ABSTRACT
Background Little is known about the achievement of low density lipoprotein cholesterol (LDL-C) targets in patients at cardiovascular risk receiving stable lipid-lowering therapy (LLT) in countries outside Western Europe. Methods This cross-sectional observational study was conducted in 452 centres (August 2015-August 2016) in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America. Patients ( n = 9049) treated for ≥3 months with any LLT and in whom an LDL-C measurement on stable LLT was available within the previous 12 months were included. Results The mean±SD age was 60.2 ± 11.7 years, 55.0% of patients were men and the mean ± SD LDL-C value on LLT was 2.6 ± 1.3 mmol/L (101.0 ± 49.2 mg/dL). At enrolment, 97.9% of patients were receiving a statin (25.3% on high intensity treatment). Only 32.1% of the very high risk patients versus 51.9% of the high risk and 55.7% of the moderate risk patients achieved their LDL-C goals. On multivariable analysis, factors independently associated with not achieving LDL-C goals were no (versus lower dose) statin therapy, a higher (versus lower) dose of statin, statin intolerance, overweight and obesity, female sex, neurocognitive disorders, level of cardiovascular risk, LDL-C value unknown at diagnosis, high blood pressure and current smoking. Diabetes was associated with a lower risk of not achieving LDL-C goals. Conclusions These observational data suggest that the achievement of LDL-C goals is suboptimal in selected countries outside Western Europe. Efforts are needed to improve the management of patients using combination therapy and/or more intensive LLTs.
Subject(s)
Anticholesteremic Agents/therapeutic use , Cardiovascular Diseases/prevention & control , Cholesterol, LDL/blood , Dyslipidemias/drug therapy , Adult , Aged , Anticholesteremic Agents/adverse effects , Biomarkers/blood , Cardiovascular Diseases/blood , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Comorbidity , Cross-Sectional Studies , Down-Regulation , Dyslipidemias/blood , Dyslipidemias/diagnosis , Dyslipidemias/epidemiology , Female , Guideline Adherence , Humans , Male , Middle Aged , Practice Guidelines as Topic , Practice Patterns, Physicians' , Risk Factors , Sex Factors , Smoking/adverse effects , Smoking/epidemiology , Time Factors , Treatment OutcomeABSTRACT
Os efeitos da infecçäo do Trypanosoma cruzi nos traçados eletrocardiográficos de camundongos forma estudados em quatro grupos de animais: 1. normal; 2. infectado com cepa patogênica de T. cruzi (TS, COB); 3. imunizados com três inoculaçöes intra-peritoneais de 10**6 epimastigotas de T. cruzi atenuadas (TCC) e 4. imunizados e infectados, que receberam seqüencialmente os tratamentos dos grupos 3 e 2. A infecçäo e proteçäo foram confirmadas por xenodiagnóstico e histopatologia. Alteraçöes isoladas tais como extrassistolia, bloqueio dse primeiro grau átrio-ventricular, aritmia e elevaçäo do ST foram observados tanto em camundongos normais como infectados. Entretanto, os traçados tomados de maneira repetida em camundongo durante um período de 293 dias revelaram conjunto de alteraçöes que foram vistas mais freqüentemente em animais infectados (14/22) que nos normais (4/27) (p=0.00048). Estas alteraçöes consistiram de taquicardia supra-ventricular, bradicardia sinusal e bloqueios de primeiro grau AV, persistentes, freqüentemente associadas a alteraçöes do "pacemaker". A inoculaçäo da cepa atenuada de T. cruzi (grupo 3) näo aumentou estas alteraçöes (2/27) mas preveniu de maneira significante o seu desenvolvimento após o desafio com a cepa patogênica (1/19 versus 14/22 camundongos, p = 0.000095). Portanto, a pré-imunizaçäo reduziu näo somente a parasitemia mas a conseqüência patogênica da infeccäo pelo T. cruzi. Esta evidência é relevante nos estudos de imunoprevençäo em doença de Chagas
