ABSTRACT
Las estatinas son la base actual del tratamiento hipolipemiante, pese a lo cual pueden tener limitaciones de eficacia y de seguridad. En pacientes de alto riesgo que no alcanzan objetivos terapéuticos, en los que no toleran las estatinas o en los que tienen dislipidemia aterógena podemos combinar 2 o más fármacos de distintas clases terapéuticas, incluyendo, además de las estatinas, ezetimiba, secuestradores de ácidos biliares, fibratos, niacina o ácidos grasos omega 3 de prescripción. No disponemos aún, sin embargo, de evidencias en cuanto a la disminución de episodios cardiovasculares con estas combinaciones (AU)
Statins are the current basis of lipid-lowering therapy, despite which may have limitations on efficacy and safety. In high risk patients who do not achieve current lipid goals, in those intolerant to statins or those with atherogenic dyslipidemia, it is possible combine two or more lipid lowering drugs, including statins, ezetimibe, bile acid sequestrants, fibrates, niacin and prescription omega-3 fatty acids. However, for most of these combination therapies pivotal data on clinical outcomes are still lacking
Subject(s)
Humans , Hypercholesterolemia/drug therapy , Combined Modality Therapy/methods , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Anticholesteremic Agents/therapeutic use , Fibrin/therapeutic use , Fatty Acids, Omega-3/therapeutic useABSTRACT
Statins are the current basis of lipid-lowering therapy, despite which may have limitations on efficacy and safety. In high risk patients who do not achieve current lipid goals, in those intolerant to statins or those with atherogenic dyslipidemia, it is possible combine two or more lipid lowering drugs, including statins, ezetimibe, bile acid sequestrants, fibrates, niacin and prescription omega-3 fatty acids. However, for most of these combination therapies pivotal data on clinical outcomes are still lacking.
Subject(s)
Dyslipidemias/drug therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypolipidemic Agents/therapeutic use , Drug Therapy, Combination , Dyslipidemias/physiopathology , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hypolipidemic Agents/administration & dosage , Hypolipidemic Agents/adverse effectsABSTRACT
Increased levels of oxidative stress have been demonstrated in Preeclampsia in previous studies, but this finding has not been established in other hypertensive disorders in pregnancy (HDP). We measured different markers of lipid peroxidation and antioxidant defenses by spectrophotometry or enzymoimmunoanalysis in 339 pregnant women: 85 with gestational hypertension (GH), 88 chronic hypertension (CH), 104 Preeclampsia and 62 healthy pregnant control women (PCW). Lower activity of superoxide dismutase and higher levels of catalase were found in GH, CH and preeclampsia compared with PCW (964.4±116.5, 970.0±120.4, 971.2±137.5 and 1063.4±133.7 U g(-1) Hb, P<0.001; and 313.0±71.7, 292.2±45.3, 297.1±47.2, 215.5±26.2 U mg(-1) Hb, P<0.0001; respectively). Regarding the glutathione REDOX cycle, we found the following in GH, CH and preeclampsia compared with PCW: a decrease in its reduced form (2.6±0.6, 2.7±0.8, 2.7±0.9, 3.3±1.3 µmol l(-1), P<0.003), a parallel increase in the oxidized form (185.6±68.9, 194.7±75.0, 184.3±78.3, 85.1±27.5 µmol l(-1), P<0.0001) and an increment in glutathione peroxidase (85.9±22.0, 86.4±20.9, 82.1±23.5 and 77.2±19.7 U g(-1) Hb, P<0.04) and glutathione reductase (6384.3±1261.9, 6724.6±1154.1, 6287.9±1399.9 and 6044.4±1208.4 mU g(-1) Hb, P<0.01, respectively). Nitrites/nitrates were higher in patients with preeclampsia than in PCW (31.50±15.08, 26.80±8.39 µmol l(-1), P<0.002). Although malondialdehyde and oxidized-LDL levels were similar among groups, free fatty acids were increased in every HDP (GH 514.6±194.6, CH 501.3±197.4, preeclampsia 555.2±230.1 µmol l(-1)) compared with PCW (351.4±146.1 µmol l(-1)), P<0.0001. Our results show an oxidation/reduction imbalance with an increase in oxidative stress coupled with a decreased capacity of antioxidant systems, not only in preeclampsia but also in every HDP.
Subject(s)
Catalase/blood , Glutathione Peroxidase/blood , Hypertension, Pregnancy-Induced/blood , Hypertension/blood , Pre-Eclampsia/blood , Pregnancy Complications, Cardiovascular/blood , Superoxide Dismutase/blood , Adult , Biomarkers/blood , Case-Control Studies , Chronic Disease , Female , Glutathione Reductase/blood , Humans , Lipoproteins, LDL/blood , Malondialdehyde/blood , PregnancyABSTRACT
BACKGROUND: Glucose effectiveness (SG) is a parameter that indicates the glucose ability to clearing itself from the plasma independently of insulin's action. Our purpose was to analyze the cluster characteristics associated with the metabolic syndrome in a group of non-obese, recent-onset hypertensives and to test if there was a correlation with SG and the effectiveness of glucose at basal insulin point (GEZI). PATIENTS AND METHOD: We studied 36 patients with mild hypertension with normal basal glucose levels. We determined plasma lipid subfractions, apolipoproteins and urate levels. An intravenous glucose tolerance test (TTGI) and minimal model analysis according to Bergman was performed and SG, GEZI and insulin sensitivity (SI) were calculated. RESULTS: Patients with lower SG and GEZI had higher levels of total triglycerides (Tg) (r = 0.42; p = 0.01 and r = 0.48; p = 0.002, respectively) and triglycerides bind to VLDL (Tg-VLDL) (r = 0.40; p < 0.01 and r = 0.49; p = 0.002, respectively). When the cluster of metabolic syndrome was analyzed, SG was inversely related to uric acid levels and to the waist-hip index. However, SI was only related to the uric acid levels (r = 0.38; p = 0.01). CONCLUSIONS: In non-obese, recently diagnosed hypertensive patients, the SG parameter seems to be an early marker for the development of metabolic syndrome.
