ABSTRACT
This study assessed the effect of 3 lipid-lowering therapies on the reduction of the carotid intima-media thickness (IMT) in high-risk coronary Mexican patients. The study was a randomized, comparative, and open clinical trial. Ninety high-risk coronary patients were allocated to 3 groups: pravastatin 40 mg, simvastatin 40 mg, and simvastatin 20 mg and ezetimibe 10 mg initially. If the therapeutic goals were not attained (<100 mg/dL of low-density lipoprotein cholesterol [LDL-C] for type C and <70 mg for type D), patients in group 1 received pravastatin 40 mg and ezetimibe 10 mg, group 2 received simvastatin 80 mg, and group 3 received simvastatin 40 mg and ezetimibe 10 mg. The primary endpoint was the change of IMT over the course of 1 year. The secondary endpoints were changes in LDL-C and in high sensitive C-reactive protein (CRPhs). The overall baseline IMTs generated by combining measurements in the internal carotid artery were 1.33+/-0.32 mm, 1.30+/-0.11 mm, and 1.23+/-0.28 mm for groups 1, 2, and 3, respectively. After 1 year, IMT values were 0.93+/-0.13 mm, 0.90+/-0.11 mm, and 0.92+/-0.01 mm for groups 1, 2, and 3, respectively. At the end of the study, LDL-C levels were 48+/-41, 45+/-37, and 48+/-31 in groups 1, 2, and 3, respectively. No significant differences were observed in CRP, high-density lipoprotein cholesterol, triglycerides, blood pressure, and body mass index, among the groups. This study is one of the first providing evidence that dual therapy has a beneficial effect on a surrogate marker of atherosclerosis.
Subject(s)
Anticholesteremic Agents/pharmacology , Azetidines/pharmacology , Carotid Artery, Internal/drug effects , Carotid Artery, Internal/pathology , Simvastatin/pharmacology , Tunica Intima/drug effects , Tunica Intima/pathology , Tunica Media/drug effects , Tunica Media/pathology , Adult , Aged , Anticholesteremic Agents/therapeutic use , Azetidines/therapeutic use , Blood Pressure/drug effects , Body Mass Index , C-Reactive Protein/metabolism , Cholesterol/blood , Coronary Disease/blood , Coronary Disease/diagnosis , Drug Combinations , Drug Therapy, Combination , Ezetimibe, Simvastatin Drug Combination , Female , Humans , Male , Middle Aged , Simvastatin/therapeutic use , Triglycerides/bloodABSTRACT
1. Metabolic syndrome (MS) is one of the greatest public health problems in Mexico, where more than 75% of adults in urban populations are overweight or obese. Metabolic syndrome has several comorbidities, which result in a high cardiometabolic risk. 2. Some of the vasopathogenic phenomena in MS are caused by nitroxidant stress, secondary to cardiometabolic dysfunction. 3. The action of metformin to diminish or control MS remains a matter of debate. 4. In the present study, 60 patients with at least three diagnostic criteria for MS were divided into two groups. Both groups received similar dietary counselling, but one group was given 850 mg metformin daily. 5. The variables assessed were body mass index, waist circumference, systolic and diastolic blood pressures (SBP and DBP, respectively), total cholesterol (TC), high- and low-density lipoprotein-cholesterol, triglycerides (TG), fasting glucose, nitroxidant metabolites (free carbonyls, malondialdehyde, dityrosines and advanced oxidative protein products (AOPP)), nitric oxide (NO), carotid vascular stiffness, carotid intima-media thickness (IMT) and C-reactive protein (CRP). 6. After 1 year follow up, both groups reported weight loss, as well as decreases in waist circumference, SBP and DBP. 7. Patients on metformin exhibited reductions in TC and IMT and there were marked changes in nitroxidation: levels of carbonyls, dityrosines and AOPP were reduced, whereas those of NO were increased, indicating better endothelial function. In addition, in patients given metformin, CRP levels decreased. 8. In conclusion, metformin has a considerable beneficial effect on nitroxidation, endothelial function and IMT in patients with MS.
Subject(s)
Metabolic Syndrome/drug therapy , Metformin/therapeutic use , Tunica Intima/pathology , Adult , Arginine/analogs & derivatives , Arginine/metabolism , Carotid Arteries/pathology , Female , Humans , Hypoglycemic Agents/therapeutic use , Male , Metabolic Syndrome/metabolism , Metabolic Syndrome/pathology , Middle Aged , Nitric Oxide/metabolism , Nitric Oxide Synthase Type III/antagonists & inhibitors , Nitric Oxide Synthase Type III/metabolism , Oxidative StressABSTRACT
In a retrospective study to determine rate of patients attaining therapeutic LDL-C goal values with lipid-lowering drugs, 20 specialists and general practitioners were selected who enrolled 120 patients whose lipids were measured after at least 12 weeks of treatment. They were grouped in three categories: group A (absolute risk of CHD in 10 years <10%); group B, with 10-20% risk, and group C, with >20% risk. Goal LDL-C values were <160 mg/dL for group A, <130 for group B, and <100 for group C. Mean age was 57 +/- 12 years, 59% were males, and 51% were in group C; 83% took statins, 12% fibrates alone, and 5%, combinations. Atorvastatin and simvastatin were the most used drugs, at medium doses (mean 12 and 27 mg/day). LDL-C was reduced 25%; overall, 22% of patient doses were adjusted. Therapeutic goals were attained in 29% with initial doses and 42% at the end of study. Goal values were better attained in groups with lower risk. No differences were noticed among distinct physician categories. Data show poor compliance with international guidelines and insufficient attainment of therapeutic goals.
Subject(s)
Anticholesteremic Agents/therapeutic use , Hyperlipidemias/drug therapy , Patient Compliance , Female , Humans , Male , Medicine , Mexico , Middle Aged , Retrospective Studies , SpecializationABSTRACT
En un estudio retrospectivo para determinar el porcentaje de pacientes que alcanzan las metas terapéuticas de C-LDL con hipolipemiantes, se seleccionaron 20 especialistas y médicos generales, quienes trabajaron con 120 pacientes y les midieron los lípidos después de por lo menos 12 semanas de tratamiento. Fueron agrupados en tres categorías: grupo A (riesgo absoluto de cardiopatía coronaria a 10 años <10%); grupo B, con riesgo entre 10 y 20%, y grupo C, con riesgo >20%. Los valores meta del C-LDL fueron: <160 mg/dl para el grupo A, <130 para el B y <100 para el C. La edad fue 57 ± 12 años, 59% fueron hombres y 51% del grupo C. De éstos 83% recibió estatinas, 12% fibratos solos y 5% combinaciones. Atorvastatina y Simvastatina fueron los fármacos más utilizados, a dosis promedio moderadas (12 y 27 mg/día). El C-LDL se redujo 25%. En 22% se ajustó la dosis. Alcanzó las metas de C-LDL con la primera dosis (29%) y al final del estudio (42%). Las metas se alcanzaron mejor en los grupos de menor riesgo. No hubo diferencias entre los distintos tipos de médicos. Los datos indican pobre apego a las recomendaciones internacionales e insuficiente alcance de las metas terapéuticas.
In a retrospective study to determine rate of patients attaining therapeutic LDL-C goal values with lipid-lowering drugs, 20 specialists and general practitioners were selected who enrolled 120 patients whose lipids were measured after at least 12 weeks of treatment. They were grouped in three categories: group A (absolute risk of CHD in 10 years <10%); group B, with 10-20% risk, and group C, with >20% risk. Goal LDL-C values were < 160 mg/dL for group A, < 130 for group B, and < 100 for group C Mean age was 57 ± 12 years, 59% were males, and 51% were in group C; 83% took statins, 12% fibrates alone, and 5%, combinations. Atorvastatin and simvastatin were the most used drugs, at medium doses (mean 12 and 27 mg/day). LDL-C was reduced 25%; overall, 22% of patient doses were adjusted. Therapeutic goals were attained in 29% with initial doses and 42% at the end of study. Goalvalues were better attained in groups with lower risk. No differences were noticed among distinct physician categories. Data show poor compliance with international guidelines and insufficient attainment of therapeutic goals.
Subject(s)
Female , Humans , Male , Middle Aged , Anticholesteremic Agents/therapeutic use , Hyperlipidemias/drug therapy , Patient Compliance , Medicine , Mexico , Retrospective Studies , SpecializationABSTRACT
El cateterismo cardiaco diagnóstico y terapéutico por la vía femoral obliga a lapsos de hospitalización mayores de 24 horas y en ocasiones se complica de eventos vasculares. Se informan los primeros 95 casos de cateterismo por vía radial percutánea en nuestro centro, con el propósito de comunicar la técnica empleada y de estimar los tiempos en que los procedimientos se efectuaron, las complicaciones y el tiempo de hospitalización. Se incluyeron 83 pacientes masculinos y 12 femeninos, con edad promedio de 54 ñ 12 años, 87 con cardiopatía isquémica. En 71 casos fueron procedimientos diagnósticos, 11 angiplastías coronarias percutáneas y 13 implantes electivo de stents intracoronarios. Al principio, la tasa de éxito fue del 63 por ciento, que aumentó a 97 por ciento después de tres meses. El tiempo de los procedimientos fue de 46' para los diagnósticos, 51' para las angioplastías y de 87' para los implantes. La hospitalización fue de 5, 31 y 39 horas, respectivamente. Tres pacientes perdieron permanentemente el pulso radial, sin tener isquemia distal. Hubo dolor en el 16 por ciento de los casos. No hubo otras complicaciones vasculares. Se concluye que la vía radial permite procedimientos diagnósticos y terapéuticos que requieren menor estancia hospitalaria, con pocas complicaciones vasculares.
