Target Levels Of Total Cholesterol Research Articles

FEATURES OF THE LIPID PROFILE AND ADIPOSE TISSUE IN PATIENTS WITH CAROTID ARTERY STENOSIS ON THE BACKGROUND OF CORONARY ARTERY DISEASE

HighlightsIntra-abdominal adipose tissue thickness (IAAT) was statistically significantly greater in patients with hypertriglyceridemia compared to patients with normal triglyceride levels. Linear regression analysis confirmed the following findings: the greater the thickness of IAAT and preperitoneal fat thickness (PFT), the higher the levels of triglycerides and very-low-density lipoproteins.AbstractAim. To assess the lipid profile and distribution of adipose tissue (based on ultrasound parameters) and their role in the development of carotid artery stenosis in patients with coronary heart disease (CHD).Methods. Ultrasound parameters of adipose tissue in 125 patients, diagnosed with coronary heart disease (CHD), were studied. The average age of the patients was 68 (61.0; 74.0) years old. The sample was represented predominantly by males (58.4%).Results. It was determined that in patients who did not reach the target levels of triglycerides (TG), the thickness of the IAAT is 15 mm more than in patients with the adequate level of this indicator (p = 0.031). Subcutaneous adipose tissue (SAT) values also exceeded the values ​​in individuals with low HDL levels (p = 0.050), in contrast to patients with normal HDL. Linear regression analysis (after adjusting for gender and age) showed that the increase in IAAT thickness was associated with the increase in TG (b = 0.002, p = 0.028) and VLDL (b = 0.001, p = 0.023). It was also found that only 43.4% of the examined individuals received lipid-lowering therapy, and 17.3% received an adequate dose of statins (reached the target LDL values).Conclusion. No statistically significant patterns were found between the achievement of lipid targets and the presence of carotid stenosis. An extremely low percentage of patients taking adequate lipid-lowering therapy (17.3%) was determined, and the proportion of the people with carotid stenosis who reached the target levels of total cholesterol was 58.4%, TG – 79.3%, HDL – 31.7%, LDL – 12.2%. The thickness of the IAAT is statistically significantly higher in individuals with hypertriglyceridemia, in contrast to patients with normal TG levels. The tendencies towards statistical significance of PFT indicators in individuals with hypertriglyceridemia, minimum and maximum SAT values, depending on the level of HDL, were determined. Linear regression analysis confirmed the data obtained: the higher the thickness of IAAT and PFT, the higher the levels of TG and VLDL.

Gender characteristics of lipid metabolism in patients with coronary heart disease and type 2 diabetes mellitus

Heart and metabolic diseases are very common in society today. There are many special features in their manifestation that have influence on prognosis and therapy approaches. Among them are gender characteristics. The aim of the research was to determine the gender peculiarities of disorders of lipid metabolism in patients with coronary heart disease and type 2 diabetes mellitus (T2DM). The study of the blood lipid spectrum in patients with coronary heart disease and T2DM was conducted in 72 patients aged 37 to 85 years old. The patients with coronary heart disease were divided into 2 groups depending on the presence or absence of T2DM: 1 group (n = 40) – patients with coronary heart disease only (Stable Angina Pectoris); group 2 (n = 32) – patients with coronary heart disease and T2DM. Each group was divided into subgroups depending on the gender of the patients: 1A and 2A – males, 1B and 2B – females. Despite the presence of T2DM, a majority of patients with coronary heart disease were overweight and obese. At the same time, obesity was more common in the female subgroups (1B – 45.0%, 2B – 64.7%) than in the male subgroups (1A – 35.0% and 2A – 33.3% respectively). There was an increase in the levels of total cholesterol, triglycerides and low-density lipoproteins for impaired lipid metabolism in patients with coronary heart disease. There was a slightly higher level of total cholesterol (6.12 ± 2.06 mmol/L) and low-density lipoproteins (4.24 ± 1.79 mmol/L) and a lower level of triglycerides (1.63 ± 0.65 mmol/L) in females than in males (5.15 ± 1.29, 3.71 ± 1.14 and 2.40 ± 1.06 mmol/l, respectively). Disruption of lipid metabolism was characterized predominantly by an increase in levels of triglycerides and low-density lipoproteins in blood in patients with coronary heart disease and T2DM regardless of gender. About a quarter of males (25.0% with coronary heart disease and 26.7% with coronary heart disease with T2DM) and females with T2DM (23.5%) reached the target total cholesterol level (<4.0 mmol/L), less frequently females with coronary heart disease (15.0%). The incidence of low-density lipoproteins target (<1.8 mmol/L) was significantly lower than total cholesterol: about 5.0% in males (regardless of the presence of T2DM) and 10.0% in females with coronary heart disease. Women with coronary heart disease and T2DM did not reach the target low-density lipoproteins level (<1.8 mmol/L). In most patients with coronary heart disease dyslipidemia grade II by Fredrickson was observed regardless of the presence of T2DM: in 100% of patients with coronary heart disease and 81.1% of patients with coronary heart disease and T2DM. A distinctive feature of impaired lipid metabolism in patients with coronary heart disease and T2DM is the presence in some of patients of Dyslipidemia grade IV by Fredrickson (6.7% of males and 5.9% of females) and the absence of Dyslipidemia class IIa in males in this group. Analysis of the achievement of the target levels of total cholesterol and low-density lipoproteins indicates insufficient prescribing of adequate hypolipidemic therapy for patients with coronary heart disease and T2DM.

Efficacy and safety of statin therapy in multimorbid outpatients with very high cardiovascular risk

Aim. To analyze the efficacy and safety of statin therapy in multimorbid outpatients with very high cardiovascular risk in actual clinical practice.Material and methods. The study included 131 patients with an established very high cardiovascular risk. History and anthropometric data were collected. The Charlson Comorbidity Index (CCI) was calculated; patients were divided into groups of moderate (№ 1, ≤6 points) and high (№ 2,> 6 points) multimorbidity. The frequency of prescribing statins, the range of doses used, the achievement of lipid metabolism targets, and the incidence of adverse effects were evaluated.Results. The median of the CCI was 6 (5÷8) points. Group 1 included 72 patients, group 2 — 59 patients. Statins received 87 (66,4%) patients, more often in group 1 (n=54) than 2 (n=33), p=0,026. The minimum doses were taken by 17 patients, the mean — 66, the maximum — 4. Patients of group 2 received higher dosages (χ2 =9,3, p=0,010). The target level of total cholesterol was achieved in 8 (6,1%) patients, low-density lipoprotein cholesterol — no one (0,0%). Of the 106 patients ever taking statins, they were withdrawn in 19 (17,9%) patients. The reason for discontinuation in 7 patients were adverse effects, in 5 — the high cost of therapy; in 7 patients, the reason was identified. Adverse effects were recorded in 12 (11,3%) patients; there were no differences between groups (p=0,118).Conclusion. Patients with a very high cardiovascular risk are characterized by high multimorbidity. Statins are less commonly prescribed for patients with severe polymorbidity, but at higher doses. Despite the sufficient prescribing statins and the use of mean doses, target lipid levels were not achieved. The presence of multimorbidity was not associated with an increase in the incidence of statin adverse effects.

Highly effective lipid-lowering therapy on local vascular stiffness and symptoms of chronic heart failure in patients with postinfarction cardiosclerosis

Objective. To study the effect of achieving the target level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL–C) on the parameters of local vascular stiffness and the development of chronic heart failure (CHF) in patients with ST-elevation myocardial infarction (STEMI).Design and methods. The study included 80 patients with myocardial infarction with ST segment elevation (STEMI) aged 35 to 65 years. On the 7–9th day of STEMI, at the 24th and 48th weeks of treatment with atorvastatin 40–80 mg clinical symptoms of heart failure were analyzed, the lipid profile and brain natriuretic peptide (BNP) were determined. Ultrasound of the common carotid arteries using high-frequency RF signal technology was performed. Depending on the effectiveness of treatment with atorvastatin, patients were retrospectively divided into 2 groups: 40 people who reached the target level of LDL–C (highly effective therapy, HET) and 37 patients who did not reach the target level of LDL–C (relatively effective therapy, RET).Results. In patients who reached the target LDL–С level, the initial BNP values were 115,2 pg/ml, with the regression by 34,5 % at follow-up (p = 0,03). There was no significant change in the RET group. In the HET group, a decrease in IMT, an improvement in distensibility parameters, a decrease in local PWV and stiffness index of common carotid arteries, were found. Based on the 6-minute walk test, only patients in HET group showed an increase in exercise tolerance after 24th week (p = 0,04). Also, individuals who did not reach the target LDL–С level, showed a decrease in the quality of life 27,4 % (p = 0,03). Patients in the HET group showed no negative dynamics.Conclusion. We showed that at the long-term follow-up after STEMI, the achievement of the target LDL cholesterol values was accompanied by a significant improvement in the parameters of local rigidity of the main arteries, and a decrease in BNP level, as well as by more favorable course of CHF.

Features of the clinics and treatment of patients with obesity and hypertension (according to the National register of arterial hypertension).

The purpose of this study lied in the examination of the clinical characteristics and assessment of the quality of treatment for patients with arterial hypertension (AH) with obesity according to the National Registry of the AH. The frequency of obesity in a sample of patients with AH, observed in 2010-2016. in polyclinics and cardiological dispensaries for cardiovascular diseases (CVD), was 38.3%, of which the incidence of severe obesity (grade III) was 8%. Women account for the majority of obese AH patients (72%). The study revealed the burden of AH patients with obesity in the following risk factors for CVD: dyslipidemia, hyperglycemia and a history of early cardiovascular disease. Relatively often in patients with hypertension with obesity, there were lesions of target organs (hypertrophy of the left ventricle, chronic kidney disease of the third stage), CVD [ischemic heart disease (CHD), chronic heart failure (CHF) II-IV functional class NYHA] and diabetes mellitus type 2 These data indicate that patients with AH obesity refers to a high and very high cardiovascular risk. Conducted antihypertensive and hypolipidemic therapy (statins) in patients with AH obesity was not optimal, only 30% of patients achieved the target level of BP and 23.6% - the target level of total cholesterol.

POSSIBILITY OF IMPROVING THE QUALITY OF DIAGNOSIS AND TREATMENT OF HYPERTENSION AND DYSLIPIDEMIA BY PHYSICIANS EDUCATION

Objective: To study the possibility of improving the educational level of primary health care physicians (cardiologists and internists) of Kursk city (Russia) aimed at improving the quality of diagnosis and treatment of hypertension and dyslipidemia in the short and long term. Design and method: The educational project (EP) covered all primary care physicians and cardiologists of Kursk (n = 144). During 1 year several seminars were held for physicians by the experts of national guidelines on hypertension and dyslipidemia. The criteria for the efficacy of EP was the achievement of target levels of blood pressure (BP) and total cholesterol, as well as positive changes of physicians actions on the diagnosis and treatment of hypertension and dyslipidemia. For this reason physician records from 300 randomly selected ambulatory cards was analysed before the start of the EP and following 1 and 3 years. Results: Following 3 years after the EP, the frequency of achieving target BP was 39.6% (n = 119), which is significantly higher than before the project – 31,6%(n = 95), p < 0.05, but lower than 1 year after the EP - 51% (n = 153), p < 0,01). The frequency of achievement of the target level of total cholesterol after 3 years was 38.3% (n = 115), significantly higher than before the start of the project 9,3%(p < 0.01), and differs a little from the figures obtained after 1 year- 43,3% (n = 130), p 0,05. There were the improvement of situation with the investigations aimed at revealing of target organ damages. So, after 3 years, heart ultrasound has appointed 24.7% (n = 74) of doctors, significantly higher than before the start of the EP (p < 0.001), but lower than 1 year after the EP (p < 0.05). Impressive increase of investigations to reveal microalbuminuria was found - after 3 years −32,7% (n = 98), which is significantly higher than before the project (p < 0.001) and after 1 year (p < 0.001). Conclusions: EP demonstrated not only short, but long-term efficacy. However, given a decline in several important variables of efficacy of education it should be done on systematic basis.

EFFECT OF ROSUVASTATIN ON CAROTID INTIMAMEDIA THICKNESS IN PATIENTS WITH CORONARY ARTERY DISEASE OF DIFFERENT GENDER AND CARDIOVASCULAR RISK PROFILE

Secondary prevention in patients with coronary artery disease (CAD) is provided by the use of statins, as well as by the impact on modiable risk factors. Rosuvastatin causes the regression of intima-media thickness (IMT) of common carotid artery (CCA), which is signicantly associated with CAD. The aim of the study was to evaluate the change in carotid intima-media thickness (CIMT) in patients with CAD of different gender, and having different number of cardiovascular risk factors, provided that patients attain target levels of total cholesterol (TC <4.0 mmol/l) and low density lipoprotein-cholesterol (LDL-C<1.8 mmol/l). Materials and methods. 72 patients with CAD: Stable angina of functional Classes II–III were recruited. They were treated with rosuvastatin, with gradual increase of its dose from 5 to 40 mg daily to attain target levels of TC and LDL-C. Maximum CIMT was assessed at the time of inclusion into the study and after 12 months of therapy. Results and discussion. In conditions of attaining target TC and LDL-C levels, maximum CIMT signicantly decreased both in men (p=0,006) and in women (p=0,002), the latter had lower CIMT (p=0,03) than men after 1 year of therapy, taking into account no difference in baseline values. The patients who had 2 or fewer risk factors (RF) (hypertension, a family history of cardiovascular disease, smoking, obesity, diabetes mellitus were taken into consideration) showed decrease in CIMT (p=0.0001), and those who were characterized by 3 or more RF, showed only lack of its growth (p=0.07). Attained lipid levels in the compared groups of different gender and number of RF did not differ. Conclusion. The study revealed the differences in the change of CIMT in patients with CAD of different sex, and of different number of cardiovascular risk factors.

THE ROLE OF MODERN TECHNOLOGIES IN DISPENSARY FOLLOW-UP OF ARTERIAL HYPERTENSION PATIENTS IN TYUMEN REGION, INCLUDED INTO THE CHRONIC NON-COMMUNICABLE DISEASE REGISTRY

Aim . To assess the influence of sex, type of settlement on the dynamics of risk factors (RF) and treatment adherence in arterial hypertension (AH). Material and methods . Randomly, 1704 AH patients selected and investigated in 3 outpatient institutions of Tyumenskaya oblast. Mean patients age 62±7,5 y.o., 31,5% — males, 18,7% — rural inhabitants. The prevalence of RF evaluated for cardiovascular diseases, as treatment adherence to antihypertension therapy (AHT). Patients were selected to the groups of active observation and control. Active observation group received SMS and e-mail with preventional kind content. General practitioners were educated on the specifics of dispensary follow-up of AH patients. In 12±3,2 months patients were assessed second time. The efficacy of RF correction was evaluated, as AHT adherence, according to sex and settlement type. Results . At the baseline, the prevalence of RF was as following: current smokers 24,1%, hypodynamic 64,0%, salt overconsuming 47,0%, insufficient vegetables and fruits intake 38,0%, elevated total cholesterol (TC) and low density lipoproteides (LDL) in 89,0% and 90,7%, respectively, body mass index (BMI) ≥30 kg/m2 in 49,5%, visceral obesity in 39,0%. Regularly received treatment 39,9%, of those effectively — 39,0%. In one year of follow-up, patients were investigated second time. In the active follow-up group there was 6% decrease of smoking rate (p<0,01); by 20,2% and 15,9% increased the number of those achieved target TC level (p<0,01) and LDL (p<0,01). There was significant number of BMI decrease and target waist circumference — 7,4% (p<0,01) and 6,1% (p<0,05), resp. By 14,3% the number of adherent to AHT increased (p<0,01) and by 10,9% — of those with effective treatment (p<0,01). Males quit smoking more frequently, and females reached target LDL levels, regularly took therapy and were more effective. Citizens more commonly reached target levels of TC, LDL, BMI, and took AHT more frequently. Conclusion . The proposed model of active follow-up of AH patients makes it to improve the control of dyslipidemia, obesity, smoking, and to increase treatment adherence.

TREATMENT OF PATIENTS WITH SEVERE DYSLIPIDEMIA IN REAL CLINICAL PRACTICE

Cardiovascular diseases remain the most common cause of death in Russia. In real clinical practice doctors are more focused on the modification of other major risk factors rather than on the correction of dyslipidemia, or pay more attention to secondary prevention of cardiovascular diseases. Aim. To analyze the incidence of severe dyslipidemia (total cholesterol >9 mmol/l), clinical signs of atherosclerosis at its presence and the adequacy of hypolipidemic treatment according to the data of multi-field medical hospital. Material and methods. We have analyzed 28225 medical charts of patients undergoing treatment in Therapeutic Departments of Petrozavodsk urgent care hospital for the years from 2001 to 2012. Results. The incidence of severe dyslipidemia (total cholesterol >9 mmol/l) was 1.59%. The most frequent nonlipid risk factor for ischemic heart disease was arterial hypertension (was diagnosed in 85% of patients). The main clinical manifestation of atherosclerosis was ischemic heart disease (it was diagnosed in 79.3%), 48.9% of patients had a history of acute myocardial infarction, 28.9% - of stroke. In patients with severe dyslipidemia (total cholesterol >9 mmol/l) the frequency of statins prescription in 2009-2012 was 70%. In 28.9% of the patients the target levels of total cholesterol and low-density lipoprotein were obtained. High doses of statins were prescribed rarely. Conclusion. There is a serious therapeutic problem related to the insufficient attention of doctors to examination and treatment of patients with newly-diagnosed severe dyslipidemia, especially when the primary disease is not a cardiovascular one.

HYPOLIPIDEMIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE IN 2004-2010 ACCORDING TO THE PROGNOZ IBS REGISTER

Aim. To evaluate the frequency of prescription, efficacy and patients adherence to statin therapy in a cohort of patients with ischemic heart disease (IHD), confirmed by coronary angiography data, during the period from 2004 to 2010 based on the data from the PROGNOZ IBS register. Material and methods. The PROGNOZ IBS register database was used in the study. The data of 550 patients from a cohort of patients with the confirmed IHD, who had undergone coronary angiography from 2004 to 2008 (303 of them were on the follow-up visit) were included in the final analysis. Results. Low frequency of statins prescription in patients with stable IHD prior to hospitalization in 2004-2007 and a significant improvement of its quality during the stay in a specialized cardiology unit were revealed in the PROGNOZ IBS register. The frequency of statin prescription at discharge increased from 10% to 85.5% (in most cases original drugs were used), but the prescribed doses were usually inadequate. Target blood lipid levels were not achieved in the majority of patients. The level of low density cholesterol <2.5 mmol/L at discharge was present in 6.3% of the patients (the short period of hospitalization insufficient for the achievement of statins maximum effect should be taken into consideration). 67% of patients had good adherence to lipid-lowering therapy 3.9 years after the admission, however, the original drugs had been replaced by a variety of generics in most patients. The efficacy of the therapy was inadequate: the target levels of total cholesterol (<4.5 mmol/L) and low density cholesterol (<2.5 mmol/L) were achieved in 40% of patients, of low density cholesterol (<2.0 mmol/l) - in 15.8%. Conclusion. Low frequency of statins prescription in patients with stable IHD before the admission to the hospital, its significant growth during the stay and its reduction after the discharge were revealed. The treatment efficacy was low at all stages of the observation. Patients' adherence to statin therapy in the outpatient setting remains inadequate.

ANALYSIS OF HYPERCHOLESTEROLEMIA PREVALENCE IN THE OUTPATIENT PRACTICE (ACCORDING TO THE ARGO STUDY): PART I

Aim. To study the level of total cholesterol in patients at high and very high cardiovascular risk in real clinical practice and the correspondence of their follow-up to current guidelines for the treatment of dyslipidemia issued by European Society of Cardiology and European Atherosclerosis Society (2011), as well as Russian Society of Cardiology and Russian National Society of Atherosclerosis (2012). Material and methods. Patients aged 30 years and older who visited a general practitioner or a cardiologist in an outpatient clinic in the period from October 2013 to July 2014 were included into the study. Every patient filled out a special questionnaire. The total cholesterol measurement was performed without special preparation of the patient with portable photometric blood analyzer, which allows the evaluation of total cholesterol in 3 minutes. Results. 18.273 patients (58.9% women) were included in the final analysis. Hypercholesterolemia was found in 81.3% women and 78.9% males. In all federal districts the total cholesterol level was significantly above the target and varied from 5.82 to 6.10 mmol/L. At that, statins had not been prescribed to almost half of the patients. Total cholesterol> 5 mmol/L was found in 84.7% of the patients treated with simvastatin, in 75.2% of the patients treated with atorvastatin, in 59% of the patients treated with rosuvastatin. Target level of total cholesterol (<4 mmol/L) was achieved in 2.04-7.38% of the patients at a very high cardiovascular risk. Conclusion. The situation with the diagnosis and treatment of dyslipidemias in a real clinical practice is far from perfect, despite the availability of information for doctors and patients. The causes of this problem require further investigation.

Prevalence of cardiovascular risk factors and cardiovascular prevention quality in primary healthcare in Russia and European countries: EURIKA Study results

Background. In the Russian Federation (RF), the prevalence of cardiovascular disease (CVD) and CVD mortality levels are very high. Selected aspects of cardiovascular risk factor (RF) control and preventive activity of healthcare professionals have been investigated in numerous studies; however, relatively little research has been done in the area of primary CVD prevention. The EURIKA Study (NCT00882336) is a multicentre international cross-sectional study which involved 12 countries. In the RF, 604 patients were enrolled in the study at 26 clinical centres. Material and methods. The participating patients were recruited during routine clinical visits. The study population included primary care and ambulatory patients aged over 50 years, with at least one additional RF, but without previously registered CVD events or CVD hospitalisations. Results. In the Russian sample, the proportion of patients under 65 years was 81,5% (mean age 58,3±7,3 years). The proportion of women was 68,2%. Mean levels of body mass index and waist circumference were, respectively, 29,6±5,1 kg/m2 and 96±14,0 cm. More than a half of the patients (54,5%) reported low levels of physical activity. Weekly alcohol consumption was 1,8±3,9 drinks; 25,5% of the patients were current smokers, and 15,4% were ex-smokers. Mean levels of systolic and diastolic blood pressure (BP) were 136,5±17,5 and 84,3±11 mm Hg, respectively. The prevalence of arterial hypertension (AH) was 80,5%, left ventricular hypertrophy – 14,3%, and microalbuminuria – only 0,7%. Family history of premature CVD, dyslipidemia (DLP), or diabetes mellitus was reported by 37,9%, 50,5%, and 15,7%, respectively. Among AH patients, 85,4% received antihypertensive therapy, but only 35,9% achieved target BP levels. Only 49,8% of DLP patients received lipidlowering therapy, with target levels of total cholesterol and low-density lipoprotein cholesterol achieved in 24,3%. Conclusion. Currently, the main target group for cardiovascular prevention in the Russian Federation is represented by women of early retirement age, with AH and low or moderate SCORE risk levels, who actively seek medical help. However, the highest risk of CVD events is observed in working-age men over 40 years, who rarely seek medical help and, therefore, are not covered by cardiovascular prevention measures.

Potential and methods of target cholesterol level achievement in daily clinical practice: results of the Russian multi-centre observational study “TREAT TO GOAL”

Aim. To study potential therapeutic approaches to the management of coronary heart disease (CHD) patients with hypercholesterolemia (HCH), who receive statins, but do not achieve target levels of total cholesterol (TCH) and low-density lipoprotein cholesterol (LDL-CH) in daily clinical practice. Material and methods. The research project “Treat To Goal” is an observational study, involving 10 clinical centres in 6 Russian cities. In total, the study included 712 patients with CHD and HCH (386 men and 324 women; mean age 59 years), who received statins as secondary prevention measure, but did not achieve target levels of TCH and LDL-CH. Results. In order to achieve target TCH levels, the lipid-lowering therapy was modified as follows: 42,4 % patients were administered a new statin; in 32,1 %, the “old” statin dose was titrated; in 25,5 %, statin therapy was combined with ezetimibe. The target TCH levels were achieved, respectively, in 33,5 %, 37,4 %, and 50,4 % of the patients. All three types of therapy modification were well tolerated and safe.Conclusion. Combined lipid-lowering therapy with ezetimibe and statins is the optimal treatment option for Russian patients with CHD and HCH, who otherwise cannot achieve the target levels of blood lipids.

GENDER DIFFERENCES IN THE EFFICACY OF RISK FACTORS CORRECTION AND TREATMENT COMPLIANCE IN PATIENTS AFTER ACUTE CORONARY SYNDROME

Aim. To compare the efficacy of correction of modifiable risk factors for ischemic heart disease (IHD), and treatment compliance within 6 months of observation in group of men and group of women after acute coronary syndrome (ACS). Material and мethods. Patients (n=147: 100 men and 47 women) aged under 70 years who underwent ACS were examined. Prevalence of cardiovascular risk factors and frequency of basic drugs taking were evaluated at baseline and after 6 months. The efficacy of risk factors correction in men was compared with this in women. Results. A general number of patients with effective blood pressure (BP) control as well as patients who reached the target levels of total cholesterol (TC) density lipoproteins (LDC) reach the advisable values. Women have better antihypertensive treatment compliance, but worse lipidemia level control; they more often have glucose metabolism disorders, arterial hypertension and obesity. Men smoked more often, but have better BP, TC and cholesterol LDC control. Conclusion. The high prevalence of cardiovascular risk factors requires intensification of preventive activity regarding IHD onset and progression among both men and women.

Glycaemic control among patients with type 2 diabetes mellitus treated in primary care setting in Jordan

Aims Determine the rate of glycaemic control among patients with type 2 diabetes treated in a university teaching family health centre and determine factors associated with glycaemic control. Methods A family physician reviewed medical records of all type 2 diabetic patients aged 18 years or older, who attended the university medical centre of Jordan University of Science and Technology between September 2007 and December 2008. All relevant information were abstracted from medical records and filled in a special form. Results Of the total 337 patients, 56.1% had HbA1c < 7%. The mean HbA1c was 7.1%. About half (46.6%) achieved target blood pressure <130/80. Furthermore, half of the patients achieved the target levels of total cholesterol, triglycerides and HDL. However, only 10.4% achieved the target level of LDL. In multivariate analysis only increased duration of disease (>5 years vs. ≤5 years) and type of treatment (insulin alone or combination therapy vs. oral therapy only) were significantly associated with increased odds of HbA1C > 7%. Conclusions More than half (56.1%) of diabetic patients had HbA1c values of less than 7%. Such finding highlight the importance of providing an organised care in managing diabetic patients in primary care setting and can be a base for further longitudinal studies to evaluate such care.

Can low-fat/cholesterol nutrition counseling improve food intake habits and hyperlipidemia of renal transplant patients?

Objective: To assess the impact of low-fat/cholesterol nutrition counseling on food intake habits and blood lipid levels of renal transplant patients. Design: Prospective practice-based outcome study. Setting: Acute care hospital post-renal transplant outpatient clinic. Patients: Forty-three renal transplant patients not on lipid-lowering medications referred to the renal dietitian for low-fat/cholesterol nutrition counseling between September 1994 and September 1997. Intervention: Individual assessment and counseling using the Healthy Heart Nutrition Guidelines Step 1 diet (<30% of total calories from fat, <300 mg cholesterol, and <10% of total calories from saturated fatty acids). Main outcome measures: Three-day food records precounseling and 3-day food records (n = 13) or descriptive intake changes (n = 30) postcounseling (time interval: 2 to 8 months). Fasting/random serum total cholesterol, high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C), as available. Results: Total cholesterol (n = 43) and LDL-C (n = 22) decreased significantly (0.54 mmol/L P < .000 and 0.53 mmol/L P < .000, respectively). There were no significant changes in HDL-C and triglycerides. Twenty percent of patients (n = 43) reached target levels of total cholesterol <5.2 mmol/L, and 35% of patients (n = 22) reached target levels of LDL-C <3.4 mmol/L. Percentage of total calories from fat decreased significantly (7.58% P < .03). Descriptive intake changes of lower fat choices were reported in the no post-food records group. Conclusion: Patients can make changes in food intake habits after nutrition counseling. Serum lipid levels can improve after nutrition counseling, but many patients may still require lipid lowering medications to reach target levels. Nutrition counseling should be considered for the initial treatment of hyperlipidemia in renal transplant patients.