo asociados. La detección precoz de la hipercolesterolemia en niños con factores de riesgo, previene la morbimortalidad cardiovascular en el adulto. Se propone un esquema de detección y manejo de la dislipidemia, basado en la experiencia de grupos de expertos, así como medidas dietéticas y terapéuticas a seguir. Se debe hacer hincapié en cambios de estilo de vida a largo plazo, recomendando hábitos alimentarios saludables y ejercicio ya que la obesidad es la causa mas frecuente de dislipidemia en el niño. Existen varias alternativas farmacológicas, y en su uso y selección se debe evaluar el riesgo en forma individual, tomando en cuenta la edad, los niveles séricos de lípidos, la magnitud y el número de eventos cardiovasculares en familiares y los posibles efectos secundarios. Actualmente las estatinas están tomando un papel importante en el tratamiento de la hipercolesterolemia familiar en niños sin embargo se requieren más estudios a fin de establecer su seguridad en este grupo de edad. En vista que la hipercolesterolemia es un factor de riesgo modificable y determinante en la enfermedad cardiovascular, todas las intervenciones que se puedan hacer en la niñez, ofrecen una oportunidad de prevención.

Recent evidence corroborate that cardiovascular disease begins in childhood and that hyperlipidemia is one of the main associated risk factors. Early screening of hypercholesterolemia in high risk children should be performed in order to prevent cardiovascular morbidity and mortality in adulthood. An approach for detection and management of hypercholesterolemia is proposed with dietary and therapeutic strategies based on the experience of expert groups. Since obesity is the most common cause of hyperlipidemia in children, special emphasis should be made in long lasting lifestyle changes. Treatment always must include dietary modifications and exercise. Several pharmacologic alternatives are available, and when deciding its use, the child's risk must be individually analyzed, considering age, type and degree of dyslipidemia, and possible adverse effects. Since hypercholesterolemia is a modifiable and determinant risk in cardiovascular disease, all interventions done in childhood offer the opportunity of cardiovascular disease prevention in adulthood.

Equivalencia terapéutica entre atorvastatina amorfa (Atovarol) y atorvastatina cristalina tipo I (Lipitor) en el tratamiento de pacientes con hipercolesterolemia / Therapeutic equivalence of amorphous atorvastatin (atovarol) and type I crystalline atorvastatin (lipitor) in the treatment of hypercholesterolemic patients

Determinar la equivalencia terapéutica y la seguridad de la atorvastatina amorfa y la atorvastatina cristalina, utilizadas en la fabricación de Atovarol® y Lipitor ®, a la dosis de 10 mg/día en pacientes con hipercolesterolemia. Estudio clínico multicéntrico, prospectivo, comparativo, simple-ciego, distribuido al azar, de grupos paralelos. A los pacientes que cumplieron los criterios de inclusión les fue administrada atorvastatina amorfa (Atovarol®) o atorvastatina cristalina (Lipitor®) durante un mes. Se realizó una evaluación de laboratorio previa y otra al mes de tratamiento. Se incluyeron 43 pacientes, de los cuales uno fue retirado del estudio por efectos adversos. Los 42 pacientes que completaron el tratamiento con atorvastatina (20 pacientes en el grupo atorvastatina amorfa y 22 pacientes en el grupo atorvastatina cristalina) durante un período de 4 semanas presentaron reducciones estadísticamente significativas en los valores séricos de colesterol total, colesterol LDL y triglicéridos comparados con los valores basales en cada grupo de tratamiento. No se observaron diferencias estadísticamente significativas entre los dos grupos de tratamiento, ni previo ni posterior al tratamiento. Atorvastatina amorfa fue terapéuticamente equivalente a atorvastatina cristalina en la disminución de los valores de colesterol total, colesterol LDL y triglicéridos. El porcentaje de reducción de estos valores está dentro de los rangos reportado por otros estudios clínicos realizados con atorvastatina.

To determine the therapeutic equivalence and the safety of amoãphous and crystalline atorvastatin, used in the manufacture of Atovarol® and Lipitor®, at a dose of 10 mg/day in patients with hypercholesterolemia. Multicenter, prospective, comparative, somple-blind, randomized, parallel group clínical study. Amorphous atorvastatin (Atovarol®) or crystalline atorvastatin (Lipitor®) were administered for one month to patients that met the inclusion criteria. Laboratory evaluations were performed previously and one month after treatment. 43 patients were included, of which one was withdrawn from the study due to adverse effects. The 42 patients that completed atorvastatin treatment for a period of 4 weeks (20 patients in the amorphous atorvastatin and 22 patients in the crystalline atorvastatin group), presented statistically significant reductions in serum values of total cholesterol, cholesterol-LDL and triglycerides, as compared with pretreatment values in each group. Statistically significant differences were not observed between the groups, either before or after treatment. Amorphous atorvastatin is therapeutically equivalent to crystalline atorvastatin in the reduction of total cholesterol, cholesteron-LDL and triglyceride values. The percentage of reduction of these values is withim the range reported by other atorvastatin clinical studies.

Antioxidant properties of Spirulina (Arthospira) platensis cultivated under different temperatures and nitrogen regimes

The main aim of this work was to investigate the effects of temperature and nitrogen concentration on the antioxidant potential of extracts from Spirulina (Arthospira) platensis biomass. S. platensis biomass obtained at 35°C and with 1.875 g.L-1 or 2.5 g.L-1 of sodium nitrate in the culture medium presented higher concentrations of phenolic compounds. The antioxidant potential of methanol extracts of biomass on the enzymatic browning caused by peroxidase were 29 and 35 percent, respectively, being the reduction related to the amount of phenolic compounds present in this extract.

A cianobactéria Spirulina tem sido comercializada e estudada devido as suas propriedades nutricionais e terapêuticas no tratamento de doenças como o câncer, a hipercolesterolemia e a aterosclerose. Determinados compostos presentes na Spirulina, como os compostos fenólicos, a ficocianina e o tocoferol, podem apresentar atividade antioxidante. O principal objetivo deste trabalho foi avaliar o efeito da temperatura de cultivo e da concentração de nitrogênio no meio de cultivo, sobre o potencial antioxidante da microalga Spirulina (Arthospira) platensis. Quando a microalga foi cultivada a 35°C e concentrações de nitrato de sódio de 1,875 g.L-1 ou 2,5 g.L-1, o potencial antioxidante dos extratos obtidos a partir da biomassa, sobre o escurecimento enzimático causado pela peroxidase, foi de 29 por cento e 35 por cento, respectivamente, sendo a redução no escurecimento relacionada com as quantidades de compostos fenólicos presentes nos extratos.