Coexistence Of Hypercholesterolemia Research Articles

Evaluation of Counseling Practices and Patient's Satisfaction Offered by Pharmacists for Diabetics Attending Outpatient Pharmacies in Al Ahsa.

Introduction:Patient counseling can be helpful in improving the outcome of disease management, particularly chronic diseases such as diabetes mellitus, which is common in Saudi Arabia. The present study looks to investigate the levels of counseling and satisfaction among patients attending diabetic clinics in outpatient hospital pharmacy in Al Ahsa, Saudi Arabia.Method:This is a cross-sectional investigation, carried out by using interview-structured questionnaire, targeting diabetes mellitus patients with or without comorbid states. The questionnaire was divided into 3 parts comprising of demographics, counseling types given while collecting prescription, and satisfaction rating of services provided.Result:More males than females participated; most of whom were college graduates older than 51 years. Sixty-three percent of the entire participants are type 1 diabetic patients, while 37% are type 2 diabetes mellitus patients. Coexistence of hypercholesterolemia was higher among type 1 diabetes patients with 51.9%, while hypertension was more common among type 2 diabetic patients representing 68.2%. Findings also showed that counseling was provided for medication use among type 1 diabetic patients but was deficient in the case of type 2 diabetic patients. Patients received low level of counseling on side effects and healthy lifestyle living. Satisfaction level was only 11.1%, indicating that counseling services might be deficient.Conclusion:This study has revealed poor counseling practices and low satisfaction levels in services provided by outpatient hospital pharmacies to diabetic patients. In the face of increasing prevalence of diabetes and comorbidity, counseling of diabetic patients is critical.

Relationship between body composition and both cardiovascular risk factors and lung function in systemic sclerosis

The aims of this study were to evaluate body composition in systemic sclerosis (SSc) and to assess its association with the traditional risk factors for atherosclerosis and parameters of lung function. Eighty-six patients affected by SSc (13 men and 73 women, mean age 58.5years, mean disease duration 10.7years, 31 with diffuse form and 55 with limited pattern) underwent evaluation of body composition using a dual-energy X-ray (DXA) fan beam densitometer (GE Lunar iDXA) in order to assess total and regional body fat mass and fat-free mass. Clinical features, pulmonary function parameters, and the concomitant presence of the traditional cardiovascular risk factors were recorded. Android fat resulted to be higher in SSc patients with coexistence of hypercholesterolemia (P = 0.021), hypertension (P = 0.028), and overweight/obesity (P < 0.001) and positively correlated with body mass index (P < 0.001). Forced vital capacity (FVC) was inversely correlated with android fat (P = 0.034) and with the android fat/gynoid fat ratio (P = 0.013) and positively correlated with android lean (P = 0.041); the correlations were improved when FVC data were adjusted for sex, age, disease duration, and smoking habits (P = 0.010 for android fat, P = 0.010 for android fat/gynoid fat ratio, P = 0.011 for android lean). In this study, we showed that visceral abdominal fat, measured by DXA, is correlated with the main cardiovascular risk factors and lung volumes in SSc patients. Longitudinal studies are needed to evaluate if decrease of abdominal fat would improve lung function.

Comorbidities associated with Egyptian diabetic foot disease subtypes

Abstract Introduction Diabetic foot problems are highly prevalent, responsible for almost 50% of all diabetes-related hospital admissions and a 10-year reduction in life expectancy. The main factors involved in the pathology of diabetic foot are neuropathy, ischemia, and infection. The comorbidities of diabetes are hypertension, obesity, and dyslipidemia. Because of the huge premature morbidity and mortality associated with diabetes, prevention of complications is a key issue and, therefore, it is essential to understand the basic mechanisms that lead to tissue damage. Aim of the work The aim of our study was to detect the association between patient comorbidities, chronic complications, and different diabetic foot types for the early detection and management of these conditions. Patients We carried out a cross-sectional study of 80 consecutive outpatient Egyptian patients with diabetic foot disease in the National Institute of Diabetes and Endocrinology. Results Sixty-three percent were purely neuropathic, followed by 19% that were neuroischemic, whereas 18% were of the ischemic type. Hypertension is the most common comorbid condition and coronary artery disease is highly prevalent in the ischemic and neuroischemic types. The coexistence of hypercholesterolemia, smoking, diabetes, and male sex appears to significantly increase the incidence of ischemic diabetic foot. Nephropathy and retinopathy are significantly associated with neuropathic foot ulcers. Hypertriglyceridemia correlates positively to ischemic and neuroischemic ulcers whereas low HDL and proteinuria correlate positively to both neuropathic and neuroischemic ulcers. Conclusion Special attention should be paid toward the identification of patients who are at risk of foot ulceration to help prevent foot problems. Comorbid conditions must also be identified early and managed aggressively.

Obesity and Hypercholesterolemia are Associated with NOX2 Generated Oxidative Stress and Arterial Dysfunction

To analyze the interplay among oxidative stress, NOX2, the catalytic core of nicotinamide-adenine dinucleotide phosphate oxidase, and endothelial dysfunction in children with obesity and/or hypercholesterolemia. We performed a cross-sectional study comparing flow-mediated arterial dilation (FMD), oxidized low-density lipoprotein, and urinary excretion of isoprostanes (8-iso-PGF2α), as markers of oxidative stress, and NOX2 activity, as assessed by blood levels of soluble NOX2-dp (sNOX2-dp), in a population of 100 children, matched for age and sex, including 40 healthy subjects (HS), 20 children with hypercholesterolemia (HC), 20 obese children (OC), and 20 children with coexistence of hypercholesterolemia and obesity (HOC). HOC had higher sNOX2-dp and oxidized low-density lipoprotein levels compared with HS, HC, and OC. HC, OC, and HOC had lower FMD values compared with HS. Urinary 8-iso-PGF2α excretion was higher in HOC compared with HS. FMD was inversely correlated with sNOX2-dp levels (r = -0.483; P < .001) and with the number of cardiovascular risk factors (r = -0.617; P < .001). Multiple linear regression analysis showed that the number of cardiovascular risk factors was the only independent predictive variable associated with FMD (β: -0.585; P < .001; R(2) = 35%) and sNOX2-dp (β: 0.587; P < .001; R(2) = 34%). The study suggests that NOX2-generating oxidative stress may have a pathogenic role in the functional changes of the arterial wall occurring in HOC.

Abstract 1667: Angiotensin II and Free Cholesterol Synergistically Impaired eNOS Bioavailability via Lipid Raft

Both hypercholesterolemia and angiotensin II (Ang II) are potent factors inducing endothelial dysfunction that leads to atherosclerosis. It has been reported that coexistence of hypercho-lesterolemia and Ang II accelerates atherogenesis markedly. Several studies showed that elevated cellular cholesterol affected cellular function by modifying lipid raft. We investigated the contribution of lipid raft to bridging hypercholesterolemia and Ang II in endothelial cells. Free cholesterol (Chol) loading induced 2–3 fold increase in cellular cholesterol content. Co-treatment of Ang II and Chol markedly impaired eNOS phosphorylation and dimerization than Chol or Ang II loading alone. This inactivation of eNOS corresponded to eNOS translocation to Chol-rich fractions in density centrifugation. In this fraction, eNOS phosphorylation and dimerization were markedly suppressed. Olmesartan or ROS inhibitor suppressed this eNOS trafficking and reversed the impairment of eNOS bioavailability. In immunohistochemistry, the target of this eNOS trafficking was identified as Chol-rich vesicle structure at the perinuclear area and those were fused with lysosomal membrane associated protein-1 (LAMP-1), a lysosome marker, labeled endosome. These results suggested that in cholesterol enriched condition, AngII induced eNOS trafficking to Chol-rich vesicles that were fused with lysosome at the perinuclear area and keeps eNOS inactive. We next investigated the association between these Chol-rich vesicles and lipid raft. GM1, phospho-caveilin1 and Rac, which are all lipid raft actors, also shifted to Chol-rich fractions in density centrifugation and assembled at LAMP-1 labeled endosome at the perinuclear area after Ang II and Chol loading. Therefore, LAMP-1 labeled endosome was considered to be the intracellular target of lipid raft in that condition. In electron microscopy, Chol-rich vesicles corresponded to multivesicular bodies and these converged to lysosome with Ang II addition, which were consistent with immunohistochemical findings. These studies show the important crosstalk between AngII and Chol signaling leading to endothelial dysfunction and provide a novel insight into the mechanisms of endothelial dysfunction by hypercholesterolemia.

Hypercholesterolemia and Smoking Habits of Lithuanian Military Personnel

To investigate the prevalence of risk factors for cardiovascular disease, namely, hypercholesterolemia and current smoking, among 25- to 54-year-old men and women among Lithuanian active duty military personnel. Serum cholesterol levels were measured enzymatically for 200 persons (126 men and 74 women). Interviews regarding smoking habits were performed for 82.5% of those persons (98 men and 67 women). Hypercholesterolemia (total cholesterol level of > or = 6.2 mmol/L) was determined for 45.2% of men and 40.5% of women. After distribution of men and women into three age groups (25-34, 35-44, and 45-54 years), it was determined that the rate of hypercholesterolemia increased with age (among groups of men, 29.6%, 46.7%, and 74.0%; among groups of women, 18.8%, 51.5%, and 40.0%, respectively). The proportion of current smokers among men was 2.6 times higher than that among women (45.9% vs. 17.9%; p < 0.001). The highest rate of current smoking was in the 35- to 44-year group of men (64.5%). The coexistence of hypercholesterolemia and current smoking among men was 3.1 times higher than that among women (23.5% vs. 7.5%; p < 0.01). The highest rates of current smoking with hypercholesterolemia were in the 35- to 44-year and 45- to 54-year groups of men (32.2% and 31.8%, respectively). The data demonstrated a relatively high rate (32.1%) of coexistence of two independent risk factors for cardiovascular disease (hypercholesterolemia and current smoking) among men 35 to 54 years of age from Lithuanian military personnel.

Plasma profiles of peripheral monocyte-related inflammatory markers in patients with arterial hypertension. Correlations with plasma endothelin-1

Background: This study investigates the plasma activity of inflammatory mediators such as granulocyte-macrophage colony-stimulating factor (GM-CSF), C-C chemokines and soluble adhesion molecules, produced by monocyte–endothelial cell adhesive interaction, in patients with arterial hypertension. Methods: We studied 66 untreated patients with mild to moderate arterial hypertension (hypercholesterolemic: 34, normocholesterolemic: 32) and 30 sex- and age-matched normocholesterolemic normotensive controls. Plasma concentrations of GM-CSF, macrophage chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), RANTES (regulated on activation normally T-cell expressed and secreted), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1), as well as plasma endothelin-1 (ET-1), were determined in study population by ELISA and RIA, respectively. Results: Hypertensives exhibited significantly higher levels of GM-CSF (6.5±1.3 vs. 2.3±0.7 pg/ml, P=0.099), MCP-1 (175±31 vs. 120±24 pg/ml, P=0.0093), MIP-1α (23±4 vs. 15±2 pg/ml, P=0.0089), RANTES (17±4 vs. 14±3 ng/ml, P=0.047), sICAM-1 (235±39 vs. 187±21 ng/ml, P=0.0041), sVCAM-1 (684±42 vs. 589±23 ng/ml, P=0.0045) and ET-1 (6.1±1.5 vs. 2.4±0.3 pg/ml, P=0.0095) than those of normotensives. The normocholesterolemic hypertensives had significantly lower levels of GM-CSF, MCP-1, MIP-1α, sICAM-1 and sVCAM-1 than hypercholesterolemic hypertensives but higher than normotensives. In hypertensives, ET-1 levels were significantly correlated with mean arterial pressure ( r=0.51, P=0.028), MCP-1 values ( r=0.45, P=0.047) and sICAM-1 levels ( r=0.64, P=0.0090). Significant correlations were also found between LDL cholesterol values and plasma inflammatory factors GM-CSF ( r=0.58, P=0.0088), MCP-1 ( r=0.49, P=0.040) and sICAM-1 ( r=0.53, P=0.034) in the hypercholesterolemic sub-group of hypertensives. Conclusions: Inflammatory markers of monocyte–endothelial cell adhesive interaction are elevated in hypertensives in comparison to normotensives and may be related to plasma ET-1 activity. The coexistence of hypercholesterolemia may enhance this inflammatory process induced by arterial hypertension.

Coexistence of hypercholesterolemia and hypertension impairs adventitial vascularization.

We have shown that adventitial vasa vasorum (AVV) formation is enhanced in hypertensive rat aorta to compensate hypoxia in the thickened media and that hypercholesterolemia impairs angiogenesis in rat ischemic hindlimb. Thus, we examined the effects of coexistence of hypercholesterolemia and hypertension on AVV formation. In Wistar rats, hypercholesterolemia was established by high-cholesterol diet from Day -14 (HC rats), and hypertension was induced by a suprarenal aortic constriction at Day 0 (HT rats). At Day 28, we studied AVV density, adventitial area, and medial thickness in the ascending aorta of control (standard diet+sham operation), HC, HT, and HC+HT rats (n=5/group). In HC rats, although the adventitial area was modestly increased, the AVV density and medial thickness were unchanged versus controls. In addition to medial thickening, marked enlargement of the adventitial area accompanied by increased AVV density was observed in HT rats, compared with controls. HC+HT rats showed lower AVV density, despite larger adventitial area, than HT rats, whereas the medial thickness was similar in HT and HC+HT rats. Immunohistostaining revealed hypoxia-inducible factor-1alpha expression in the media only in HC+HT rats but not in the other 3 groups, suggesting persistent medial hypoxia in HC+HT rats. In conclusion, it is suggested that coexistence of hypercholesterolemia and hypertension impairs AVV formation, resulting in insufficient compensation for hypoxia in the thickened media. Our findings provide an insight into the mechanism of the aggravation of arteriosclerosis when both hypercholesterolemia and hypertension are present.

Plasma levels of soluble cellular adhesion molecules in patients with arterial hypertension. Correlations with plasma endothelin-1

Background: Several reports have shown that circulating, soluble cellular adhesion molecules and endothelin-1 (ET-1) are implicated in the pathophysiological events of atherosclerosis and may reflect the endothelial dysfunction characterizing this disorder. Methods: To evaluate the expression of these factors in arterial hypertension (AH), we measured plasma levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble P-selectin (sP-selectin), and ET-1 in 60 untreated patients with mild to moderate AH (hypercholesterolemic: n=31, normocholesterolemic: n=29) and 30 sex- and age-matched normocholesterolemic normotensive controls. Results: Hypertensive patients exhibited significantly higher levels of sICAM-1 (234±21 vs. 187±12 ng/ml, P<0.005), sVCAM-1 (681±42 vs. 589±23 ng/ml, P<0.005), sP-selectin (89±17 vs. 55±11 ng/ml, P<0.01) and ET-1 (6.2±0.7 vs. 2.4±0.3 pg/ml, P<0.01) than did normotensive controls. The normocholesterolemic hypertensives had lower levels of sICAM-1, sVCAM-1 ( P<0.01), sP-selectin and ET-1 ( P<0.05) than hypercholesterolemic hypertensives, but higher levels than normotensive controls ( P<0.05). In hypertensives, plasma ET-1 was significantly correlated with mean arterial pressure ( r=0.51, P<0.03) and sICAM-1 levels ( r=0.64, P<0.01). In hypercholesterolemic hypertensives, LDL cholesterol was also significantly correlated with plasma levels of sICAM-1 ( r=0.53, P<0.04) and sP-selectin ( r=0.41, P<0.05). Conclusions: Plasma levels of soluble cellular adhesion molecules are elevated in hypertensive patients in comparison to normotensive controls and may be related to plasma ET-1 activity. The coexistence of hypercholesterolemia may enhance the plasma soluble adhesion molecule activity induced by AH.

Safety and tolerability of fluvastatin with concomitant use of antihypertensive agents. An analysis of a clinical trial database.

The coexistence of hypercholesterolemia and hypertension often requires concomitant drug treatments. Thus, it is interesting to evaluate the efficacy, safety, and tolerability of the new lipid-lowering agent fluvastatin, a 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA)-reductase inhibitor, in patients receiving concomitant antihypertensive/cardiovascular drug treatments. A retrospective analysis was based on data from controlled clinical trials in which 1815 patients were treated with fluvastatin and 783 patients received placebo. The daily dose of fluvastatin was > or = 20 mg. At least one of the following drug treatments was taken by 445 of the fluvastatin-treated patients (24.5%) and 181 of those receiving placebo (23.1%): beta-adrenergic-receptor blockers (fluvastatin: n = 182; placebo: n = 84); diuretics (fluvastatin: n = 168; placebo: n = 72); calcium antagonists (fluvastatin: n = 161; placebo: n = 69); and angiotensin-converting enzyme (ACE) inhibitors (fluvastatin: n = 101; placebo: n = 30). The majority of patients received monotherapy with one of the above-mentioned antihypertensive agents (fluvastatin: 69%; placebo: 65%). The efficacy of fluvastatin in modifying low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol and triglyceride levels was not consistently different in patients taking a given antihypertensive compared with the overall group and the patients not taking the antihypertensive agent. In patients taking fluvastatin and antihypertensives, confirmed (measured at two consecutive occasions) increases more than three times the upper limit of normal in aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) occurred in only two patients. One case involved the concomitant use of a beta-blocker (ASAT and ALAT) and the other a diuretic (ALAT).(ABSTRACT TRUNCATED AT 250 WORDS)