[LDL-cholesterol goals and changes in C reactive protein in high coronary risk patients]. / Objetivos terapéuticos del colesterol LDL y cambios de la proteína C reactiva en pacientes de alto riesgo coronario.

INTRODUCTION: We performed this study to compare the achievement of lipid targets as well as the change on C reactive protein (CRP) values of two different strategies, the combination of ezetimibe plus statins compared to the doubling of the previous statin dose. METHODS: Retrospective longitudinal study of 111 dyslipidemic patients, treated with statins, whose cholesterol values were still elevated. In 59 patients the previous statin dose was doubled, in 52 patients ezetimibe was added to the statin. Differences on lipid parameters and CRP were measured. RESULTS: Patients treated with the association of ezetimibe plus statins obtained a higher reduction of LDL-cholesterol levels (38% vs. 18.1%, p<0.001), compared with those doubling the statin dose. A reduction on CRP values was observed only in patients on combined therapy (22.5%; p<0.005), CRP change was not related to lipids variation. More patients with high coronary risk treated with ezetimibe plus statin, reached lipid goals (LDL<100 mg/dl) compared to those whose statin dose was doubled (47% vs 19%; p<0.001) and the same happened on very high coronary risk patients (LDL<70 mg/dl) (43% vs 2%; p<0,001). More patients in the group ezetimibe plus statin achieved the combined target lipid control and CRP<3 mg/l (19% vs. 3%, p=0.002). DISCUSSION: Combination treatment of ezetimibe with statins on high coronary risk patients showed a better achievement of LDL-cholesterol goals with a reduction of CRP values.

Objetivos terapéuticos del colesterol LDL y cambios de la proteína C reactiva en pacientes de alto riesgo coronario / LDL-cholesterol goals and changes in C reactive protein in high coronary risk

Fundamentos y objetivo: Valorar los efectos de la asociación de ezetimiba y estatina (terapia combinada), respecto a duplicar la dosis de estatina, a la hora de alcanzar los objetivos terapéuticos de colesterol ligado a las lipoproteínas de baja densidad (c-LDL) y en la variación de la proteína C reactiva (PCR). Pacientes y métodos: Estudio longitudinal retrospectivo de pacientes con dislipemia en tratamiento con estatina y control lipídico insuficiente. Se incluyeron 111 pacientes; a 59 se les duplicó la dosis de estatina previa y a 52 se les añadió ezetimiba a la estatina (terapia combinada). Se calcularon las diferencias en lípidos y la proteína C reactiva. Resultados: La terapia combinada produjo una mayor reducción en los niveles de c-LDL que duplicar la dosis de estatina (38% frente a 18,1%, p < 0,001). También se observó una reducción de los valores de PCR, solo en los pacientes que recibieron terapia combinada (22,5%; p < 0,005). La variación de la PCR no guardó ninguna correlación con la variación de valores lipídicos. Los pacientes con alto riesgo coronario que recibieron terapia combinada consiguieron el objetivo terapéutico de c-LDL (< 100 mg/dl) en mayor proporción (48% frente a 19%, p < 0,001), al igual que los de muy alto riesgo coronario (objetivo c-LDL< 70 mg/dl, 43% frente a 2%, p < 0,001). Una mayor proporción de pacientes en terapia combinada alcanzó el objetivo combinado de control lipídico y valores de proteína C reactiva < 3 mg/l (19% frente a 3%, p = 0,002). Conclusiones: La adición de ezetimiba a una estatina puede mejorar el manejo de los pacientes de alto y muy alto riesgo coronario que no alcanzan los objetivos terapéuticos de c-LDL con estatinas disminuyendo, además, los valores de PCR (AU)

Introduction: We performed this study to compare the achievement of lipid targets as well as the change on C reactive protein (CRP) values of two different strategies, the combination of ezetimibe plus statins compared to the doubling of the previous statin dose. Methods: Retrospective longitudinal study of 111 dislipidemic patients, treated with statins, whose cholesterol values were still elevated. In 59 patients the previous statin dose was doubled, in 52 patients ezetimibe was added to the statin. Differences on lipid parameters and CRP were measured. Results: Patients treated with the association of ezetimibe plus statins obtained a higher reduction of LDL-cholesterol levels (38% vs. 18.1%, p < 0.001), compared with those doubling the statin dose. A reduction on CRP values was observed only in patients on combined therapy (22.5%; p < 0.005), CRP change was not related to lipids variation. More patients with high coronary risk treated with ezetimibe plus statin, reached lipid goals (LDL < 100 mg/dl) compared to those whose statin dose was doubled (47% vs 19%; p < 0.001) and the same happened on very high coronary risk patients (LDL < 70 mg/dl) (43% vs 2%; p < 0,001). More patients in the group ezetimibe plus statin achieved the combined target lipid control and CRP < 3 mg/l (19% vs. 3%, p = 0.002). Discussion: Combination treatment of ezetimibe with statins on high coronary risk patients showed a better achievement of LDL-cholesterol goals with a reduction of CRP values (AU)

Eficacia de una estrategia basada en ARA-II en el tratamiento de pacientes hipertensos con síndrome metabólico / Efficacy of an ARBs based strategy in the treatment of hypertensive patients with metabolic syndrome

Objetivo. Valorar el cumplimiento de objetivos terapéuticos con un tratamiento basado en antagonistas de los receptores de angiotensina II (ARA-II) en pacientes hipertensos con síndrome metabólicoPacientes y métodos. Estudio longitudinal observacional retrospectivo de cohortes de pacientes hipertensos, no diabéticos, con síndrome metabólico (51 mujeres y 83 varones) de 53,1 (13,3) años y con índice de masa corporal de 30,8 (4,7) (kg/m2) que nunca habían recibido tratamiento farmacológico. Se compararon los que habían recibido tratamiento con una estrategia a base de ARA-II respecto a los que fueron tratados con otros grupos farmacológicos (calcioantagonistas y/o betabloqueantes) como controles. El diagnóstico de síndrome metabólico se estableció a partir de los criterios del NCEP-ATP III. Se consideraron objetivos del tratamiento hipolipemian-te los del ATP-III, según su grupo de riesgo, y de presión arterial < 140/90 mmHg.Resultados. Un total de 77 pacientes fueron tratados conARA-II y 57 con otras combinaciones. Tanto los pacientes del grupo control como los del grupo ARA-II tuvieron una clara disminución de la presión arterial sistólica, 18,4 (19,5) frente a 18,9 (20,0) mmHg (p=0,86) y de la presión arterial diastólica 9,2 (12) frente a 10,1 (12,0) mmHg (p=0,46), sin que se encontraran diferencias significativas en el descenso de la presión arterial en ambos grupos. No hubo diferencias significativasentre ambos grupos en las variaciones de los parámetroslipídicos ni en los valores de proteína C reactiva. Tampoco se encontraron diferencias significativas entre ambos grupos en la variación de los valores de glucemia, ni insulina, ni del índice de HOMA, ni en la consecución de los objetivos terapéuticos metabólicos, ni de presión arterial. Al finalizar el estudio los pacientes asignados al grupo ARA-II recibían menos fármacos antihipertensivos que el grupo control: 1,81(0,54) frente a 2,02 (0,42) (p=0,001).Conclusión. En pacientes hipertensos con síndrome metabólico una estrategia terapéutica con el uso de ARA-II consigue un control de la presión arterial similar a una estrategia con betabloqueantes o calcioantagonistas, pero con el uso de menor número de fármacos antihiperten-sivos

Objective. The aim of this study was to evaluate achievements of therapeutic goals with an angiotensin receptor blockers (ARBs) based therapy in hypertensive subjects with metabolic syndrome.Patients and methods. A longitudinal, observational and retrospective follow-up study was conduced in 134 non-diabetic, non-previously treated hypertensive patients with metabolic syndrome (51 women and 83 men) of 53.1 (13.3) years and bpdy measurement index of 30.8 (4.5) (kg/m2) who have never received drug treatment. These patients who had received treatment with a strategy based on ARBs-II were compared to patients treated with other drug groups (calcium antagonists and/or beta blockers) who were used as controls. Metabolic syndrome was established according to NCEP-ATP-III criteria. Goals of the lipid lower treatment were considered to be those of the ATP-III, according to the risk group and blood pressure (<140/90 mmHg).Results. A total of 77 patients were treated with ARB-II and 55 with other combinations. Reduction of blood pressure was similar in both groups 18.4 (19.5) vs. 18.9 (20.0) mmHg (p =0.86) for systolic blood pressure and 9.2 (12) vs. 10.1 (12.0) mmHg (p=0.46) for diastolic blood pressure. No significant differences in blood pressure decrease were observed in both groups. There were also no significant differences between both groups in the variation of lipid parameters or in the CRPvalues. In addition, no significant differences were found between groups in the variation of glucose values, insulin and HOMA index, nor in the achievement of the metabolic treatment or blood pressure goals. At the end of follow-up patients treated with ARBs strategy required fewer antihypertensive drugs 1.81 (0.54) vs. 2.02 (0.42) (p = 0.001) than patients treatedwith the other strategy.Conclusion. In hypertensive patients with metabolic syndrome an ARB based strategy achieves the same therapeutic blood pressure and lipid and metabolic goals, but requires fewer antihypertensive drugs