Improvements In Total Cholesterol Research Articles

Hypolipidemic properties of a diphenyl-methylen-ethylamine derivative with affinity for β 3-adrenoceptors in a model of hypercholesterolemia

β 3-Adrenergic agonists have been proposed as potential new drugs for the treatment of diabetes and/or obesity therapy, because of the hypoglycemic and lipolytic effects found with some of these compounds. Moreover, their application in other therapeutic areas such as hypercholesterolemia and atherosclerosis has been suggested. This experimental trial was conducted to assess the effects of Trecadrine, a new molecule with affinity for β 3-adrenoceptors, on a model of hypercholesterolemia in rats, and also to explore a possible beneficial role of these agents in lipid disturbances therapy. The results indicated a marked reduction in serum triglyceride levels (−40%; P<0.01) and lipoprotein lipase activity in white fat (−49%, P<0.001) of hypercholesterolemic rats treated with Trecadrine for 16 days as compared with hypercholesterolemic non-treated rats. Moreover, Trecadrine produced a significant increase in the oxygen consumption in brown adipose tissue (+154%, P<0.01). In relation to cholesterolemia, an improvement in total cholesterol (−20%) and total/HDL–cholesterol ratio (−25%) in serum was noted in the animals receiving the pharmacological treatment. In conclusion, the results of this trial support that Trecadrine administration may have a therapeutic potential in disorders associated with hypertriglyceridemia such as obesity and some types of hyperlipidaemias.

Management of newly diagnosed non-insulin-dependent diabetes mellitus in the primary care setting: effects of 2 years of gliclazide treatment— the diadem study

Five thousand five hundred seventy-two newly diagnosed non—insulin-dependent diabetes mellitus (NIDDM) patients (3,225 men and 2,347 women; mean age, 58.5 years) were recruited through the General Practitioners (GPs) network in France. All had persistent hyperglycemia after a preliminary 3-month period with dietary and life-style modification. Gliclazide (80 to 320 mg/d) was then prescribed as diabetic pharmacotherapy for 2 years. Additional therapy for hypertension and dyslipidemia was started if necessary. The aim of the study was mainly to determine the feasibility of a GP-directed protocol for the monitoring and treatment of newly diagnosed NIDDM patients, and to assess the effectiveness of diabetic therapy in this cohort. Diabetes was diagnosed in 78% of the cohort during routine screening. Among the women, 6.5% had a history of gestational diabetes. Eighteen percent of the patients had a parental history of diabetes, and the dominant maternal role in the genesis of NIDDM was confirmed. High blood pressure (Joint National Committee V criteria) was found at inclusion in 38.8% of the whole cohort. Hyperlipidemia was known in 44.6%. A history of stroke was present in 1.6% of the patients, and coronary heart disease (CHD) in 6.3%. These data support the relationship between the atherogenic state and development of NIDDM. Microalbuminuria defined as urinary albumin excretion (UAE) of at least 20 mg/L was found in 29.6% of the patients, and retinopathy in 9.8%. Among the included patients, 23% did not complete the study and were excluded from the efficacy analysis. Of these, 14% (808 patients) had only baseline evaluation data and 9% (499 patients) withdrew later. Comparison of mean baseline and final results in study completers uncovered a significant improvement in fasting blood glucose ([FBG]) 182 ± 48 v 137 ± 40 mg/dL), post prandial blood glucose ([PPBG] 209 ± 68 v 162 ± 52 mg/dL), and hemoglobin A 1c ([HbA 1c] 8.7% ± 2.5% v 7.3% ± 2.0%). A slight improvement in total cholesterol (228 ± 44 v 222 ± 41 mg/dL), body mass index ([BMI] 28.5 ± 4.7 v 27.9 ± 4.5 kg/m 2), and waist to hip ratio (0.99 ± 0.1 v 0.98 ± 0.1) was observed. There was a decrease in the percentage of patients with high blood pressure (38.5% v 30.7%). A mild increase in the prevalence of retinopathy (10.2% v 11.8%) was noted during the study, while the incidence of microalbuminuria remained unchanged (30.2% v 29.5%). In conclusion, the data indicate that the GPs involved in this study were able to successfully monitor and manage NIDDM patients in accordance with a standardized protocol. Gliclazide appeared to be an effective and well-tolerated treatment. The high prevalence of chronic diabetic complications at diagnosis emphasizes the delay encountered in reaching the diagnosis of NIDDM and the problems associated with this delay. In addition to the classic risk factors for NIDDM exhibited in this patient cohort, we have identified CHD and a maternal genetic component as further potential predicting factors.

La prevención secundaria del infarto de miocardio en España. Estudio PREVESE

We present the results from the PREVESE Study, conducted in two phases: the first to identify the secondary prevention measurements recommended in Spain in patients who were discharged after a myocardial infarction; the second, 6 months later, to determine their evolution. Data was collected from 1,242 patients in 39 hospitals. An analysis was made of the patients background, risk factors, working status, diagnostic procedures used during hospitalization, laboratory findings and drug therapy prescribed at discharge. At the second control, the risk factors status, diagnostic or assessment tests performed during the 6-month period, working status, mortality and cardiac events were revised. The previous history and risk factors studied showed a high risk profile among patients after myocardial infarction. Among the drug therapies prescribed at discharge the small percentage (6.7%) of lipid lowering prescriptions should be highlighted. An improvement in the risk factor profile was found at the six month checkup with a substantial reduction in the number of smokers, a very low number of hypertensives and an improvement in physical activity. There was no improvement in total-cholesterol levels. The implementation of preventive measures is not similar in all risk factors. An improvement is reached in prevention of smoking habit and hypertension, but not in the treatment of abnormal levels of hyperlipidemia.

CHANGES IN CARDIOVASCULAR DISEASE RISK FACTORS IN A LIFESTYLE VERSUS A STRUCTURED EXERCISE INTERVENTION 860

Although changes in physical activity are known to positively affect cardiovascular disease (CVD) risk factors, data directly comparing the effects of different intervention methods are scarce. Project Active is a randomized clinical trial (N=237) comparing a 2-year lifestyle (L) physical activity program with a structured (S) exercise program in sedentary but healthy adults aged 35 to 60 years. The purpose of this paper is to report changes in CVD risk factors in the two treatment groups and determine whether there is an appreciable difference that results from assignment to L or S after 6 months of intervention. Specifically, we hypothesize that both treatment groups will experience similar and favorable improvements in blood lipids, blood pressure, and body composition measures. After 6 months, both L and S groups increased their energy expenditure by an average of 159 kcal/day (p<0.001) and 139 kcal/day (p<0.001), respectively. In the combined cohort, there were significant improvements in total cholesterol (-8.45mg/dl ± 1.78, p<0.001), low density lipoprotein (LDL) (-4.93mg/dl ± 1.87, p<0.01), the total cholesterol/high density lipoprotein (HDL) ratio (-0.26± 0.07, p<0.001), and triglycerides (-12.37 ± 5.44, p<0.05). Similar improvements were seen in resting blood pressures and measures of body composition. Testing for group differences, controlling for age, gender, and body mass index, revealed that change in these risk factors was independent of treatment group assignment. Changes in total cholesterol(p=0.38), HDL (p=0.54), LDL (p=0.12), the total cholesterol/HDL ratio(p=0.12), and trigylcerides (p=0.33) did not differ significantly between the L and S groups. Changes in blood pressure and body composition were also found to occur independent of treatment group. These results suggest that favorable changes during 6 months of intervention are obtained in select CVD risk factors in both a lifestyle and a structured physical activity intervention.

Effects of cardiac rehabilitation and exercise training on low-density lipoprotein cholesterol in patients with hypertriglyceridemia and coronary artery disease

Substantial data suggest that elevated triglycerides are associated with increased coronary risk, and may be an independent coronary risk factor. Although it is generally accepted that patients with hypertriglyceridemia can have marked improvement in lipids after vigorous nonpharmacologic therapy, data to support this belief are lacking. This study assessed 313 consecutive patients before and after outpatient phase II cardiac rehabilitation and exercise programs to compare the response of patients with elevated triglycerides (≥250 mg/dl; n = 39) to vigorous nonpharmacologic therapy with the response of patients with “normal” triglyceride levels (<150 mg/dl; n = 157). The independent effects that baseline triglycerides, as well as other variables, had on improving lipids after nonpharmacologic therapy were also determined. After cardiac rehabilitation and exercise training, patients had improvement in total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol levels, low-density lipoprotein (LDL) cholesterol levels, LDL HDL ratios, body mass index, percent body fat, and METs. Patients with hypertriglyceridemia were younger (p = 0.05) and had higher baseline body mass index (p < 0.001) and LDL HDL ratios (p < 0.0001) but lower HDL cholesterol levels (p < 0.0001) than patients with low baseline triglycerides. Both groups had improvement in lipids, obesity indexes, and exercise capacity. However, patients with hypertriglyceridemia had significantly greater reductions in triglycerides (−31% vs +3%; p < 0.0001), but had less improvement in both LDL cholesterol levels (0% vs −4%; p < 0.01) and LDL HDL ratios (−5% vs −9%; p = 0.03). In multivariate analysis, low baseline triglyceride levels were independently associated with greater reductions in both LDL cholesterol levels ( t value = 7.9; p < 0.0001) and LDL HDL ratios ( t value = 6.1; p < 0.0001). Thus, patients with elevated triglycerides had less significant reductions in both LDL cholesterol levels and LDL HDL ratios after cardiac rehabilitation and exercise training, although triglyceride levels improved considerably. Contrary to popular belief, patients with hypertriglyceridemia appear to be more resistant to nonpharmacologic therapy, at least with regard to reducing LDL cholesterol levels and LDL HDL ratios, and may be more likely to require drug treatment.

Efficacy of Psyllium in Reducing Serum Cholesterol Levels in Hypercholesterolemic Patients on High- or Low-Fat Diets

To determine the efficacy of psyllium in reducing serum cholesterol levels in patients on high- or low-fat diets. Double-blind, placebo-controlled, 16-week parallel trial. The study included an 8-week baseline period and an 8-week treatment period. Healthy men and women, 21 to 70 years old, with primary hypercholesterolemia (total serum cholesterol > or = 5.7 mmol/L [220 mg/dL]). Thirty-seven participants followed a high-fat diet and 81 participants followed a low-fat diet. Participants were randomly assigned to either psyllium, 5.1 g twice a day, or placebo. Fasting lipid and apolipoprotein concentrations, including direct low-density lipoprotein (LDL) cholesterol quantification; nutritional analyses of 4 days of 7-day food records to monitor dietary compliance; and physical examinations, clinical chemistry and hematologic studies, and urinalysis to assess treatment safety. Psyllium recipients in both the high- and low-fat diet groups showed small but significant decreases (P < 0.05) in total cholesterol and low-density lipoprotein (LDL) cholesterol levels. Total cholesterol and LDL cholesterol levels decreased 5.8% and 7.2%, respectively, in psyllium recipients on high-fat diets and 4.2% and 6.4%, respectively, in psyllium recipients on low-fat diets. No significant difference was seen in LDL cholesterol response when psyllium recipients on low- and high-fat diets were compared (P > 0.2). No significant reductions in lipid levels were observed in placebo recipients. Based on the National Cholesterol Education Program LDL cholesterol classification system, 39% of the psyllium recipients improved in LDL cholesterol classification (P < 0.0001) compared with 20.3% of placebo recipients (P > 0.2). Psyllium produces a modest but significant improvement in total cholesterol and LDL cholesterol levels in persons on either low-fat or high-fat diets. Psyllium, when added to a prescribed low-fat diet, may obviate the need for typical lipid-lowering medications or may prove to be a valuable adjunct to other treatments in patients with moderately elevated LDL cholesterol levels.

Treatment of Hypercholesterolemia: Comparison of Younger versus Older Patients Using Wax‐Matrix Sustained‐Release Niacin

Compare lipid response, side effect profile and toxicity of younger (less than 50 years) versus older (50 to 70 years) hypercholesterolemic subjects taking wax-matrix sustained-release niacin (Endur-acin). An 8-week randomized double-blind placebo controlled trial. General community. Volunteers from community cholesterol screening programs and chart review of patients at family practice clinics. Male and female subjects, age 20 to 70, with baseline low density lipoprotein cholesterol level within the 75th to 95th percentile, excluded if on medications that affect lipids or if a history of diabetes, gout, peptic disease, or liver disease is present. Nicotinic acid dosage schedules were 1,000 mg/day, 1,250 mg/day, 1,500 mg/day, or 2,000 mg/day for 8 weeks. Change in blood lipids and blood chemistries, side effects, and pill compliance. 158 subjects (79%) completed the study. Higher dose groups (1,500 mg and 2,000 mg) demonstrated improvements in total cholesterol, LDL-cholesterol, HDL cholesterol, and total-to-HDL-cholesterol ratio (P less than 0.05) compared to baseline and controls. Higher-dose older subjects demonstrated significantly greater improvements than younger subjects on comparable doses for total cholesterol, HDL cholesterol, total-to-HDL-cholesterol ratio, and triglycerides, P less than 0.02). Adherence to medication schedules was better and incidence of side effects and toxicity no greater in older subjects compared to younger. Wax-matrix niacin (Endur-acin) was shown to be effective and well tolerated for the pharmacological treatment of hypercholesterolemia. Older persons, ages 50 to 70, appear to experience greater benefits with no greater side effects when compared to younger subjects on similar doses.

Impact of Intensive Educational Approach to Dietary Change in NIDDM

The aim of this study was to compare the effects of an intensive educational approach incorporating longer time, greater simplicity, repetition, and cognitive motivational techniques with a conventional one in subjects with established non-insulin-dependent diabetes mellitus (NIDDM) whose weight, glycemic control, and diet were not optimal. Subjects were randomly allocated to intensive or conventional education. Of 350 subjects, 70 met the study criteria, which included established NIDDM (greater than or equal to 3 mo), suboptimal recent glycemic control, dietary fat intake greater than or equal to 35% of total energy intake, and body mass index greater than or equal to 25 kg/m2. The intensive approach was associated with significantly greater improvements in dietary compliance, dietary intake (complex carbohydrate, [P = 0.013], legumes [P less than 0.0001], fiber [P less than 0.0001], total fat [P less than 0.004], saturated fat [P less than 0.004]), and total cholesterol level (P = 0.007). The transient improvement in glycemic control was similar in both groups. An intensive education program can improve dietary compliance in established NIDDM subjects more than a conventional one. These recommended dietary improvements achieve better improvement in total cholesterol but do not necessarily improve glycemic control.