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2.
Eur J Prev Cardiol ; 22(7): 849-54, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24776375

RESUMO

Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL) cholesterol and causes premature coronary heart disease. There are at least 20 million people with FH worldwide, but the majority remains undetected and current treatment is often suboptimal.To address this major gap in coronary prevention we present, from an international perspective, consensus-based guidance on the care of FH. The guidance was generated from seminars and workshops held at an international symposium. The recommendations focus on the detection, diagnosis, assessment and management of FH in adults and children, and set guidelines for clinical purposes. They also refer to best practice for cascade screening and risk notifying and testing families for FH, including use of genetic testing. Guidance on treatment is based on risk stratification, management of non-cholesterol risk factors and safe and effective use of LDL lowering therapies. Recommendations are given on lipoprotein apheresis. The use of emerging therapies for FH is also foreshadowed.This international guidance acknowledges evidence gaps, but aims to make the best use of contemporary practice and technology to achieve the best outcomes for the care of FH. It should accordingly be employed to inform clinical judgment and be adjusted for country-specific and local healthcare needs and resources.


Assuntos
Anticolesterolemiantes/uso terapêutico , Remoção de Componentes Sanguíneos/normas , LDL-Colesterol/sangue , Hiperlipoproteinemia Tipo II/terapia , Padrões de Prática Médica/normas , Adolescente , Adulto , Fatores Etários , Anticolesterolemiantes/efeitos adversos , Anticolesterolemiantes/normas , Biomarcadores/sangue , Remoção de Componentes Sanguíneos/efeitos adversos , Criança , Consenso , Comportamento Cooperativo , Aconselhamento Genético/normas , Predisposição Genética para Doença , Testes Genéticos/normas , Hereditariedade , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/genética , Cooperação Internacional , Linhagem , Fenótipo , Valor Preditivo dos Testes
3.
Can J Diet Pract Res ; 73(1): 31-4, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22397963

RESUMO

Health Canada's recent approval of plant sterols as food ingredients to decrease low-density lipoprotein cholesterol (LDL-C) is believed to be a significant step toward improving Canadians' cardiovascular health and reducing the economic burden of heart disease. When dyslipidemic patients consume plant sterols at a recommended daily dose of 2 g, they can reduce LDL-C by 10% to 15%, with no deleterious effects on high-density lipoprotein cholesterol. A 10% LDL-C reduction in response to plant sterol consumption is projected to reduce heart disease risk by 25%. Because they are available without a prescription, plant sterols are an option for dietitians who wish to provide cholesterol-lowering guidance beyond traditional dietary advice (i.e., lowering saturated fat intake and restricting dietary cholesterol). In addition, plant sterols can be used in combination with a statin or when statin use is contraindicated, and they have recently emerged as a potentially valuable triglyceride-lowering option. However, the projected improvement in public health and health care savings will be realized only if impediments to daily use are removed. One such impediment is the higher cost of fortified food products, such as yogurt and margarine. If the cost of plant sterol food products is to decline, cost-effective sources must be investigated and a larger range of foods containing plant sterols must be made available.


Assuntos
Anticolesterolemiantes/uso terapêutico , Qualidade de Produtos para o Consumidor , Suplementos Nutricionais , Prática Clínica Baseada em Evidências , Promoção da Saúde , Fitosteróis/uso terapêutico , Anticolesterolemiantes/efeitos adversos , Anticolesterolemiantes/normas , Canadá , Suplementos Nutricionais/efeitos adversos , Suplementos Nutricionais/normas , Dietética , Alimentos Fortificados/efeitos adversos , Alimentos Fortificados/análise , Alimentos Fortificados/normas , Humanos , Legislação sobre Alimentos , Programas Nacionais de Saúde , Fitosteróis/efeitos adversos , Fitosteróis/normas
4.
Vasc Health Risk Manag ; 6: 1023-37, 2010 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-21127699

RESUMO

High-dose potent statin therapy in combination with ezetimibe is now standard practice for the treatment of adult patients with heterozygous familial hypercholesterolemia (heFH), as the result of numerous studies in patients with primary hypercholesterolemia or heFH. These studies have shown the combination to be both effective and safe in the short to medium term. Recently, short-term ezetimibe therapy has also been shown to be effective and safe in combination with statin therapy for children and adolescents with heFH. Effective statin-ezetimibe combination therapy is capable of achieving near-normal lipid profiles in heFH patients, with expected improvement in risk for cardiovascular disease (CVD) and improved life expectancy resulting predominantly from reduction in levels of low-density lipoprotein cholesterol. There are few data to support a pleiotropic action of ezetimibe with regard to CVD benefit, unlike therapy with statins. No serious and unexpected clinical adverse effects of combination statin-ezetimibe therapy have emerged till date, although data are limited in children and adolescents, for whom longer-term studies are required. Recent data suggesting possible proatherogenic effects of ezetimibe require confirmation. One large long-term randomized controlled clinical outcomes trial is in progress in non-FH patients to determine the efficacy and safety of ezetimibe therapy; it is unlikely that such a trial will ever be performed in patients with FH.


Assuntos
Anticolesterolemiantes/uso terapêutico , Azetidinas/uso terapêutico , LDL-Colesterol/efeitos dos fármacos , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Animais , Anticolesterolemiantes/farmacologia , Anticolesterolemiantes/normas , Azetidinas/farmacologia , Azetidinas/normas , LDL-Colesterol/sangue , Modelos Animais de Doenças , Quimioterapia Combinada , Dislipidemias/tratamento farmacológico , Dislipidemias/etiologia , Ezetimiba , Infecções por HIV/complicações , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Int J Cardiol ; 104(3): 251-6, 2005 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-16186052

RESUMO

BACKGROUND: Lowering low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of coronary heart disease. The introduction of a highly efficacious new statin, rosuvastatin, may enable more patients to be treated to LDL-C goal within a fixed budget. OBJECTIVES: To compare the cost-effectiveness of rosuvastatin 10 mg and atorvastatin 10 mg in lowering LDL-C and achieving guideline goals after 12 weeks of treatment. The LDL-C goals were those recommended by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and the Third Joint European Task Force. METHODS: The analysis was performed on pooled data from three clinical trials. Efficacy was measured as the percent reduction in LDL-C and the proportion of patients who reached guideline LDL-C goals following the first 12 weeks of treatment, prior to dose titration. Costs comprised drug acquisition costs only. The cost-effectiveness measures were cost per 1% reduction in LDL-C and cost per patient treated to their LDL-C goal. RESULTS: Treatment with rosuvastatin 10 mg costs 1.85 per 1% reduction in LDL-C, compared with 2.37 per 1% reduction with atorvastatin 10 mg. The average costs per patient treated to the European LDL-C goals were 130.18 for rosuvastatin 10 mg and 242.44 for atorvastatin 10 mg. Treating to NCEP ATP III goals costs 115 per patient treated with rosuvastatin 10 mg vs. 163 per patient treated with atorvastatin 10 mg. CONCLUSIONS: Rosuvastatin has the same acquisition costs as and is more efficacious than atorvastatin in lowering LDL-C and treating patients to target LDL-C levels.


Assuntos
LDL-Colesterol/sangue , Fluorbenzenos/economia , Ácidos Heptanoicos/economia , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Hipercolesterolemia/tratamento farmacológico , Pirimidinas/economia , Pirróis/economia , Sulfonamidas/economia , Adolescente , Adulto , Idoso , Anticolesterolemiantes/economia , Anticolesterolemiantes/normas , Anticolesterolemiantes/uso terapêutico , Atorvastatina , Análise Custo-Benefício , Método Duplo-Cego , Europa (Continente) , Feminino , Fluorbenzenos/normas , Fluorbenzenos/uso terapêutico , Ácidos Heptanoicos/normas , Ácidos Heptanoicos/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/normas , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/sangue , Masculino , Pessoa de Meia-Idade , América do Norte , Pirimidinas/normas , Pirimidinas/uso terapêutico , Pirróis/normas , Pirróis/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Rosuvastatina Cálcica , Sulfonamidas/normas , Sulfonamidas/uso terapêutico , Resultado do Tratamento , Triglicerídeos/sangue
6.
Circ J ; 68(2): 107-13, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14745143

RESUMO

BACKGROUND: Data from Western comparative trials suggest that rosuvastatin is more effective than atorvastatin, simvastatin, and pravastatin in helping hypercholesterolemic patients achieve US and European lipid-lowering guidelines. The purpose of this analysis was to assess the comparative efficacy of rosuvastatin in reducing low-density lipoprotein cholesterol (LDL-C) to levels recommended by the Japan Atherosclerosis Society (JAS). METHODS AND RESULTS: A post hoc analysis of data from 6 randomized, double-blind, active-controlled trials was conducted to evaluate the relative efficacy of rosuvastatin and comparator statins in helping patients achieve the LDL-C goals established by the JAS. The first 5 trials, prospectively designed for pooling, were originally conducted to compare the effects of rosuvastatin with either atorvastatin, simvastatin, or pravastatin in reducing lipid levels and helping patients achieve the LDL-C goals established by the National Cholesterol Education Program. The 6th trial was conducted with similar objectives, but in patients with heterozygous familial hypercholesterolemia (HeFH). Data from 2,139 hypercholesterolemic patients in the first 5 trials were pooled for analysis: rosuvastatin 5 mg (n=390) or 10 mg (n=389) vs atorvastatin 10 mg (n=393); rosuvastatin 5 mg (n=240) or 10 mg (n=226) vs simvastatin 20 mg (n=249) or pravastatin 20 mg (n=252). In the studies with atorvastatin as the comparator, JAS-defined LDL-C goals were reached by 67.2% of the rosuvastatin 5-mg group, 82.3% of the rosuvastatin 10-mg group, and 58.0% of the atorvastatin 10-mg group (p<0.001 for both rosuvastatin groups vs atorvastatin) at 12 weeks. Similarly, in the trials with pravastatin and simvastatin as comparators, the JAS LDL-C goals were reached by 77.5% of the rosuvastatin 5-mg group, 86.7% of the rosuvastatin 10-mg group, 45.2% of the pravastatin 20-mg group and 65.5% of the simvastatin 20-mg group (p<0.001 for both rosuvastatin groups vs pravastatin and simvastatin). In the trial of HeFH patients (n=433 for rosuvastatin, n=187 for atorvastatin), 31.9% of patients treated with rosuvastatin 20 mg achieved JAS LDL-C goals, compared with 17.6% of patients treated with atorvastatin 20 mg (p<0.001). CONCLUSIONS: Rosuvastatin has demonstrated clinical superiority over atorvastatin, pravastatin, and simvastatin in reducing LDL-C levels and in enabling patients to reach goals established by the JAS.


Assuntos
Anticolesterolemiantes/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Idoso , Anticolesterolemiantes/efeitos adversos , Anticolesterolemiantes/normas , Atorvastatina , LDL-Colesterol/sangue , LDL-Colesterol/efeitos dos fármacos , Avaliação de Medicamentos , Europa (Continente) , Feminino , Fluorbenzenos/efeitos adversos , Fluorbenzenos/normas , Fluorbenzenos/uso terapêutico , Ácidos Heptanoicos/efeitos adversos , Ácidos Heptanoicos/normas , Ácidos Heptanoicos/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/normas , Hipercolesterolemia/epidemiologia , Japão , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Pravastatina/efeitos adversos , Pravastatina/normas , Pravastatina/uso terapêutico , Pirimidinas/efeitos adversos , Pirimidinas/normas , Pirimidinas/uso terapêutico , Pirróis/efeitos adversos , Pirróis/normas , Pirróis/uso terapêutico , Grupos Raciais , Ensaios Clínicos Controlados Aleatórios como Assunto , Rosuvastatina Cálcica , Sinvastatina/efeitos adversos , Sinvastatina/normas , Sinvastatina/uso terapêutico , Sulfonamidas/efeitos adversos , Sulfonamidas/normas , Sulfonamidas/uso terapêutico , Resultado do Tratamento , Estados Unidos
11.
Acta Diabetol ; 34(4): 294-300, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9451475

RESUMO

Patients with diabetes mellitus (DM), type 1 and type 2, have an increased risk of coronary heart disease as a result of accelerated atherosclerosis. Dyslipidemia, often found in these patients, plays an important role in this process. This study investigates the efficacy and safety of lipid-lowering therapy with pravastatin, a 3-HMG-Coenzym A reductase inhibitor in hypercholesterolemic type-1 and type-2 diabetic patients. Of 49 patients (22 type-1 DM and 27 type-2 DM), 24 patients were treated with pravastatin, 20 mg/day, and 25 patients with placebo. After 24 weeks, total cholesterol (TC) was decreased by 22.2%, low-density lipoprotein (LDL) cholesterol by 25.8% and triglycerides (TG) by 13.6%. Pravastatin treatment did not induce a significant change in high-density (HDL) cholesterol levels. No differences in effects of pravastatin treatment on serum lipids and lipoproteins were found with respect to the diabetes type. No serious side effects occurred and pravastatin treatment did not cause any deterioration in glycemia control. The data suggest that pravastatin is effective and safe in the treatment of dyslipidemia in both type-1 and type-2 diabetic patients.


Assuntos
Anticolesterolemiantes/uso terapêutico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Hipercolesterolemia/tratamento farmacológico , Lipídeos/sangue , Pravastatina/uso terapêutico , Adulto , Idoso , Anticolesterolemiantes/efeitos adversos , Anticolesterolemiantes/normas , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Hipercolesterolemia/complicações , Metabolismo dos Lipídeos , Lipídeos/classificação , Masculino , Pessoa de Meia-Idade , Pravastatina/efeitos adversos , Pravastatina/normas , Fatores de Tempo
12.
J Am Diet Assoc ; 95(11): 1263-7, 1995 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-7594121

RESUMO

ADA congratulates NCEP on 10 years of important contributions to reducing cardiovascular disease. Dietitians have played a major role in implementing dietary recommendations of the cholesterol education campaign through its members, programs, research projects, and publications. The partnership is strong and dynamic. Together, there is much to accomplish in the years ahead to further reduce the risk of cardiovascular disease and improve the nutritional status of all Americans.


Assuntos
Colesterol/sangue , Dietética/educação , Educação em Saúde/tendências , Anticolesterolemiantes/normas , Anticolesterolemiantes/uso terapêutico , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Análise Custo-Benefício , Dietética/organização & administração , Educação em Saúde/economia , Promoção da Saúde , Linhas Diretas , Humanos , Hipercolesterolemia/dietoterapia , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/epidemiologia , National Institutes of Health (U.S.) , Avaliação Nutricional , Inquéritos Nutricionais , Saúde Pública/economia , Saúde Pública/educação , Saúde Pública/tendências , Sociedades , Estados Unidos/epidemiologia
13.
Indian J Med Res ; 102: 241-4, 1995 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8675245

RESUMO

India is the second largest producer of rice in the world and has the high potential to produce rice bran oil (RBO), a by-product of the rice milling industry. Since RBO is, an unconventional oil, the chemical composition, nutrient evaluation and toxicological safety were assessed. The fatty acid composition RBO is very close to that of groundnut oil (GNO). Though RBO has high unsaponifiable matter (4.2%), it is rich In minor constituents such as phytosterols, triterpene alcohols, tocopherols and tocotrienols. Experimental as well as human studies have demonstrated the hypolipidaemic effects of RBO. Further, It was established that minor constituents present in unsaponifiable fraction of RBO were responsible for its hypolipidaemic effects. Nutritional evaluation studies, carried out with 10 per cent RBO and 20 per cent protein, indicated that growth, feed efficiency and mineral balance were comparable to GNO-fed animals. Toxicological studies had shown that there were no abnormalities In animals fed either RBO or GNO. The reproductive performance was also found to be normal as compared with that of GNO-fed animals in all three generations. In addition, neither RBO nor the foods deepfried in it showed any mutagenicity as judged by Ames test. In view of its safety and hypolipidaemic activity, RBO could be considered as an alternative source of edible oil.


Assuntos
Anticolesterolemiantes/normas , Avaliação Nutricional , Óleos de Plantas/normas , Animais , Anticolesterolemiantes/efeitos adversos , Anticolesterolemiantes/análise , Gorduras Insaturadas na Dieta/efeitos adversos , Gorduras Insaturadas na Dieta/análise , Feminino , Manipulação de Alimentos , Humanos , Hiperlipidemias/epidemiologia , Hiperlipidemias/prevenção & controle , Índia/epidemiologia , Masculino , Valor Nutritivo , Óleos de Plantas/efeitos adversos , Óleos de Plantas/análise , Ratos , Ratos Wistar , Óleo de Farelo de Arroz
15.
Metabolism ; 24(7): 795-8, 1975 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-1138154

RESUMO

Human growth hormone (hGH) was administered to a group of osteoporotic patients at two dosage levels for a period of 6 mo each. The first dose employed was 2 units subcutaneously daily, and the second dose was 0.2W-3/4 units (where W is body weight expressed in kg) daily. There was no significant change in serum-cholesterol or triglyceride concentration despite the production of hyperglycemia and soft-tissue swelling on the higher dosage regimen. A number of factors may account for the conflict between our findings and a previous report in which hGH administration had a lypocholesterolemic, hyperglyceridemic effect. These factors include differences in sex, age, dosage, and duration of treatment. Nonetheless, it is clear that from a therapeutic vantage, even if hGH were readily available, it would not be a useful hypocholesterolemic agent.


Assuntos
Hormônio do Crescimento/farmacologia , Lipídeos/sangue , Osteoporose/sangue , Idoso , Anticolesterolemiantes/normas , Glicemia/metabolismo , Colesterol/sangue , Relação Dose-Resposta a Droga , Feminino , Hormônio do Crescimento/uso terapêutico , Humanos , Hiperlipidemias/metabolismo , Pessoa de Meia-Idade , Osteoporose/tratamento farmacológico , Fatores de Tempo , Triglicerídeos/sangue
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