1
|
Yu Z, Yang H, Shou B, Cheng Z, Jiang C, Ye Y, Xu J. Remnant cholesterol and the risk of carotid plaque in hypertension: results from a community-based screening among old adults in Hangzhou, China. Sci Rep 2024; 14:8407. [PMID: 38600230 PMCID: PMC11006856 DOI: 10.1038/s41598-024-58484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
Elevated remnant cholesterol (RC) is considered a risk factor for atherosclerotic cardiovascular disease, but the evidence on this association applies to the Chinese population with hypertension is limited. We aimed to explore the association between RC levels and carotid plaque in old adults with hypertension. 8523 hypertensive patients aged ≥ 60 years with serum lipids and carotid ultrasonography data were included in this community-based screening. Fasting RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDLC). The associations of RC levels with carotid plaque risk were evaluated using Logistic regression and restricted cubic spline models. Carotid plaque was screened in 4821 (56.56%) subjects. After multivariable-adjusted, RC was significantly related to carotid plaque [Odd ratio (OR)] = 1.043 per 0.1 mmol/L increase, 95% confidence interval (CI): 1.030-1.056). The highest versus the lowest quartile of RC was 1.928 (1.673-2.223) for carotid plaque. A nonlinear association was found between serum RC levels and the risk of carotid plaque (P for nonlinearity < 0.001). Moreover, an RC > 0.78 mmol/L differentiated patients at a higher risk of carotid plaque compared to those at lower concentrations, regardless of whether LDLC was on target at 2.59 mmol/L. In old adults with hypertension, elevated RC was positively associated with carotid plaque, independent of LDLC and other conventional risk factors.
Collapse
Affiliation(s)
- Zhecong Yu
- Institute for Chronic Non-Communicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, People's Republic of China
| | - Haifeng Yang
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, People's Republic of China
| | - Biqi Shou
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, People's Republic of China
| | - Zongxue Cheng
- Institute for Chronic Non-Communicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, People's Republic of China
| | - Caixia Jiang
- Institute for Chronic Non-Communicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, People's Republic of China
| | - Yang Ye
- Tonglu Center for Disease Control and Prevention, Hangzhou, 311400, People's Republic of China
| | - Jue Xu
- Institute for Chronic Non-Communicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, People's Republic of China.
| |
Collapse
|
2
|
Lau DCW, Shaw E, Farris MS, McMullen S, Brar S, Cowling T, Chatterjee S, Quansah K, Kyaw MH, Girard LP. Prevalence of Adult Type 2 Diabetes Mellitus and Related Complications in Alberta, Canada: A Retrospective, Observational Study Using Administrative Data. Can J Diabetes 2024; 48:155-162.e8. [PMID: 38135113 DOI: 10.1016/j.jcjd.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease and a leading cause of morbidity/mortality in Canada. We evaluated the burden of T2DM in Alberta, Canada, by estimating the 5-year period prevalence of T2DM and rates of comorbidities and complications/conditions after T2DM. METHODS We conducted a population-based, retrospective study linking administrative health databases. Individuals with T2DM (≥18 years of age) were identified between 2008-2009 and 2018-2019 using a published algorithm, with follow-up data to March 2020. The 5-year period prevalence was estimated for 2014-2015 to 2018-2019. Individuals with newly identified T2DM, ascertained between 2010-2011 and 2017-2018 with a lookback period between 2008-2009 and 2009-2010 and a minimum 1 year of follow-up data, were evaluated for subsequent cardiovascular, diabetic, renal, and other complication/condition frequencies (%) and rates (per 100 person-years). Complications/conditions were stratified by atherosclerotic cardiovascular disease (ASCVD) status at index and age. RESULTS The 5-year period prevalence of T2DM was 11,051 per 100,000 persons, with the highest prevalence in men 65 to <75 years of age. There were 195,102 individuals included in the cohort (mean age 56.7±14.7 years). The most frequently reported complications/conditions (rates per 100 person-years) were acute infection (23.10, 95% confidence interval [CI] 23.00 to 23.30), hypertension (17.30, 95% CI 16.80 to 17.70), and dyslipidemia (12.20, 95% CI 11.90 to 12.40). Individuals who had an ASCVD event/procedure and those ≥75 years of age had higher rates of complications/conditions. CONCLUSIONS We found that over half of the individuals had hypertension or infection after T2DM. Also, those with ASCVD had higher rates of complications/conditions. Strategies to mitigate complications/conditions after T2DM are required to reduce the burden of this disease on individuals and health-care systems.
Collapse
Affiliation(s)
- David C W Lau
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
| | - Eileen Shaw
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Megan S Farris
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | | | - Saman Brar
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Tara Cowling
- Medlior Health Outcomes Research, Ltd, Calgary, Alberta, Canada
| | - Satabdi Chatterjee
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Kobina Quansah
- Boehringer Ingelheim (Canada), Ltd, Burlington, Ontario, Canada
| | - Moe H Kyaw
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, United States
| | - Louis P Girard
- Division of Nephrology, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|
3
|
Lee J, Ryu DH. Recognition of Early Cardiovascular Disease Symptoms in Hypertensive and Dyslipidemic Individuals of Icheon, Korea: Insights into Educational Levels and Health Literacy. Healthcare (Basel) 2024; 12:736. [PMID: 38610158 PMCID: PMC11011673 DOI: 10.3390/healthcare12070736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
The study aimed to explore the relationship between the presence of hypertension or dyslipidemia and the recognition of early symptoms of cardiovascular diseases (CVD), particularly acute myocardial infarction (AMI) and stroke. It is crucial for individuals with hypertension or dyslipidemia to recognize early symptoms of AMI and stroke, as timely and appropriate intervention can lead to favorable health outcomes. The study enrolled 104 participants aged 19 and above who are current residents of the Icheon region, Gyeonggi, Korea. The assessment of early symptoms of AMI and stroke utilized adapted items from the Korea Community Health Survey. In consideration of health literacy and education attainment, logistic regression analyses were conducted. While there was no significant association between hypertension and awareness of AMI or stoke symptoms, individuals with dyslipidemia demonstrated enhanced recognition of specific AMI symptoms, such as 'sudden chest pain or pressure' and 'sudden feeling of breathlessness'. No significant associations were observed between hypertension or dyslipidemia and awareness of stroke symptoms. The study emphasized the significance of targeted health education programs for individuals with chronic conditions to enhance their awareness of early symptoms of AMI and stroke.
Collapse
Affiliation(s)
- Jeehye Lee
- Department of Preventive Medicine, College of Medicine, Konkuk University, Chungju 27478, Republic of Korea;
| | - Dong-Hee Ryu
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu 42472, Republic of Korea
| |
Collapse
|
4
|
Jeon ES, Lim SW, Kim SY, Yang HM, Kim MH, Rhee MY, Han SH, Shin J, Kim KI, Jeong JO, Sung KC, Hong GR, Kim HS, Kwon K, Kang TS, Lee HY, Han SE. A randomized, double-blind, multicenter, phase III study on the efficacy and safety of a combination treatment involving fimasartan, amlodipine, rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy. Clin Hypertens 2022; 28:40. [DOI: 10.1186/s40885-022-00223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Abstract
Background
To assess the efficacy and safety of a combination therapy involving fimasartan, amlodipine, and rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond to fimasartan monotherapy.
Methods
This phase III, randomized, double-blind, multicenter study was conducted in adults aged 19–70 years. Patients who voluntarily consented were screened for eligibility to enroll in the study. Patients who failed to respond to 4 weeks of fimasartan monotherapy were randomized with a 1:1:1 ratio to the fimasartan 60 mg/amlodipine 10 mg + rosuvastatin 20 mg (FMS/ALD + RSV) as study group, fimasartan 60 mg/amlodipine 10 mg (FMS/ALD) as control 1 group, and fimasartan 60 mg + rosuvastatin 20 mg (FMS + RSV) as control 2 group. The primary efficacy endpoints were the change in the sitting systolic blood pressure and the rate of change in the low-density lipoprotein cholesterol (LDL-C) level from baseline to 8 weeks. The adverse events, adverse drug reactions, physical examination findings, laboratory test results, electrocardiograms, and vital signs were evaluated to assess safety in the study.
Results
Of 138 randomized patients, 131 were conducted efficacy analysis, and 125 completed the study. For the change in LDL-C and sitting SBP (SiSBP) as primary efficacy assessments, the change in LDL-C at week 8 was significantly reduce in the FMS/ALD + RSV group than in the control 1 group (P < 0.001). The change in SiSBP at week 8 were greater reduce in the FMS/ALD + RSV group than in the FMS + RSV group (both P < 0.001). For the safety evaluation, there were no differences among the treatment groups in the incidence of adverse drug reactions.
Conclusions
The fimasartan/amlodipine + rosuvastatin combination therapy can effectively and safely lower blood pressure and improve lipid levels in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy.
Trial registration
NCT03156842, Registered 17 May 2017
Collapse
|
5
|
Han KT, Choi DW, Kim S. The effect of continuity of care of dyslipidaemia patients on preventable hospitalisation and healthcare expenditures. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5831-e5838. [PMID: 36073616 DOI: 10.1111/hsc.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/24/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Although continuous treatment leads to better patient outcomes, evidence regarding the effect of the continuity of care (COC) on preventable hospitalisation and medical expenses in Korea for patients with dyslipidaemia is insufficient. We evaluated the effect of COC on preventable hospitalisation and medical expenses for patients with dyslipidaemia. This study used National Health Insurance Sampling cohort data (2008-2015). We measured COC with the Bice-Boxerman index based on the outpatient visits of patients diagnosed with dyslipidaemia for the first time. Preventable hospitalisation included admission for cardiovascular disease (CVD) and all costs for outpatient visits. We evaluated the association of COC with preventable hospitalisation and medical expenses using a generalised estimating equation model. Patients (N = 53,372) with newly diagnosed dyslipidaemia participated. Compared to non-hospitalised patients, hospitalised patients had higher fragmentation scores for CVD, met more healthcare providers, had higher total outpatient visits and had a lower proportion of primary healthcare providers served. A higher fragmentation score was associated with an increased risk of hospitalisation (rate ratio [RR]: 1.873, 95% confidence interval [CI]: 1.520-2.309) and healthcare expenditure (RR: 1.381, 95% CI: 1.322-1.442). The magnitude of the effect of COC on hospitalisation differed according to patients' drug intake and residence location. Fragmentation of care was associated with preventable hospitalisation and increased healthcare costs, especially for patients taking medications/living in rural areas. It is necessary to promote a more effective COC.
Collapse
Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Dong-Woo Choi
- Data Link & Operation Team, Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Seungju Kim
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
6
|
Wei L, Sun J, Xie H, Zhuang Q, Wei P, Zhao X, Chen Y, Dong J, Li M, Chen C, Yang S, Shen C. Interaction Analysis of Abnormal Lipid Indices and Hypertension for Ischemic Stroke: A 10-Year Prospective Cohort Study. Front Cardiovasc Med 2022; 9:819274. [PMID: 35360026 PMCID: PMC8962740 DOI: 10.3389/fcvm.2022.819274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/18/2022] [Indexed: 01/23/2023] Open
Abstract
BackgroundDyslipidemia and hypertension are two important independent risk factors for ischemic stroke (IS); however, their combined effect on IS remains uncertain.ObjectivesThis present study aimed to evaluate the interaction effect of hypertension and abnormal lipid indices on IS in a 10-year prospective cohort in Chinese adults.MethodsThe cohort study of 4,128 participants was conducted in May 2009 and was followed up to July 2020. All qualified participants received a questionnaire survey, physical examination, and blood sample detection. Cox regression was used to evaluate the association of dyslipidemia and hypertension with IS, and calculate the hazard ratio (HR) and 95% confidence interval (CI). The relative excess risk of interaction (RERI) and the HR (95%CI) of interaction terms were used to examine additive and multiplicative interactions.ResultsIn the hypertensive population, Non-HDL-C ≥190 mg/dl, LDL-C/HDL-C ≥2 and HDL-C ≥60 mg/dl were statistically associated with IS, and after adjusting for covariates, HRs (95%CIs) were 1.565 (1.007–2.429), 1.414 (1.034–1.933) and 0.665 (0.450–0.983), respectively. While in the non-hypertension population, no significant association of Non-HDL-C ≥190 mg/dl, LDL-C/HDL-C ≥2, and HDL-C ≥60 was detected with IS (P > 0.05). There was a significant association between TC/HDL-C ≥ 3.6 and the decreased risk of IS in the non-hypertension population, and the HR (95%CI) was 0.479 (0.307–0.750). Whereas, a similar association was not observed in the hypertensive population. HDL-C ≥ 60 mg/dl, Non-HDL-C ≥ 190 mg/dl, TC/HDL-C ≥ 3.6, and TG/HDL-C ≥ 1 have additive and multiplicative interactions with hypertension (P < 0.05). The RERIs (95% CIs) of the additive interaction are −0.93 (−1.882–0.044), 1.394 (0.38–2.407), 0.752 (0.354–1.151) and 0.575 (0.086–1.065), respectively. The HRs (95% CIs) of the multiplicative interaction terms were 0.498 (0.272–0.911), 4.218 (1.230–14.464), 2.423 (1.437–4.086) and 1.701 (1.016–2.848), respectively.ConclusionHigh concentration of HDL-C reduces the impact of hypertension on IS, while the high concentration of Non-HDL-C, TC/HDL-C, and TG/HDL-C positively interact with hypertension affecting the incidence of IS. This study provides useful evidence for the combined effects of dyslipidemia and hypertension in predicting IS.
Collapse
Affiliation(s)
- Lai Wei
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Junxiang Sun
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Hankun Xie
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qian Zhuang
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Pengfei Wei
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Xianghai Zhao
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Yanchun Chen
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Jiayi Dong
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengxia Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Changying Chen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Song Yang
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
- Song Yang
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Chong Shen
| |
Collapse
|
7
|
Xie H, Zhuang Q, Mu J, Sun J, Wei P, Zhao X, Chen Y, Dong J, Chen C, Wei L, Yin Y, Yang S, Shen C. The relationship between lipid risk score and new-onset hypertension in a prospective cohort study. Front Endocrinol (Lausanne) 2022; 13:916951. [PMID: 36246874 PMCID: PMC9555054 DOI: 10.3389/fendo.2022.916951] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyslipidemia and hypertension are both important risk factors for atherosclerotic cardiovascular diseases. However, the relationship between dyslipidemia and incident hypertension remains to be elucidated comprehensively. The main purpose of this study was to construct the lipid risk score to explore the risk prediction effect of integrated lipid indices on new-onset hypertension. METHODS This prospective cohort study with 2116 non-hypertensive subjects was conducted from 2009 to 2020. New hypertension events during the follow-up period were recorded and verified. The lipid risk score was calculated by summing coded total cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol weighted with corresponding effect sizes. Cox regression analysis was used to estimate the association between the lipid risk score or lipid indices and incident hypertension in the subgroup of age (< 55 and≥ 55 years at baseline). RESULTS After a median of 10.75-year follow-up, 637 incident hypertension cases were identified. The restricted cubic spline showed that the lipid risk score had a positive linear correlation with hypertension (P< 0.001). Among people< 55 years, with every increase of 0.94 in lipid risk score, the risk of hypertension increased by 37% (adjusted HR [95%CI]: 1.369 [1.164-1.610]). This association was not modified by overweight or obesity. CONCLUSIONS The integrated lipid risk score, independent of traditional risk factors, has a significantly predictive effect on hypertension in people younger than 55 years. This finding may aid in identifying high-risk individuals for hypertension, as well as facilitating early intervention and management to reduce adverse cardiovascular events. Comprehensive lipid management should be attached importance in the prevention and control of hypertension.
Collapse
Affiliation(s)
- Hankun Xie
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qian Zhuang
- Department of Cardiology, Affiliated Yixing People’s Hospital of Jiangsu University, People’s Hospital of Yixing City, Yixing, China
| | - Jialing Mu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Junxiang Sun
- Department of Cardiology, Affiliated Yixing People’s Hospital of Jiangsu University, People’s Hospital of Yixing City, Yixing, China
| | - Pengfei Wei
- Department of Cardiology, Affiliated Yixing People’s Hospital of Jiangsu University, People’s Hospital of Yixing City, Yixing, China
| | - Xianghai Zhao
- Department of Cardiology, Affiliated Yixing People’s Hospital of Jiangsu University, People’s Hospital of Yixing City, Yixing, China
| | - Yanchun Chen
- Department of Cardiology, Affiliated Yixing People’s Hospital of Jiangsu University, People’s Hospital of Yixing City, Yixing, China
| | - Jiayi Dong
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Changying Chen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lai Wei
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yunjie Yin
- Department of Cardiology, Affiliated Yixing People’s Hospital of Jiangsu University, People’s Hospital of Yixing City, Yixing, China
| | - Song Yang
- Department of Cardiology, Affiliated Yixing People’s Hospital of Jiangsu University, People’s Hospital of Yixing City, Yixing, China
- *Correspondence: Chong Shen, ; Song Yang,
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Chong Shen, ; Song Yang,
| |
Collapse
|
8
|
Effectiveness of Fixed-Dose Combination Therapy (Polypill) Versus Exercise to Improve the Blood-Lipid Profile: A Network Meta-analysis. Sports Med 2021; 52:1161-1173. [PMID: 34878638 DOI: 10.1007/s40279-021-01607-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Both exercise and polypills are recommended treatments to improve the blood-lipid profile. OBJECTIVE The aim of this study was to compare head-to-head the effectiveness of polypill and exercise strategies in improving the blood-lipid profile in high-risk cardiovascular patients. METHODS We performed an electronic search in Web of Science, EMBASE, Cochrane Database of Systematic Reviews, MEDLINE and SPORTDiscus, from inception to August 2021. Randomized controlled trials (RCTs) testing the effectiveness of exercise interventions or treatment with fixed-dose combination therapy (polypill) in improving the blood-lipid profile in adults with atherosclerotic cardiovascular disease or presenting at least one well recognized cardiovascular risk factor were included. RESULTS A total of 131 RCTs were included: 15 and 116 studies analyzing the effects of polypills and exercise, respectively, on blood-lipid levels. Both exercise and polypill strategies were effective in reducing low-density lipoprotein cholesterol (LDL-c) and total cholesterol (TC), but only exercise interventions improved high-density lipoprotein cholesterol (HDL-c) and triglyceride levels compared with the control group. The results of the network meta-analyses showed that the polypill without antiplatelet therapy was the most effective pharmacological treatment for improving the lipid profile, while aerobic interval exercise was the most effective exercise intervention. CONCLUSIONS Considering that both polypills and exercise are effective in reducing LDL-c and TC but only exercise improves HDL-c and triglycerides, and that exercise provides further health benefits (e.g., increases in physical fitness and decreases in adiposity), it seems reasonable to recommend exercise as the first treatment option in dyslipidemia when the patient's general condition and symptoms allow it. PROSPERO REGISTRATION NUMBER CRD42019122794.
Collapse
|
9
|
Park S, Nam JY. The Impact of Sedentary Behavior and Self-Rated Health on Cardiovascular Disease and Cancer among South Korean Elderly Persons Using the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2018 Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7426. [PMID: 34299877 PMCID: PMC8305062 DOI: 10.3390/ijerph18147426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 01/27/2023]
Abstract
Cardiovascular disease and cancer have increased the risk of mortality and morbidity in elderly persons worldwide. The aim of this study was to investigate the association of sedentary behavior and self-rated health with cardiovascular disease or cancer in elderly people. The data of 6785 elderly persons aged above 65 years from the Korea National Health and Nutrition Examination Survey 2014-2018 were examined. Binary logistic regression analyses assessed the association of sedentary behavior, self-rated health, and other risk factors with cardiovascular disease or cancer. Prolonged sedentary behavior in elderly people was associated with a high risk for cardiovascular disease (odds ratio (OR): 1.28, 95% confidence interval (CI): 1.08-1.52). There was a high risk for cardiovascular disease (OR: 2.36, 95% CI: 1.85-3.01) or cancer (OR: 1.48, 95% CI: 1.17-1.88) in elderly people who had poor self-rated health. This study identified the association between prolonged sedentary behavior and cardiovascular disease, and between poor self-rated health and cancer. Since prolonged sedentary behavior is related to cardiovascular disease, efforts are needed to reduce sedentary behavior hours and maintain good self-rated health.
Collapse
Affiliation(s)
| | - Jin Young Nam
- Department of Healthcare Management, Eulji University, Sungnam-si 13135, Korea;
| |
Collapse
|
10
|
Building a Cardiovascular Disease Prediction Model for Smartwatch Users Using Machine Learning: Based on the Korea National Health and Nutrition Examination Survey. BIOSENSORS-BASEL 2021; 11:bios11070228. [PMID: 34356699 PMCID: PMC8301976 DOI: 10.3390/bios11070228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
Smartwatches have the potential to support health care in everyday life by supporting self-monitoring of health conditions and personal activities. This paper aims to develop a model that predicts the prevalence of cardiovascular disease using health-related data that can be easily measured by smartwatch users. To this end, the data corresponding to the health-related data variables provided by the smartwatch are selected from the Korea National Health and Nutrition Examination Survey. To classify the prevalence of cardiovascular disease with these selected variables, we apply logistic regression, artificial neural network, and support vector machine among machine learning classification techniques, and compare the appropriateness of the algorithm through classification performance indicators. The prediction model using support vector machine showed the highest accuracy. Next, we analyze which structures or parameters of the support vector machine contribute to increasing accuracy and derive the importance of input variables. Since it is very important to diagnose cardiovascular disease early correctly, we expect that this model will be very useful if there is a tool to predict whether cardiovascular disease develops or not.
Collapse
|
11
|
Weisser B, Predel HG, Gillessen A, Hacke C, Vor dem Esche J, Rippin G, Noetel A, Randerath O. Single Pill Regimen Leads to Better Adherence and Clinical Outcome in Daily Practice in Patients Suffering from Hypertension and/or Dyslipidemia: Results of a Meta-Analysis. High Blood Press Cardiovasc Prev 2020; 27:157-164. [PMID: 32219670 PMCID: PMC7160084 DOI: 10.1007/s40292-020-00370-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/16/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Cardiovascular diseases (CVD) represent the first cause of mortality in western countries. Hypertension and dyslipidemia are strong risk factors for CVD, and are prevalent either alone or in combination. Although effective substances for the treatment of both factors are available, there is space for optimization of treatment regimens due to poor patient’s adherence to medication, which is usually a combination of several substances. Adherence decreases with the number of pills a patient needs to take. A combination of substances in one single-pill (single pill combination, SPC), might increase adherence, and lead to a better clinical outcome. Aim We conducted a meta-analysis to compare the effect of SPC with that of free-combination treatment (FCT) in patients with either hypertension, dyslipidemia or the combination of both diseases under conditions of daily practice. Methods Studies were identified by searching in PubMed from November 2014 until February 2015. Search criteria focused on trials in identical hypertension and/or dyslipidemia treatment as FCT therapy or as SPC. Adherence and persistence outcome included proportion-of-days-covered (PDC), medication possession ratio (MPR), time-to treatment gap of 30 and 60 days and no treatment gap of 30 days (y/n). Clinical outcomes were all cause hospitalisation, hypertension-related hospitalisation, all cause emergency room visits, hypertension-related emergency room visits, outpatient visits, hypertension-related outpatient visits, and number of patients reaching blood pressure goal. Randomized clinical studies were excluded because they usually do not reflect daily practice. Results 11 out of 1.465 studies met the predefined inclusion criteria. PDC ≥ 80% showed an odds ratio (OR) of 1.78 (95% CI: 1.30–2.45; p = 0.004) after 6 months and an OR of 1.85 (95% CI: 1.71; 2.37; p < 0.001) after ≥ 12 months in favour to the SPC. MPR ≥ 80% after 12 months also was in favour to SPC (OR 2.13; 95% CI: 1.30; 3.47; p = 0.003). Persistence was positively affected by SPC after 6, 12, and 18 months. Time to treatment gap of 60 days resulted in a hazard ratio (HR) of 2.03 (95% CI: 1.77; 2.33, p < 0.001). The use of SPC was associated with a significant improvement in systolic blood pressure reduction, leading to a higher number of patients reaching individual blood pressure goals (FCT vs SPC results in OR = 0.77; 95% CI: 0.69; 0.85, p < 0.001). Outpatient visits, emergency room visits and hospitalisations, both overall and hypertension-related were reduced by SPC: all-cause hospitalisation (SPC vs FCT: 15.0% vs 18.2%, OR 0.79, 95% CI 0.67; 0.94, p = 0.009), all-cause emergency room visits (SPC vs FCT: 25.7% vs 31.4%, OR 0.75, 95% CI 0.65; 0.87, p = 0.001) and hypertension related emergency room visits (SPC vs FCT: 9.7% vs 14.1%, OR 0.65, 95% CI 0.54; 0.80, p < 0.001). Conclusions SPC improved medication adherence and clinical outcome parameter in patients suffering from hypertension and/or dyslipidemia and led to a better clinical outcome compared to FCT under conditions of daily practice.
Collapse
Affiliation(s)
- Burkhard Weisser
- Institut für Sportwissenschaft, Christian-Albrechts-Universität zu Kiel, Olshausenstraße 74, 24098, Kiel, Germany.
| | - Hans-Georg Predel
- Instituts für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Cologne, Germany
| | | | - Claudia Hacke
- Klinik für Kinder- und Jugendmedizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Andrea Noetel
- APONTIS Pharma GmbH & Co. KG, Monheim am Rhein, Germany
| | | |
Collapse
|
12
|
Kim W, Chang K, Cho EJ, Ahn J, Yu CW, Cho K, Kim Y, Kang D, Kim S, Lee S, Kim U, Kim S, Ahn YK, Lee CH, Shin JH, Kim M, Park CG. A randomized, double‐blind clinical trial to evaluate the efficacy and safety of a fixed‐dose combination of amlodipine/rosuvastatin in patients with dyslipidemia and hypertension. J Clin Hypertens (Greenwich) 2020; 22:261-269. [DOI: 10.1111/jch.13774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Woohyeun Kim
- Cardiovascular Center Korea University Guro Hospital Seoul Korea
| | - Kiyuk Chang
- Division of Cardiology Seoul St. Mary's Hospital Seoul Korea
| | - Eun Joo Cho
- Division of Cardiology St. Paul's Hospital Seoul Korea
| | - Jeong‐Cheon Ahn
- Division of Cardiology Korea University Ansan Hospital Ansan Korea
| | - Cheol Woong Yu
- Division of Cardiology Korea University Anam Hospital Seoul Korea
| | - Kyoung‐Im Cho
- Division of Cardiology Maryknoll Medical Center Busan Korea
| | - Yong‐Jin Kim
- Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Duk‐Hyun Kang
- Valvular Heart Disease Center Asan Medical Center Heart Institute Seoul Korea
| | - Seok‐Yeon Kim
- Department of Cardiology Seoul Medical Center Seoul Korea
| | - Sang‐Hak Lee
- Division of Cardiology Severance Cardiovascular Hospital Seoul Korea
| | - Ung Kim
- Division of Cardiology Yeungnam University Medical Center Daegu Korea
| | - Shin‐Jae Kim
- Division of Cardiology Ulsan University Hospital Ulsan Korea
| | - Young Keun Ahn
- Heart Center of Chonnam National University Hospital Gwangju Korea
| | - Chang Hoon Lee
- Division of Cardiology Veterans Health Service Medical Center Seoul Korea
| | - Jin Ho Shin
- Division of Cardiology Hanyang University Hospital Seoul Korea
| | - Mikyung Kim
- Yuhan Research Institute Yuhan Corporation Yongin Korea
| | - Chang Gyu Park
- Cardiovascular Center Korea University Guro Hospital Seoul Korea
| |
Collapse
|
13
|
Pharmacokinetic Drug Interactions Between Amlodipine, Valsartan, and Rosuvastatin in Healthy Volunteers. Adv Ther 2019; 36:1642-1656. [PMID: 31119689 DOI: 10.1007/s12325-019-00976-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Amlodipine, valsartan, and rosuvastatin are among the medications widely coadministered for the treatment of hyperlipidemia accompanied by hypertension. The aim of this study was to investigate the possible pharmacokinetic drug-drug interactions between amlodipine, valsartan, and rosuvastatin in healthy Korean male volunteers. METHODS In this phase 1, open-label, multiple-dose, two-part, two-period, fixed-sequence study, the enrolled subjects were randomized into two parts (A and B). In part A (n = 32), each subject received one fixed-dose combination (FDC) tablet of amlodipine/valsartan 10 mg/160 mg alone for 10 consecutive days in period I, and the same FDC for 10 days with concomitant 7-day administration of 20 mg rosuvastatin in period II. In part B (n = 25), each subject received rosuvastatin alone for 7 days in period I, and the FDC for 10 days with concomitant 7-day administration of rosuvastatin in period II. In both parts, there was a 12-day washout between periods. Serial blood samples were collected for up to 72 h for amlodipine and rosuvastatin, and for up to 48 h for valsartan after the last dose of each period. The plasma concentrations of amlodipine, valsartan, and rosuvastatin were determined by using liquid chromatography-tandem mass spectrometry. RESULTS Fifty-seven subjects were enrolled; 30 and 25 subjects completed part A and part B, respectively. The geometric mean ratios and 90% confidence intervals for the maximum plasma concentration at steady state (Cmax,ss) and the area under the plasma concentration-time curve over the dosing interval at steady state (AUCτ,ss) were 0.9389 (0.9029-0.9763) and 0.9316 (0.8970-0.9675) for amlodipine, 0.7698 (0.6503-0.9114) and 0.7888 (0.6943-0.8962) for valsartan, and 0.9737 (0.8312-1.1407) and 0.9596 (0.8826-1.0433) for rosuvastatin, respectively. Of the 57 subjects enrolled in this study, 10 subjects experienced 13 adverse events (AEs); no severe or serious AEs were reported. CONCLUSION When amlodipine, valsartan, and rosuvastatin were coadministered to healthy volunteers, the pharmacokinetic exposure to valsartan was decreased, but no change in exposure to amlodipine and rosuvastatin occurred. All treatments were well tolerated. CLINICAL TRIAL REGISTRATION https://cris.nih.go.kr CRIS KCT0001660. FUNDING KyungDong Pharmaceutical Corp. Ltd., Seoul, Republic of Korea.
Collapse
|
14
|
Morita Y, Murayama H, Odawara M, Bauer M. Treatment patterns of drug-naive patients with type 2 diabetes mellitus: a retrospective cohort study using a Japanese hospital database. Diabetol Metab Syndr 2019; 11:90. [PMID: 31695754 PMCID: PMC6824122 DOI: 10.1186/s13098-019-0486-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Guidelines for Type 2 diabetes mellitus (T2DM) management in Japan provide physicians the discretion to select treatment options based on patient pathophysiology of the disease. There exists a wide variation of preference for initial antidiabetes drugs (AD). The current database analysis aimed to understand the real world treatment patterns in drug-naive patients with T2DM in Japan. METHODS We analyzed data of patients (≥ 18 years) diagnosed with T2DM between October 2012 and September 2016 from the Medical Data Vision, a Diagnosis Procedure Combination database. The primary objective was to determine the proportion of T2DM patients receiving each type of treatment as first-line therapy among the drug-naive cohort. RESULTS Of the 436,546 drug-naive patients, 224,761 received their first-line T2DM treatment in the outpatient setting. The mean age of the patient population was 65.6 years at index date. Dipeptidyl peptidase-4 (DPP-4) inhibitor was the most prescribed (56.8%) outpatient AD monotherapy, followed by metformin (15.4%). DPP-4 inhibitors were prescribed over metformin in patients with renal disease (odds ratio [OR]: 4.20; p < 0.0001), coronary heart disease and stroke (OR: 2.22; p < 0.0001). Male (OR: 1.03; p = 0.0026), presence of diabetic complications [retinopathy (OR: 1.33; p < 0.0001), neuropathy (OR: 1.05; p = 0.0037), nephropathy (OR: 1.08; p < 0.0001)] and a high baseline HbA1c (OR: 1.45; p < 0.0001) received treatment intensification during 180 days. CONCLUSION DPP-4 inhibitors were the most prevalent first-line T2DM treatment followed by metformin in Japan. The findings from this retrospective analysis also support the previously published web survey results and can help understand the real world utilization of T2DM treatment.Trial registration Retrospectively registered.
Collapse
Affiliation(s)
- Yohei Morita
- Medical Division, Novartis Pharma K.K, Toranomon Hills, Mori Tower 23-1, Toranomon 1-Chome, Minato-ku, Tokyo, 105-6333 Japan
| | - Hiroki Murayama
- Medical Division, Novartis Pharma K.K, Toranomon Hills, Mori Tower 23-1, Toranomon 1-Chome, Minato-ku, Tokyo, 105-6333 Japan
| | - Masato Odawara
- Department of Diabetes, Endocrinology, Metabolism and Rheumatology, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Melissa Bauer
- Real World Data Analytics, Novartis Global Service Center, Vista Building, Elm Park Business Campus, Merrion Road, Dublin, Ireland
| |
Collapse
|
15
|
Kim KS, Bang E. Metabolomics Profiling of the Effects of Taurine Supplementation on Dyslipidemia in a High-Fat-Diet-Induced Rat Model by 1H NMR Spectroscopy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 975 Pt 1:329-336. [PMID: 28849467 DOI: 10.1007/978-94-024-1079-2_29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Metabolomics, the comprehensive study of metabolites, has merged as a potent tool for analyzing complex phenotypes and identifying biomarkers of specific physiological responses and has the potential to lead to innovative therapeutic and diagnostic schemes for many diseases. In a former report, we showed that taurine supplementation considerably ameliorated dyslipidemia in rats fed a high-caloric diet. In this work, we examined the metabolic changes that occur in rat serum after they were fed a normal diet, a high-fat diet, and a high-fat diet containing 2% taurine (tau) by NMR spectroscopy combined with a multivariate statistical analysis containing PCA, PLS-DA, and OPLS-DA. We obtained 1H-NMR spectra of rat serum and used pattern recognition to identify key metabolites related to taurine supplementation. We found significant changes in creatine, methionine, glutamine, and threonine as well as in lipids, all of which decreased in the Tau group. To use these changes in metabolites as novel therapeutic and diagnostic markers, it should first be investigated whether these results are reproducible in future experiments. Next, researchers should determine how these changes affect serum lipid changes. This study identified some changes in serum metabolites and demonstrated the possibility of using an NMR-based metabolomics method to explore the effects of a taurine supplement on dyslipidemia in a high-fat-diet-induced rat model.
Collapse
Affiliation(s)
- Kyoung Soo Kim
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Kyung Hee University, Seoul, South Korea.
- East-West Bone and Joint Disease Research Institute, Kyung Hee University Hospital at Gangdong, 149 Sangil-dong, Gangdong-gu, Seoul, South Korea.
| | - Eunjung Bang
- Integrated Metabolomics Research Group, Western Seoul Center, Korea Basic Science Institute, Seoul, South Korea.
| |
Collapse
|
16
|
Oh M, Ghim JL, Park SE, Kim EY, Shin JG. Pharmacokinetic comparison of a fixed-dose combination versus concomitant administration of fimasartan, amlodipine, and rosuvastatin using partial replicated design in healthy adult subjects. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1157-1164. [PMID: 29780236 PMCID: PMC5951219 DOI: 10.2147/dddt.s164215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective The aim of this study was to compare the pharmacokinetics (PK) and safety profiles of a fixed-dose combination (FDC) formulation of fimasartan, amlodipine, and rosuvastatin with the co-administration of the two products by using a replicated crossover study design in healthy male subjects. Results This was an open-label, randomized, three-sequence, three-period replicated crossover study in healthy male subjects. The replicated crossover design was done because of high coefficient of variation of PK parameter for fimasartan, that is, >30%. With a 14 days washout period, an FDC tablet containing 60 mg fimasartan, 10 mg amlodipine, and 20 mg rosuvastatin was administered only once, and separate formulations of fimasartan/amlodipine 60 mg/10 mg FDC tablet and 20 mg rosuvastatin tablet administered twice. Blood samples were collected up to 72 hours following drug administration. The plasma concentrations of fimasartan, amlodipine, and rosuvastatin were measured by liquid chromatography tandem mass spectrometry. Safety was assessed by evaluating vital signs, clinical laboratory parameters, physical examinations, and medical interviews. Results The geometric mean ratios and 90% confidence intervals (CIs) for the maximum plasma concentration (Cmax) and area under the curve from time zero to the last measurable sampling time (AUCt) were 1.0776 (0.9201-1.2622) and 0.9978 (0.9538-1.0439) for fimasartan, 1.0038 (0.9782-1.0301) and 1.0055 (0.9828-1.0288) for amlodipine, and 1.0006 (0.9290-1.0776) and 0.9986 (0.9532-1.0461) for rosuvastatin, respectively. A total of 22 adverse events (AEs) were reported by 60 subjects; there were no significant differences in the incidence of AEs between the two groups. Conclusion The 90% CI of the Cmax of fimasartan was within the widened acceptance limit, ln(0.6984)-ln(1.4319). The 90% CIs of the other PK parameters for drugs were between ln(0.8) and ln(1.25). These results suggest that the FDC formulation is pharmacokinetically bioequivalent and has a similar safety profile, to the co-administration of its three constituent drugs.
Collapse
Affiliation(s)
- Minkyung Oh
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea
| | - Jong-Lyul Ghim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Sung-Eun Park
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Eun-Young Kim
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jae-Gook Shin
- Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.,Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| |
Collapse
|
17
|
Abstract
During the past decades, stem cell-based therapy has acquired a promising role in regenerative medicine. The application of novel cell therapeutics for the treatment of cardiovascular diseases could potentially achieve the ambitious aim of effective cardiac regeneration. Despite the highly positive results from preclinical studies, data from phase I/II clinical trials are inconsistent and the improvement of cardiac remodeling and heart performance was found to be quite limited. The major issues which cardiac stem cell therapy is facing include inefficient cell delivery to the site of injury, accompanied by low cell retention and weak effectiveness of remaining stem cells in tissue regeneration. According to preclinical and clinical studies, various stem cells (adult stem cells, embryonic stem cells, and induced pluripotent stem cells) represent the most promising cell types so far. Beside the selection of the appropriate cell type, researchers have developed several strategies to produce “second-generation” stem cell products with improved regenerative capacity. Genetic and nongenetic modifications, chemical and physical preconditioning, and the application of biomaterials were found to significantly enhance the regenerative capacity of transplanted stem cells. In this review, we will give an overview of the recent developments in stem cell engineering with the goal to facilitate stem cell delivery and to promote their cardiac regenerative activity.
Collapse
|
18
|
Novello MF, Rosa MLG, Ferreira RT, Nunes IG, Jorge AJL, Correia DMDS, Martins WDA, Mesquita ET. Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care. Arq Bras Cardiol 2017; 108:135-142. [PMID: 28327875 PMCID: PMC5344658 DOI: 10.5935/abc.20170009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023] Open
Abstract
Background Hypertension is the most prevalent risk factor for cardiovascular disease,
and its proper control can prevent the high morbidity and mortality
associated with this disease. Objective To assess the degree of compliance of antihypertensive prescriptions with the
VI Brazilian Guidelines on Hypertension and the blood pressure control rate
in primary care. Methods Cross-sectional study conducted between August 2011 and November 2012,
including 332 adults ≥ 45 years registered in the Family Doctor
Program in Niteroi and selected randomly. The analysis included the
prescribed antihypertensive classes, doses, and frequencies, as well as the
blood pressure (BP) of the individuals. Results The rate of prescription compliance was 80%. Diuretics were the most
prescribed medications, and dual therapy was the most used treatment. The
most common non-compliances were underdosing and underfrequencies. The BP
goal in all cases was < 140/90 mmHg, except for diabetic patients, in
whom the goal was set at < 130/80 mmHg. Control rates according to these
goals were 44.9% and 38.6%, respectively. There was no correlation between
prescription compliance and BP control. Conclusions The degree of compliance was considered satisfactory. The achievement of the
targets was consistent with national and international studies, suggesting
that the family health model is effective in BP management, although it
still needs improvement.
Collapse
Affiliation(s)
- Mayra Faria Novello
- Departamento de Medicina Clínica - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Maria Luiza Garcia Rosa
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Ranier Tagarro Ferreira
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Icaro Gusmão Nunes
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | | | - Dayse Mary da Silva Correia
- Departamento de Fundamentos de Enfermagem e Administração - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | | | | |
Collapse
|
19
|
Emamian M, Hasanian SM, Tayefi M, Bijari M, Movahedian Far F, Shafiee M, Avan A, Heidari-Bakavoli A, Moohebati M, Ebrahimi M, Darroudi S, Zamani P, Azarpazhooh MR, Nematy M, Safarian M, Ferns GA, Esmaeili H, Parizadeh MR, Ghayour-Mobarhan M. Association of hematocrit with blood pressure and hypertension. J Clin Lab Anal 2017; 31. [PMID: 28105697 DOI: 10.1002/jcla.22124] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/01/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is a risk factor for stroke, renal failure, and cardiovascular disease. The association between biochemical and hematological parameters with high blood pressure may provide a more precise approach to risk prediction conferred by HTN in these patients. OBJECTIVE The aim of current study was to explore whether biochemical and hematological parameters are associated with HTN in a cohort study with a 7-year follow-up. MATERIALS AND METHODS A total of 9808 individuals were enrolled and recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study, and biochemical and hematological factors were measured in all subjects. Univariate and multivariate logistic regression analysis were performed to determine the association of biochemical and hematological parameters with HTN. RESULTS Several biochemical parameters including fasting plasma glucose (FBG), serum high-sensitivity C-reactive protein (hs-CRP), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and uric acid were increased in hypertensive participants. In contrast, serum high-density lipoprotein cholesterol (HDL-C) was lower in hypertensive individuals. Furthermore, we demonstrated that hematological parameters including white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (HGB), hematocrit (HCT), and mean corpuscular hemoglobin (MCH) were higher in the hypertensive group compared to the control group. But mean corpuscular volume (MCV), and red cell distribution width (RDW), were decreased in the hypertensive group. Furthermore, our results strongly suggested that among these parameters, hematocrit was the independent risk factor for hypertension in the population. CONCLUSION We demonstrated the association of altered biochemical and hematological factors with hypertension supporting the value of emerging markers for early prediction of high blood pressure in prone individuals.
Collapse
Affiliation(s)
- Marzieh Emamian
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hasanian
- Department of Medical Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Microanatomy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Tayefi
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Biostatistics & Epidemiology, School of Health, Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Moniba Bijari
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Faeze Movahedian Far
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Shafiee
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Avan
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Heidari-Bakavoli
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Moohebati
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Ebrahimi
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sousan Darroudi
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parvin Zamani
- Department of Medical Biotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Azarpazhooh
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Nematy
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Safarian
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, UK
| | - Habibollah Esmaeili
- Department of Biostatistics & Epidemiology, School of Health, Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Parizadeh
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Biochemistry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
20
|
Song S, Paik HY, Park M, Song Y. Dyslipidemia patterns are differentially associated with dietary factors. Clin Nutr 2015; 35:885-91. [PMID: 26140958 DOI: 10.1016/j.clnu.2015.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 05/04/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Dyslipidemia, a strong predictor of cardiovascular diseases, is prevalent among Korean adults, but little is known about the associations between overall lipid profiles and dietary factors. We identified dyslipidemia patterns among lipid indicators and examined dietary factors associated with dyslipidemia patterns in Korean adults. METHODS Subjects in this cross-sectional study were recruited from the Family Medicine Division or the Health Examination Center of the general hospital in Seoul between 2010 and 2012. Measurements of biochemical and dietary variables repeated three times were collected from a total of 138 subjects at 3- to 4-month intervals when the subjects visited the hospital. Dietary intake data were obtained using 24-h recalls. In order to estimate typical values for biochemical and dietary variables, the averages of repeated measures for each subject were calculated. To identify dyslipidemia patterns, factor analysis was used based on total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), triglycerides (TG), and high-density lipoprotein cholesterol (HDLC). RESULTS Two dyslipidemia patterns, (1) TC & LDLC and (2) TG & HDLC, were identified. Dietary fat and cholesterol intakes were positively associated with the TC & LDLC pattern score, but not associated with the TG & HDLC pattern score. The TG & HDLC pattern was significantly associated with low intakes of calcium, potassium, milk and dairy products. CONCLUSIONS Two dyslipidemia patterns were associated with dietary factors in Korean adults. Further studies should investigate specific dietary recommendations according to lipid profiles in the prevention and management of dyslipidemia in Korea.
Collapse
Affiliation(s)
- SuJin Song
- Department of Food and Nutrition, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea
| | - Hee Young Paik
- Department of Food and Nutrition, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Republic of Korea
| | - Minseon Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - YoonJu Song
- Major of Food and Nutrition, School of Human Ecology, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-743, Republic of Korea.
| |
Collapse
|
21
|
Taurine Ameliorates Hypercholesterolemia But Not Obesity in Rats Fed a Lard-Based, High-Fat Diet. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 803:271-8. [DOI: 10.1007/978-3-319-15126-7_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
|
22
|
Kang MJ, Seo JS, Kim EM, Park MS, Woo MH, Ju DL, Wie GA, Lee SM, Cha JA, Sohn CM. Development of Job Standards for Clinical Nutrition Therapy for Dyslipidemia Patients. Clin Nutr Res 2015; 4:76-89. [PMID: 25954728 PMCID: PMC4418419 DOI: 10.7762/cnr.2015.4.2.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- Min-Jae Kang
- Department of Food and Nutrition, Wonkwang University, Iksan 570-749, Korea
| | - Jung-Sook Seo
- Department of Food and Nutrition, Yeungnam University, Gyeongsan 712-749, Korea
| | - Eun-Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul 110-746, Korea
| | - Mi-Sun Park
- Department of Food and Nutrition Care, Seoul National University Hospital, Seoul 110-744, Korea
| | - Mi-Hye Woo
- Department of Nutrition Team, Kyung Hee University Medical Center, Seoul 130-872, Korea
| | - Dal-Lae Ju
- Department of Food and Nutrition Care, Seoul National University Hospital, Seoul 110-744, Korea
| | - Gyung-Ah Wie
- Department of Clinical Nutrition, National Cancer Center, Goyang 410-769, Korea
| | - Song-Mi Lee
- Department of Nutrition, Gangnam Severance Hospital, Seoul 135-720, Korea
| | - Jin-A Cha
- Department of Korean Cuisine, Jeonju University, Jeonju 560-759, Korea
| | - Cheong-Min Sohn
- Department of Food and Nutrition, Wonkwang University, Iksan 570-749, Korea
| |
Collapse
|
23
|
Ogbera AO, Oshinaike OO, Dada O, Brodie-Mends A, Ekpebegh C. Glucose and lipid assessment in patients with acute stroke. Int Arch Med 2014; 7:45. [PMID: 25379056 PMCID: PMC4221686 DOI: 10.1186/1755-7682-7-45] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/28/2014] [Indexed: 01/04/2023] Open
Abstract
Background Stroke is a major health issue in Nigeria and it is also a common cause of emergency admissions. Stroke often results in increased morbidity, mortality and reduced quality of life in people thus affected. The risk factors for stroke include metabolic abnormalities such as dyslipidaemia and diabetes mellitus (DM). The stress of an acute stroke may present with hyperglycaemia and in persons without a prior history of DM, may be a pointer to stress hyperglycaemia or undiagnosed DM. Methodology This was a cross sectional study carried out over a period of one year in a teaching hospital in Lagos, Nigeria. Patients with acute stroke admitted to the hospital within three days of the episode of stroke and who met other inclusion criteria for the Study were consecutively recruited. Clinically relevant data was documented and biochemical assessments were carried out within three days of hospitalization. Tests for lipid profile, glycosylated haemoglobin(HbA1c), and blood glucose at presentation were carried out. The presence of past history of DM, undiagnosed DM, stress hyperglycaemia and abnormal lipid profile were noted. Students t test and Chi square were the statistical tests employed. Results A total of 137 persons with stroke were recruited of which 107 (76%) met the defining criteria for ischaemic stroke. The mean age and age range of the Study subjects were 62.2 (11.7) and 26–89 years respectively. The Study subjects were classified according to their glycaemic status into the following categories viz; stress hyperglycaemia, euglycaemia, DM and previously undiagnosed DM. Stress hyperglycaemia occurred commonly in the fifth decade of life and its incidence was comparable between those with cerebral and haemorrhagic stroke. The commonly occurring lipid abnormalities were elevated LDL-C and low HDL. Conclusions The detection of abnormal metabolic milieu is a window of opportunity for aggressive management in persons with stroke as this will improve outcome. Routine screening for hyperglycaemia in persons with stroke using glycosylated haemoglobin tests and blood glucose may uncover previously undiagnosed DM.
Collapse
Affiliation(s)
- Anthonia O Ogbera
- Department of Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Olajumoke O Oshinaike
- Department of Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Olusola Dada
- Department of Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ayodeji Brodie-Mends
- Department of Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Chukwuma Ekpebegh
- Department of Internal Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape Province South Africa
| |
Collapse
|
24
|
Lee NJ, Cho E, Bakken S. Identification of Hypertension Management-related Errors in a Personal Digital Assistant-based Clinical Log for Nurses in Advanced Practice Nurse Training. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 4:19-31. [PMID: 25030790 DOI: 10.1016/s1976-1317(10)60003-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 02/02/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purposes of this study were to develop a taxonomy for detection of errors related to hypertension management and to apply the taxonomy to retrospectively analyze the documentation of nurses in Advanced Practice Nurse (APN) training. METHOD We developed the Hypertension Diagnosis and Management Error Taxonomy and applied it in a sample of adult patient encounters (N = 15,862) that were documented in a personal digital assistant-based clinical log by registered nurses in APN training. We used Standard Query Language queries to retrieve hypertension-related data from the central database. The data were summarized using descriptive statistics. RESULT Blood pressure was documented in 77.5% (n = 12,297) of encounters; 21% had high blood pressure values. Missed diagnosis, incomplete diagnosis and misdiagnosis rates were 63.7%, 6.8% and 7.5% respectively. In terms of treatment, the omission rates were 17.9% for essential medications and 69.9% for essential patient teaching. Contraindicated anti-hypertensive medications were documented in 12% of encounters with co-occurring diagnoses of hypertension and asthma. CONCLUSION The Hypertension Diagnosis and Management Error Taxonomy was useful for identifying errors based on documentation in a clinical log. The results provide an initial understanding of the nature of errors associated with hypertension diagnosis and management of nurses in APN training. The information gained from this study can contribute to educational interventions that promote APN competencies in identification and management of hypertension as well as overall patient safety and informatics competencies.
Collapse
Affiliation(s)
- Nam-Ju Lee
- Full-time Instructor and Researcher, Research Institute of Nursing Science, Seoul National University College of Nursing, Seoul, Korea
| | - Eunhee Cho
- Assistant Professor and Researcher, Nursing Policy Research Institute Yonsei University College of Nursing, Seoul, Korea
| | - Suzanne Bakken
- Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University School of Nursing, New York, USA
| |
Collapse
|
25
|
Lima LO, Bruxel EM, Hutz MH, Van der Sand CR, Van der Sand LC, Ferreira MEW, Pires RC, Fiegenbaum M, Almeida S. Influence of PPARA, RXRA, NR1I2 and NR1I3 gene polymorphisms on the lipid-lowering efficacy and safety of statin therapy. ACTA ACUST UNITED AC 2013; 57:513-9. [DOI: 10.1590/s0004-27302013000700003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/05/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The aim of the present study was investigate the association between six genetic variants in the nuclear receptor genes PPARA, RXRA, NR1I2 and NR1I3 and the lipid-lowering efficacy and safety of statin therapy. SUBJECTS AND METHODS: The study was carried out on 240 Brazilian hypercholesterolemic patients on simvastatin and atorvastatin therapy. The polymorphisms were analyzed by PCR-based methods. RESULTS: The NR1I3 rs2307424 genotype distribution was different between subjects with and without adverse drug reactions. Among subjects in the ADR group, no T/T homozygotes were observed for this polymorphism, while in the non-ADR group the frequency of this genotype was 19.4% (P = 0.007, after multiple testing corrections P = 0.042). CONCLUSION: The polymorphisms investigated in PPARA (rs1800206), RXRA (rs11381416), and NR1I2 (rs1523130) did not influence the lipid-lowering efficacy and safety of statin. Our results show the possible influence of NR1I3 genetic variant on the safety of statin.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Marilu Fiegenbaum
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil; Centro Universitário Metodista do IPA, Brasil
| | - Silvana Almeida
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
| |
Collapse
|
26
|
Kim JH, Zamorano J, Erdine S, Pavia A, Al-Khadra A, Sutradhar S, Yunis C. Reduction in cardiovascular risk using proactive multifactorial intervention versus usual care in younger (< 65 years) and older (≥ 65 years) patients in the CRUCIAL trial. Curr Med Res Opin 2013; 29:453-63. [PMID: 23448581 DOI: 10.1185/03007995.2013.781503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the reduction in calculated Framingham 10 year coronary heart disease (CHD) risk after 52 weeks' intervention with a proactive multifactorial intervention (PMI) strategy (based on single-pill amlodipine/atorvastatin [SPAA]) versus continuing usual care (UC) (based on investigators' best clinical judgment) among younger (<65 years) and older (≥ 65 years) patients. RESEARCH DESIGN AND METHODS Sub-analysis of the Cluster Randomized Usual Care versus Caduet Investigation Assessing Long-term risk (CRUCIAL) trial. Eligible patients had hypertension and ≥ 3 cardiovascular risk factors. MAIN OUTCOME MEASURE Treatment-related reduction in calculated Framingham 10 year CHD risk between baseline and Week 52 in younger and older patients. RESULTS Nine hundred patients (63.5%) were <65 years (mean age 54.2 years, 57.4% men) and 517 patients (36.5%) were ≥ 65 years (mean age 70.5 years, 42.7% men). Younger patients had lower mean baseline CHD risk versus older patients (17.1% vs. 22.6%). A greater reduction in calculated CHD risk at Week 52 was observed in the PMI versus the UC arm in both younger (-33.2% vs. -2.9%, p < 0.001) and older (-32.7% vs. -5.7%, p < 0.001) patients. Least-squares mean treatment differences (PMI vs. UC) in percentage change from baseline in calculated CHD risk were similar in younger and older patients (-26.3% vs. -25.7%, age interaction p = 0.887). CHD risk reduction was slightly greater among younger men than younger women (-29.3 vs. -23.9, gender interaction p = 0.062). A low proportion of patients discontinued the PMI strategy due to adverse events in both age groups (5.8% vs. 6.1%, respectively). Study limitations included ad-hoc (not pre-specified) sub-group analysis and short duration of follow-up. CONCLUSIONS The PMI strategy based on the inclusion of SPAA in the treatment regimen is more effective than UC in reducing calculated CHD risk. This strategy may be considered as the treatment of choice in younger and older hypertensive patients with additional cardiovascular risk factors.
Collapse
Affiliation(s)
- Jae-Hyung Kim
- St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | | | | | | | | | | | | |
Collapse
|
27
|
Senesael E, Borgermans L, Van De Vijver E, Devroey D. Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: are patients responsive to information and encouragement by mail or post? Vasc Health Risk Manag 2013; 9:13-20. [PMID: 23426275 PMCID: PMC3576014 DOI: 10.2147/vhrm.s39919] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction There is important evidence on the beneficial effects of treatment of cardiovascular risk factors in terms of morbidity and mortality, but important challenges remain in motivating patients to adhere to their treatment regimen. This study aimed to describe the effectiveness of a quality improvement intervention that included information and regular encouragement by email or letter on cardiovascular risk factors for patients at high risk for cardiovascular disease. Methods This randomized single-blind study included patients of both sexes aged between 45 and 80 years old who had increased cardiovascular risk. Patients were randomly allocated to either a usual care group (UCG) or advanced care group (ACG). Patients in the UCG received regular care while patients in the ACG received usual care plus regular information and encouragement on cardiovascular risk factors by email or letter. Visits for both groups were planned at 0, 3, and 6 months. The outcome measures were blood pressure, weight, body mass index (BMI), waist circumference (WC), and smoking status. Results Out of 178 eligible patients from one single primary care practice, 55 participated in the study, three of whom dropped out. After 6 months, there was a significant decrease in mean systolic and diastolic blood pressure in the UCG and ACG (P < 0.05). The decreases were already significant after 3 months, except for systolic blood pressure in the UCG. There was also a significant increase in the proportion of patients who met the target values for blood pressure in the UCG and ACG. There was a nonsignificant decrease of the average weight in the ACG, but significantly more patients lost weight in the UCG (P = 0.02). BMI, WC, and smoking status did not change in either group. Conclusion This study found that there was a significant decrease of systolic and diastolic blood pressure in both study groups. Weight, BMI, WC, and smoking did not improve in either group. Information on cardiovascular risk factors and encouragement by means of letters or email did not provide additional benefits. Thus, effective patient empowerment probably requires more behaviorally sophisticated support to increase self-management, self-efficacy, and self-esteem in patients.
Collapse
Affiliation(s)
- Ellie Senesael
- Department of Family Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | |
Collapse
|
28
|
Devroey D, Senesael E, Moerenhout T, Van De Vijver E, Vandevoorde J. Follow-up of a cardiovascular prevention campaign. Cent Eur J Public Health 2012; 19:190-6. [PMID: 22432393 DOI: 10.21101/cejph.a3656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate the cardiovascular risk (CVR) factors and morbidity in a sample of the population that received a brief intervention on cardiovascular prevention seven years ago. All family physicians who participated in the Cardiovascular Prevention Campaign in five Belgian towns in 2002-2003 received a follow-up questionnaire for each participating patient. The questionnaire included questions about new cardiovascular diagnoses, parameters of the latest physical examination and blood tests. Analyses were based on the 318 questionnaires that included essential information such as the date of the latest contact and the new diagnosis or mortality. The proportion of patients with a low CVR decreased from 75% in 2002-2003 to 40% in 2010. Participants showed a significant increase of the abdominal circumference, triglycerides and fasting glycaemia. Only LDL-cholesterol levels decreased significantly (p = 0.002). Four percent of the patients died, more male (7 ) than female (2%) (p = 0.03). One in ten patients presented with a cardiovascular event. Most of the changes are probably attributable to age. It is clear that the long-term effect of a brief intervention only followed by usual care is not sufficient to attain optimal level of cardiovascular prevention.
Collapse
Affiliation(s)
- Dirk Devroey
- Department of Family Medicine, University of Brussels (VUB), Brussels, Belgium.
| | | | | | | | | |
Collapse
|
29
|
Does Nurse Case Management Improve Implementation of Guidelines for Cardiovascular Disease Risk Reduction? J Cardiovasc Nurs 2011; 26:145-67. [DOI: 10.1097/jcn.0b013e3181ec1337] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
30
|
Lee JWY, Lee BS, Lee JY, Ku HJ, Jeon SR, Kim JY, Ban JM, Sung SH, Shin HM, Park JE. The herbal extract HMC05 inhibits neointima formation in balloon-injured rat carotid arteries: possible therapeutic implications of HMC05. JOURNAL OF ETHNOPHARMACOLOGY 2011; 133:168-176. [PMID: 20883768 DOI: 10.1016/j.jep.2010.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/27/2010] [Accepted: 09/17/2010] [Indexed: 05/29/2023]
Abstract
AIM OF THE STUDY In a previous study, HMC05, a water extract from eight medicinal herbs was demonstrated to possess anti-inflammatory effects in murine macrophages and anti-atherosclerotic effects in apoE(-/-) mice. HSP27 expression was shown to be decreased in advanced atherosclerotic plaques of human carotid arteries. In the present study, the role of HMC05 in the prevention of restenosis and the possible mechanisms involved in the decrease of neointima formation were investigated using in vivo balloon injury rat model and in vitro biochemical assays. MATERIALS AND METHODS A rat carotid artery balloon injury restenosis model was used. Different doses of HMC05 were administered to the rats by tube feeding, starting from four days before surgery and continuing twice per week for two weeks after carotid injury. Injured carotid arteries isolated from rats were embedded in paraffin block and tissue sections were stained with H&E to assess neointima formation. Mechanism by HMC05 that are involved in smooth muscle cell proliferation and migration was assessed by western blot assay, immunohistochemistry and confocal analysis. RESULTS There was no significant difference in the medial area between the control and HMC05-treated groups. However, neointima formation was significantly inhibited in the HMC05-treated group, resulting in 47-fold lower intima to media ratios in rats treated with 25 mg/kg/day HMC05 as compared to the control. Surprisingly, monocytes infiltration in the neointima area was almost completely blocked by HMC05 administration. When rat vascular SMCs were treated with HMC05, the proliferation and migration of smooth muscle cells was dramatically inhibited in a dye uptake assay and in a scratch model in a culture dish, respectively. HMC05 dose-dependently inhibited PDGF-mediated MAPK and AKT activation. However, HMC05 did not affect PDGF-mediated HSP27 phosphorylation but it induced HSP27 overexpression and phosphorylation. In addition, medial SMCs in the arterial wall of rats treated with HMC05 showed a significant increase in HSP27 expression compared with that of the control rats. CONCLUSIONS HMC05, a strong anti-inflammatory reagent, might use HSP27 as an effector molecule in SMCs to reduce neointimal hyperplasia by inhibiting PDGF-mediated MAPK and AKT activation. HMC05 could be a useful drug candidate for the prevention of restenosis after balloon injury of the arteries.
Collapse
MESH Headings
- Animals
- Anti-Inflammatory Agents/pharmacology
- Becaplermin
- Carotid Arteries/drug effects
- Carotid Arteries/metabolism
- Carotid Artery Injuries/pathology
- Catheterization
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Coronary Restenosis/prevention & control
- Disease Models, Animal
- HSP27 Heat-Shock Proteins/metabolism
- Humans
- Male
- Mice
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Neointima/prevention & control
- Phytotherapy
- Plant Extracts/pharmacology
- Plants, Medicinal
- Plaque, Atherosclerotic/pathology
- Plaque, Atherosclerotic/prevention & control
- Platelet-Derived Growth Factor/metabolism
- Proto-Oncogene Proteins c-sis
- Rats
- Signal Transduction
Collapse
Affiliation(s)
- Jo Woon Yi Lee
- Division of Cardiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Masterson E, Patel P, Kuo YH, Francis CK. Quality of cardiovascular care in an internal medicine resident clinic. J Grad Med Educ 2010; 2:467-73. [PMID: 21976100 PMCID: PMC2951791 DOI: 10.4300/jgme-d-10-00030.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/13/2010] [Accepted: 06/07/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Attainment of treatment goals derived from evidence-based practice guidelines can be a useful measure of the quality of cardiovascular care. To date, there are few studies of the quality of care provided in a resident continuity clinic, as measured by success in meeting nationally defined guidelines for control of cardiovascular risk factors. There also is limited information regarding the quality of care in resident continuity clinics serving multiethnic uninsured/underinsured populations. This study assessed the efficacy of residents in internal medicine in attaining evidence-based, guideline-defined treatment goals for control of hypertension, dyslipidemia, and hyperglycemia in an uninsured/underinsured multiethnic population. METHODS In a cross-sectional study of patients treated exclusively by residents (with faculty supervision) between July 1 and December 31, 2005, data were abstracted from the medical records of 628 consecutive patients (mean age, 55.6 years; 62% female; 61.3% non-white; 55.5% uninsured) with hypertension, hyperlipidemia, and/or diabetes mellitus. Quality measures were the proportion of diabetic and nondiabetic patients who met guideline-defined treatment goals for hypertension, dyslipidemia, and hyperglycemia in diabetic patients. RESULTS Goal attainment overall was 44.9% for high blood pressure, 55.7% for dyslipidemia, and 43.3% for hemoglobin A(1c) for diabetic patients. There was no relationship between age, gender, race/ethnicity, insurance, or body weight to attainment of hypertension, dyslipidemia, or hemoglobin A(1c) goals in diabetic and nondiabetic cohorts from multivariate analysis. Risk factor control rates were higher in this study than in comparable educational programs. CONCLUSION An internal medicine resident continuity clinic can provide high-quality care that meets guideline-defined cardiovascular risk factor control goals in a racially and ethnically diverse, underinsured/uninsured, low-income population in a community-based academic medical center.
Collapse
Affiliation(s)
- Eileen Masterson
- Corresponding author: Eileen Masterson, MD, PhD, Director, Medical Ambulatory Care, Department of Medicine, 1945 State Route 33, P.O. Box 397, Neptune, NJ 07754-0397, 732.776.4420,
| | | | | | | |
Collapse
|
32
|
Bakhireva LN, Shainline MR, Carter S, Robinson S, Beaton SJ, Nawarskas JJ, Gunter MJ. Synergistic Effect of Statins and Postmenopausal Hormone Therapy in the Prevention of Skeletal Fractures in Elderly Women. Pharmacotherapy 2010; 30:879-87. [DOI: 10.1592/phco.30.9.879] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
33
|
Antihypertensive Treatment, High Triglycerides, and Low High-Density Lipoprotein Cholesterol and Risk of Ischemic Heart Disease Mortality: A 16-Year Follow-Up in the Copenhagen Male Study. Metab Syndr Relat Disord 2010; 8:215-22. [DOI: 10.1089/met.2009.0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
34
|
Effect of pomegranate seed oil on hyperlipidaemic subjects: a double-blind placebo-controlled clinical trial. Br J Nutr 2010; 104:402-6. [PMID: 20334708 DOI: 10.1017/s0007114510000504] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In vitro and in vivo studies have shown that punicic acid, a type of conjugated fatty acid and the main constituent of pomegranate seed oil (PSO), has anti-atherogenic effects. The present study aimed at determining the effect of PSO treatment on serum lipid profiles. This double-blind placebo-controlled randomised clinical trial included fifty-one hyperlipidaemic subjects, diagnosed according to National Cholesterol Education Program definition, and randomly assigned to the PSO and the control groups. The PSO and placebo groups received 400 mg PSO and placebo twice daily, respectively and were followed up for 4 weeks. Serum concentrations of lipids and lipoproteins were measured before and 4 weeks after intervention. Mean concentration of TAG and the TAG:HDL cholesterol (HDL-C) ratio were significantly decreased after 4 weeks in the PSO group as compared with baseline values (2.75 (sd 1.40) v. 3.45 (sd 1.56) mmol/l, P = 0.009 and 5.7 (sd 4.6) v. 7.5 (sd 5.0), P = 0.031, respectively). The treatment effect was statistically significant in the PSO group as compared with controls in diminution of cholesterol:HDL-C ratio (5.4 (sd 1.5) v. 5.9 (sd 1.4), P < 0.05) adjusted for baseline values. We found a mean difference for PSO v. placebo in HDL-C concentration (0.13 v. - 0.02 mmol/l) and cholesterol:HDL-C ratio ( - 0.42 v. 0.01, P < 0.05). Serum cholesterol, LDL cholesterol and glucose concentrations and body composition variables remained unchanged. It is concluded that administration of PSO for 4 weeks in hyperlipidaemic subjects had favourable effects on lipid profiles including TAG and TAG:HDL-C ratio.
Collapse
|
35
|
Aslam F, Haque A, Lee V, Foody J. Patient adherence and preference considerations in managing cardiovascular risk: focus on single pill and amlodipine/atorvastatin fixed combination. Patient Prefer Adherence 2009; 3:61-6. [PMID: 19936146 PMCID: PMC2778438 DOI: 10.2147/ppa.s4201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiovascular disease (CVD) accounts for in excess of 930,000 deaths in the United States each year. Risk factors for CVD often co-exist. Studies estimate that over half of the hypertensive population also has dyslipidemia. Observational data suggest that fewer than 10% of patients attain recommended therapeutic targets for both conditions. A variety of patient, regimen and system characteristics have been associated with the risk for non-adherence. Poly-pharmacy and complex drug regimens are associated with poor patient adherence and thus the use of fixed-dose combination therapies, may improve adherence by reducing the pill burden. The fixed-dose combination of amlodipine/atorvastatin offers a convenient and effective approach to manage two important CVD risk factors. The combination of amlodipine/atorvastatin has a synergistic effect. The half-life of both agents facilitates once-daily dosing and both can be administered at any time of the day with or without food. Amlodipine/atorvastatin combined pill can be used to initiate both agents or patients can be switched directly from single-agent therapy with one or both agents. The convenience of single-pill amlodipine/atorvastatin has the potential to improve patient adherence and the management of cardiovascular risk in selected patients, thereby improving clinical outcomes.
Collapse
Affiliation(s)
- Farhan Aslam
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Attiya Haque
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Veronica Lee
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - JoAnne Foody
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
36
|
Liew D, Park HJ, Ko SK. Results of a Markov model analysis to assess the cost-effectiveness of a single tablet of fixed-dose amlodipine and atorvastatin for the primary prevention of cardiovascular disease in Korea. Clin Ther 2009; 31:2189-203; discussion 2150-1. [DOI: 10.1016/j.clinthera.2009.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
|
37
|
Chapman RH, Petrilla AA, Berman L, Benner JS, Tang SS. Are High-Risk Hypertensive Patients being Prescribed Concomitant Statin Therapy? Am J Cardiovasc Drugs 2009; 9:299-308. [DOI: 10.2165/11312110-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
38
|
CROWE TC, SHABANI M, BROCKBANK CM. Dietary portfolio approach to reducing the risk of cardiovascular disease: The Polymeal revisited. Nutr Diet 2009. [DOI: 10.1111/j.1747-0080.2009.01361.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
39
|
Nichol MB, Knight TK, Wu J, Tang SSK, Cherry SB, Benner JS, Hussein M. Transition probabilities and predictors of adherence in a California Medicaid population using antihypertensive and lipid-lowering medications. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:544-550. [PMID: 19138308 DOI: 10.1111/j.1524-4733.2008.00474.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To determine adherence rates, transition probabilities, and factors associated with transition from higher to lower adherence in antihypertensive (AH) and lipid-lowering (LL) medications. METHODS California Medicaid data (1995-2003) were used to identify hypertensive patients with prescriptions for both AH and LL medications. Proportion of days covered (PDC) was used to define three adherence classifications: fully adherent (FA, PDC >or= 0.8), partially adherent (PA, 0.2 <or= PDC < 0.8), and nonadherent (NA, PDC < 0.2). Annual transition matrices documented the probability of adherence status changes. RESULTS Only 13% of the 5943 patients were FA to both drugs at baseline. Patients who were FA (60%) or NA (84%) to both drugs had high probability of maintaining status at year two (Y2). Significant variables associated with a transition from adherent to NA at Y2 included African American race (odds ratio [OR] 1.5), other race groups (OR 1.2), lack of Medicare eligibility (OR 1.3), and initiating LL therapy of fibric acid derivatives (OR 1.3) or niacin (OR 1.8). CONCLUSIONS Patients FA or NA with both drugs at baseline were more likely to maintain their adherence status. Race, insurance coverage, and type of LL medication were significantly associated with transitioning from any adherence status to nonadherence. These findings may be useful in guiding cost-effectiveness analyses incorporating adherence estimates.
Collapse
Affiliation(s)
- Michael B Nichol
- Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA 90033, USA.
| | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Highly active antiretroviral therapy (HAART) has significantly improved the prognosis for many individuals with HIV infection. Consequently, HIV infection has become a chronic and manageable disease. The focus on long-term management of patients with HIV infection has broadened to include comorbid conditions, most notably cardiovascular disease. Patients with HIV infection share many cardiovascular risk factors with the general population, and HIV infection itself may increase cardiovascular risk. Changes in lipid profiles associated with increased cardiovascular risk that have been observed with some HAART regimens have been a cause for concern among clinicians who treat HIV-infected patients. However, the lipid effects of HAART seem to depend on the type and duration of regimens employed. They can be managed effectively according to current guidelines that recommend lifestyle changes (eg, improved diet, increased exercise, smoking cessation) and pharmacologic therapy described in established treatment paradigms for patients on antiretroviral therapy and similar to measures currently used by the general population. A review of the clinical data indicates that the virologic and immunologic benefits of HAART clearly outweigh any metabolic effects observed in some patients over time and that preexisting, established cardiovascular risk factors contribute significantly to the potential development of cardiovascular events. These benefits of antiretroviral therapy have been demonstrated in studies comparing the superior efficacy of continuous vs. intermittent HAART.
Collapse
|
41
|
Schnoes KK, Jaffe IZ, Iyer L, Dabreo A, Aronovitz M, Newfell B, Hansen U, Rosano G, Mendelsohn ME. Rapid recruitment of temporally distinct vascular gene sets by estrogen. Mol Endocrinol 2008; 22:2544-56. [PMID: 18787042 DOI: 10.1210/me.2008-0044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Cardiovascular disease is the leading cause of mortality for both men and women in developed countries. The sex steroid hormone estrogen is required for normal vascular physiology. Estrogen functions by binding to intracellular estrogen receptors (ER), ERalpha and ERbeta, ligand-activated transcription factors that are expressed in both vascular endothelial and smooth muscle cells. We recently demonstrated that long-term (8 d) estrogen treatment in vivo in mice recruits distinct vascular gene sets mediated by ERalpha and ERbeta and that the promoters from these gene sets are enriched for binding sites of specific transcription factors, leading to the hypothesis that estrogen initiates a cascade of early transcriptional events that modulate gene expression in the vasculature. Here we test this hypothesis using gene expression profiling to examine initial transcriptional events (2-8 h) mediated by estrogen in blood vessels. Our data reveal that 1) estrogen regulates temporally distinct cascades of vascular gene expression, 2) initially, estrogen-mediated vascular gene repression predominates, 3) the earliest estrogen-recruited gene program is enriched in vascular transcription factors that can interact with binding sites present in estrogen-regulated vascular genes recruited subsequently, and 4) estrogen-regulated genes recruited next have specific functions, including lipid metabolism and cellular growth and proliferation that are potentially important for estrogen's known vascular functions. In summary, estrogen directly and rapidly recruits specific transcriptional factors that then propagate distinct cascades of gene expression. These data define the temporal recruitment of specific vascular genes by estrogen and enable further analysis of the mechanisms by which estrogen directly regulates vascular function.
Collapse
Affiliation(s)
- Katrin K Schnoes
- Molecular Cardiology Research Institute, Tufts Medical Center, 800 Washington Street, Box 080, Boston, Massachusetts 02111, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Bibliography. Current world literature. Imaging and echocardiography. Curr Opin Cardiol 2008; 23:512-5. [PMID: 18670264 DOI: 10.1097/hco.0b013e32830d843f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
McKeage K, Siddiqui MAA. Amlodipine/atorvastatin fixed-dose combination: a review of its use in the prevention of cardiovascular disease and in the treatment of hypertension and dyslipidemia. Am J Cardiovasc Drugs 2008; 8:51-67. [PMID: 18303938 DOI: 10.2165/00129784-200808010-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Amlodipine/atorvastatin (Caduet) is a once-daily fixed-dose combination of the dihydropyridine calcium channel antagonist amlodipine and the HMG-CoA reductase inhibitor atorvastatin. In Europe, the combination is indicated for the prevention of cardiovascular events in hypertensive patients with three concomitant cardiovascular risk factors and, in the US, it is indicated for the management of hypertension and dyslipidemia in patients for whom treatment with both agents is appropriate. In clinical trials, the fixed-dose combination of amlodipine/atorvastatin effectively managed two important risk factors simultaneously in hypertensive patients at risk of cardiovascular disease or in those with concomitant hypertension and dyslipidemia. The combination is bioequivalent to amlodipine and atorvastatin given alone and does not modify the efficacy of either single agent. Amlodipine/atorvastatin is generally well tolerated, with a tolerability profile consistent with that of each single agent. Compared with the coadministration of each single agent, the convenience of single-pill amlodipine/atorvastatin has the potential to improve patient adherence and the management of cardiovascular risk in selected patients, thereby improving clinical outcomes.
Collapse
Affiliation(s)
- Kate McKeage
- Wolters Kluwer Health, Adis, Auckland, New Zealand.
| | | |
Collapse
|
44
|
Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2008; 15:193-207. [PMID: 18316957 DOI: 10.1097/med.0b013e3282fba8b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
Zhu JR, Tomlinson B, Ro YM, Sim KH, Lee YT, Sriratanasathavorn C. A randomised study comparing the efficacy and safety of rosuvastatin with atorvastatin for achieving lipid goals in clinical practice in Asian patients at high risk of cardiovascular disease (DISCOVERY-Asia study). Curr Med Res Opin 2007; 23:3055-68. [PMID: 18196620 DOI: 10.1185/030079907x242809] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most studies investigating the benefits of statins have focused on North American and European populations. This study focuses on evaluating the lipid-lowering effects of rosuvastatin and atorvastatin in Asian patients. OBJECTIVES The DIrect Statin COmparison of LDL-C Values: an Evaluation of Rosuvastatin therapY (DISCOVERY)-Asia study is one of nine independently powered studies assessing the efficacy of starting doses of statins in achieving target lipid levels in different countries worldwide. DISCOVERY-Asia was a 12-week, randomised, open-label, parallel-group study conducted in China, Hong Kong, Korea, Malaysia, Taiwan, and Thailand. RESULTS A total of 1482 adults with primary hypercholesterolaemia and high cardiovascular risk (> 20%/10 years, type 2 diabetes, or a history of coronary heart disease) were randomised in a 2 : 1 ratio to receive rosuvastatin 10 mg once daily (o.d.) or atorvastatin 10 mg o.d. The percentage of patients achieving the 1998 European Joint Task Force low-density lipoprotein cholesterol (LDL-C) goal of < 3.0 mmol/L at 12 weeks was significantly higher in the rosuvastatin group (n = 950) compared with the atorvastatin group (n = 471) (79.5 vs. 69.4%, respectively; p < 0.0001). Similar results were observed for 1998 European goals for total cholesterol (TC), and the 2003 European goals for LDL-C and TC. LDL-C and TC levels were reduced significantly more with rosuvastatin compared with atorvastatin. Both drugs were well-tolerated and the incidence and type of adverse events were similar in each group. TRIALS REGISTRATION The trial registry summary is available at http://www.clinicaltrials.gov/; ClinicalTrials.gov Identifier: NCT00241488 CONCLUSIONS This 12-week study showed that the starting dose of rosuvastatin 10 mg o.d. was significantly more effective than the starting dose of natorvastatin 10 mg o.d. at enabling patients with primary hypercholesterolaemia to achieve European goals for LDL-C and TC in a largely Asian population in real-life clinical practice. The safety profile of rosuvastatin 10 mg is similar to that of atorvastatin 10 mg in the Asian population studied here, and is consistent with the known safety profile of rosuvastatin in the white population.
Collapse
Affiliation(s)
- Jun-ren Zhu
- Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | | | | | | |
Collapse
|