Use Of Lipid-lowering Drugs Research Articles

The plasma leptin/adiponectin ratio predicts first cardiovascular event in men: A prospective nested case–control study

ObjectiveThe plasma leptin/adiponectin (L/A) ratio has been proposed as a preferential marker of atherosclerosis susceptibility compared to leptin and adiponectin alone. We determined the extent to which the L/A ratio predicts incident cardiovascular disease (CVD) taking account of clinical risk factors, microalbuminuria, the total cholesterol/HDL cholesterol (TC/HDL-C ratio), triglycerides, high sensitive C-reactive protein (hs-CRP) and insulin sensitivity (homeostasis model assessment (HOMAir)). MethodsA community-based prospective nested case–control study was carried out in 103 non-diabetic men who developed a first cardiovascular event (cases) and 106 male control subjects (no clinically manifest CVD and no lipid lowering drug use at baseline; median follow-up of 3.0 and 10.5years, respectively). Plasma leptin, adiponectin, the leptin/adipnectin (L/A) ratio, as well as hs-CRP, HOMAir and the TC/HDL-C ratio were determined at baseline. ResultsPlasma leptin levels and the L/A ratio were higher in cases vs. controls (p=0.002 for both), but the difference in adiponectin was not significant (p=0.10). Age-adjusted incident CVD was associated with plasma leptin, adiponectin and the L/A ratio (p=0.045 to p=0.001). The relationships of incident CVD with plasma leptin (p=0.19) and adiponectin (p=0.073) lost statistical significance after additional adjustment for smoking, waist circumference, hypertension, microalbuminuria, the TC/HDL-C ratio, hs-CRP and HOMAir. In this fully adjusted analysis, the L/A ratio remained predictive of incident CVD (hazard ratio: 1.40 (95% CI 1.05–1.87), p=0.024). ConclusionThis study suggests that the L/A ratio may be a preferential marker of a first cardiovascular event in men compared to plasma leptin and adiponectin levels alone.

Aortic and Mitral Annular Calcifications Are Predictive of All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes

OBJECTIVETo examine the association of aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) with all-cause and cardiovascular mortality in type 2 diabetic individuals.RESEARCH DESIGN AND METHODSWe retrospectively analyzed the data from 902 type 2 diabetic outpatients, who had undergone a transthoracic echocardiography for clinical reasons during the years 1992–2007. AVS and MAC were diagnosed by echocardiography, and a heart valve calcium (HVC) score was calculated by summing up the AVS and MAC variables. The study outcomes were all-cause and cardiovascular mortality.RESULTSAt baseline, 477 (52.9%) patients had no heart valves affected (HVC-0), 304 (33.7%) had one valve affected (HVC-1), and 121 (13.4%) had both valves affected (HVC-2). During a mean follow-up of 9 years, 137 (15.2%) patients died, 78 of them from cardiovascular causes. Compared with patients with HVC-0, those with HVC-2 had the highest risk of all-cause and cardiovascular mortality, whereas those with HVC-1 had an intermediate risk (P < 0.0001 by the log-rank test). After adjustment for sex, age, BMI, systolic blood pressure, diabetes duration, A1C, LDL cholesterol, estimated glomerular filtration rate, smoking, history of myocardial infarction, and use of antihypertensive and lipid-lowering drugs, the hazard ratio of all-cause mortality was 2.3 (95% CI 1.1–4.9; P < 0.01) for patients with HVC-1 and 9.3 (3.9–17.4; P < 0.001) for those with HVC-2. Similar results were found for cardiovascular mortality.CONCLUSIONSOur findings indicate that AVS and MAC, singly or in combination, are independently associated with all-cause and cardiovascular mortality in type 2 diabetic patients.

Relationships between high-sensitive C-reactive protein and markers of arterial stiffness in hypertensive patients. Differences by sex

BackgroundThe present study was designed to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) and arterial stiffness according to sex in patients with arterial hypertension.MethodsA case-series study was carried out in 258 hypertensive patients without antecedents of cardiovascular disease or diabetes mellitus. Nephelometry was used to determine hs-CRP. Office or clinical and home blood pressures were measured with a validated OMRON model M10 sphygmomanometer. Ambulatory blood pressure monitoring was performed with the SpaceLabs 90207 system. Pulse wave velocity (PWV) and central and peripheral augmentation index (AIx) were measured with the SphygmoCor system, and a Sonosite Micromax ultrasound unit was used for automatic measurements of carotid intima-media thickness (IMT). Ambulatory arterial stiffness index and home arterial stiffness index were calculated as “1-slope” from the within-person regression analysis of diastolic-on-systolic ambulatory blood pressure.ResultsCentral and peripheral AIx were greater in women than in men: 35.31 ± 9.95 vs 26.59 ± 11.45 and 102.06 ± 20.47 vs 85.97 ± 19.13, respectively. IMT was greater in men (0.73 ± 0.13 vs 0.69 ± 0.10). hs-CRP was positively correlated to IMT (r = 0.261), maximum (r = 0.290) and to peripheral AIx (r = 0.166) in men, and to PWV in both men (r = 0.280) and women (r = 0.250). In women, hs-CRP was negatively correlated to central AIx (r = −0.222). For each unit increase in hs-CRP, carotid IMT would increase 0.05 mm in men, and PWV would increase 0.07 m/sec in men and 0.08 m/sec in women, while central AIx would decrease 2.5 units in women. In the multiple linear regression analysis, hs-CRP explained 10.2% and 6.7% of PWV variability in women and men, respectively, 8.4% of carotid IMT variability in men, and 4.9% of central AIx variability in women.ConclusionsAfter adjusting for age, other cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs, hs-CRP was seen to be positively correlated to carotid IMT in men, and negatively correlated to central AIx in women. The association of hs-CRP to arterial stiffness parameters differs between men and women.

Controlled attenuation parameter (CAP): a new device for fast evaluation of liver fat?

Controlled attenuation parameter (<scp>CAP</scp>): a new device for fast evaluation of liver fat?

Apolipoprotein E polymorphism is associated with both number of diseased vessels and extent of coronary artery disease in Czech patients with CAD

The impact of ApoE polymorphism on angiographic parameters was assessed in patients referred for coronary angiography. Elective coronary angiography was performed in 671 subjects (525 men, 146 women, mean age 60 ± 10 years) with symptoms of ischemic heart disease. The patients were divided into: no CAD group (smooth coronary vessels, n=83), one-vessel (n=155), two-vessel (n=170) and three-vessel disease (n=196). Patients with stenoses 0-50% were excluded. Within patients with CAD, we evaluated overall extent of CAD measured by the number of stenotic segments according to AHA (1 segment vs. 2-3 vs. ≥4), and the severity of the most serious stenosis (in percent). ApoE genotype was determined using real-time PCR. The frequency of ε2/ε3 genotype (n=56) was lower in the three-vessel disease group compared to one-vessel disease (OR=0.25, P=0.0019), two-vessel disease (OR=0.31, P=0.0114) or no CAD group (OR=0.24, P=0.0057). Frequency of ε2/ε3 decreased with the number of affected segments (1 vs. ≥4: OR=0.35, P=0.0143). The ε3/ε4+ε4/ε4 genotypes (n=123) were more frequent in CAD patients altogether compared with no CAD group (OR=2.30, P=0.019), while no impact of the ε4 allele on angiographic parameters within the CAD patients was detected. In ε2/ε3 carriers with CAD, lower LDL-cholesterol, total cholesterol and lower use of lipid-lowering drugs were observed. The results show predominantly focal form of CAD in patients with ε2/ε3 genotype. Lower LDL-cholesterol and total cholesterol may play the key role, although other contributing factors are discussed.

Secondary medical prevention after primary vascular surgery between 1996 and 2006: a shift towards more evidence-based treatment

The implementation of evidence-based secondary medical prevention in peripheral arterial disease (PAD) patients has received increasing attention in recent years, but population-based data are sparse. This study examined the use of secondary medical prophylaxis in unselected symptomatic PAD patients in Denmark. A nationwide follow-up study based on individual-level record linkages of population-based healthcare registers was performed. All patients who underwent primary vascular reconstruction in Denmark between 1996 and 2006 with a minimum of 6 months of follow-up were included (n = 16,492). Data were obtained from prescriptions that were filled six months after primary vascular reconstruction (±90 days). The use of secondary medical prevention was examined according to calendar year and place of residence. The use of lipid-lowering drugs increased from 32.2% in 1996 to 76.1% in 2006 (adjusted relative risk (RR) 1.95, 95% CI 1.81-2.10). The overall use of antihypertensive therapy was unchanged during the study period, but treatment shifted from diuretics/calcium antagonists towards angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The use of combination therapy (concomitant lipid-lowering, antiplatelet and any antihypertensive therapies) increased from 29.1% in 1996 to 67.6% in 2006 (adjusted RR 1.95, 95% CI 1.80-2.12). This shift in the use of secondary medical prevention was independent of sociodemographic and clinical factors. No substantial differences in pharmacological use based on place of residence were observed. The use of evidence-based secondary medical prevention, especially lipid-lowering drugs, increased substantially among symptomatic PAD patients in Denmark from 1996 to 2006. However, recommendations in current clinical guidelines suggest that room for improvement remains.

Is dementia incidence declining?

To investigate whether dementia incidence has changed over the last 2 decades. We compared dementia incidence in 2 independent subcohorts of persons aged 60-90 years from the Rotterdam Study, a population-based cohort study. The first subcohort started in 1990 (n = 5,727), the second in 2000 (n = 1,769). Participants were dementia-free at baseline and followed for at maximum 5 years. We calculated age-adjusted dementia incidence rates for the 2 subcohorts in total, in 10-year age strata, and for men and women separately. We also compared mortality rates, differences in prevalence of vascular risk factors, and medication use. Finally, we compared brain volumes and the extent of cerebral small vessel disease in participants who underwent brain imaging 5 years after the baseline examinations. In the 1990 subcohort (25,696 person-years), 286 persons developed dementia, and in the 2000 subcohort (8,384 person-years), 49 persons. Age-adjusted dementia incidence rates were consistently, yet nonsignificantly, lower in the 2000 subcohort in all strata, reaching borderline significance in the overall analysis (incidence rate ratio 0.75, 95% confidence interval [CI] 0.56-1.02). Mortality rates were also lower in the 2000 subcohort (rate ratio 0.63, 95% CI 0.52-0.77). The prevalence of hypertension and obesity significantly increased between 1990 and 2000. This was paralleled by a strong increase in use of antithrombotics and lipid-lowering drugs. Participants in 2005-2006 had larger total brain volumes (p < 0.001) and less cerebral small vessel disease (although nonsignificant in men) than participants in 1995-1996. Although the differences in dementia incidence were nonsignificant, our study suggests that dementia incidence has decreased between 1990 and 2005.

Cholesterol Screening: Primary Prevention Comes of Age

The National Heart, Lung, and Blood Institute (NHLBI) recently published guidelines for cardiovascular health and risk reduction in children and adolescents. This broad-sweeping effort addresses everything from nutrition and diet to physical activity, high-risk diseases, and the metabolic syndrome. Perhaps most notable in the 42-page summary report1 is the recommendation for universal cholesterol screening in childhood. This represents an important departure from prior American Academy of Pediatrics guidelines,2–4 which had endorsed a selective screening approach for presumed at-risk children and adolescents.There are two principal reasons for the change in recommendations. First, the causal link between childhood dyslipidemia and adult coronary artery disease is now better supported by scientific study. Second, the increased incidence of childhood obesity has altered the prevalence of dyslipidemia. Though universal cholesterol screening in childhood had been discussed as early as the 1992 guidelines,2 proposals for universal screening were struck down in those guidelines and subsequent iterations due to lack of data. By 2008, the landscape was changing. Through studies such as Pathobiological Determinants of Atherosclerosis in Youth (PDAY),5 Cardiovascular Risk in Young Finns,6 and the Bogalusa Heart Study7 a more direct connection between childhood risk factors and adult cardiovascular disease has been described by researchers. Now, with accumulating evidence linking childhood dyslipidemia and adult atherosclerotic disease and a burgeoning population of obese children at risk for dyslipidemia, the time for universal cholesterol screening has finally come.The present guidelines recommend measuring non-HDL-C rather than LDL-C. This is, in part, due to ease of screening; the measurement of non-HDL-C is reliable, inexpensive, and does not require fasting. In addition, it appears to be a better screening tool than LDL-C in the metabolic syndrome and type II diabetes, which often accompany obesity. Since atherogenic particle numbers do not correlate well with LDL-C in these conditions (because there is less cholesterol per particle), measuring LDL-C alone can underestimate atherogenic potential.From hypertension to obesity to dyslipidemia we are witnessing a paradigm shift in the role of preventive medicine that could profoundly impact the economics of health care and the role of pediatrics in the health care landscape. For the first time, the medical community is looking to the field of pediatrics to address expensive, common, refractory adult medical conditions before they begin. We are now not only discussing primary prevention but primordial prevention — intervening on risk factors before they manifest. If you believe an ounce of prevention is worth a pound of cure, this is your time.The recommendation for universal cholesterol screening is clearly the most controversial aspect of these new guidelines. As others have pointed out, the use of lipid-lowering drugs in children with high cholesterol, presumably for many years, is not without risks.8 Further, it is not at all clear the benefit of these medications (lowered risk of cardiovascular disease and not just a lower cholesterol level) outweighs these risks in children and adolescents.

Women show worse control of type 2 diabetes and cardiovascular disease risk factors than men: Results from the MIND.IT Study Group of the Italian Society of Diabetology

Background and aimsThe study explores the degree of control of hyperglycaemia and cardiovascular (CV) disease risk factors in men and women with type 2 diabetes and the impact thereon of obesity, central adiposity, age and use of medications. Methods and resultsA cross-sectional survey was conducted at 10 hospital-based outpatients diabetes clinics. 1297 men and 1168 women with no previous CV events were studied. Women were slightly (only one year) older and more obese than men: average BMI was respectively 30.7 ± 5.7 vs 28.6 ± 4.1 kg/m2 (p < 0.001), and prevalence of abdominal obesity was 86% vs 44% (p < 0.001). Women smoked less, but had higher HbA1c, LDL cholesterol, non-HDL cholesterol, systolic blood pressure and serum fibrinogen than men. Accordingly optimal targets for HbA1c (<7%), LDL cholesterol (<100 mg/dL), HDL cholesterol (>40 for men, >50 for women, mg/dL), and systolic blood pressure (<130 mmHg) were less frequently achieved by women than men (respectively 33.8% vs 40.2%; 14.6% vs 19.2%; 34.1% vs 44.5%; 68.8% vs 72%; p < 0.05 for all). Findings were confirmed after stratification for waist circumference (< or ≥ 88 cm for women; < or ≥ 102 cm for men), BMI (< or ≥ 25 kg/m2) or age (< or ≥ 65 years). As for treatment, women were more likely than men to take insulin, alone or in combination with oral hypoglycaemic drugs, to be under anti-hypertensive treatment, whereas the use of lipid lowering drugs was similar in men and women. ConclusionsControl of hyperglycaemia and major CVD risk factors is less satisfactory in women than men. The gender disparities are not fully explained by the higher prevalence of total and central obesity in women; or by a less intensive medical management in women.

Cocoa intake and arterial stiffness in subjects with cardiovascular risk factors

BackgroundTo analyze the relationship of cocoa intake to central and peripheral blood pressure, arterial stiffness, and carotid intima-media thickness in subjects with some cardiovascular risk factor.FindingsDesign: A cross-sectional study of 351 subjects (mean age 54.76 years, 62.4% males). Measurements: Intake of cocoa and other foods using a food frequency questionnaire, central and peripheral (ambulatory and office) blood pressure, central and peripheral augmentation index, pulse wave velocity, ambulatory arterial stiffness index, carotid intima-media thickness, and ankle-brachial index.Results: Higher pulse wave velocity and greater cardiovascular risk were found in non-cocoa consumers as compared to high consumers (p < 0.05). In a multivariate analysis, these differences disappeared after adjusting for age, gender, the presence of diabetes, systolic blood pressure and antihypertensive and lipid-lowering drug use. All other arterial stiffness measures (central and peripheral augmentation index, ambulatory arterial stiffness index, ankle-brachial index, and carotid intima-media thickness) showed no differences between the different consumption groups.ConclusionsIn subjects with some cardiovascular risk factors, cocoa consumption does not imply improvement in the arterial stiffness values.Trial RegistrationClinical Trials.gov Identifier: NCT01325064.

Abstract 2803: Cilostazol Reduces Carotid Atherothrombotic Plaques In Patients With Acute Ischemic Stroke During A 6-month Follow-up

Introduction: We previously reported that patients treated with aspirin plus cilostazol during the acute phase of ischemic stroke had less neurological deterioration than those treated with aspirin alone. However, the mechanisms of this beneficial effect remain unknown. Although cilostazol has been reported to induce regression of carotid atherosclerosis in patients with type 2 diabetes mellitus, no report has focused on patients with acute ischemic stroke. Therefore, we performed carotid ultrasonography in a sub-study of a randomized trial to investigate the effects of aspirin plus cilostazol on the progression of carotid plaques and intima-media thickness (IMT) during the first 6 months after acute ischemic stroke. Patients and Methods: This randomized study compared the effects of oral aspirin alone to aspirin plus cilostazol in patients admitted to our hospital due to non-cardioembolic ischemic stroke within 48 h of stroke onset. Maximum IMT within the internal and common carotid arteries (max IMT) and plaque score (PS) were examined on admission and 6 months after study entry. No other antithrombotic drugs were administered during the follow-up period. For statistical analysis, on-treatment analysis was conducted, and patients who had adverse effects due to aspirin or cilostazol and were treated with other antithrombotics due to neurological deterioration (NIH Stroke Scale score ≥1) were excluded from the analysis. Results: Seventy-six patients were enrolled in the study and randomly allocated to one of the treatment groups. During the 6-month follow-up, 10 patients in the aspirin group and 3 in the aspirin plus cilostazol group experienced neurological deterioration. As a result, 16 patients in the aspirin group and 26 in the aspirin plus cilostazol group completed the 6-month follow-up. Vascular risk factors and use of antihypertensive or lipid-lowering drugs did not significantly differ between the groups. In the aspirin plus cilostazol group, the changes in max IMT had a tendency towards regression when compared with the aspirin group (-0.23 ± 0.60 vs. 0.10 ± 0.53; p = 0.08). The regression in PS was significantly greater in the aspirin plus cilostazol group than in the aspirin group (-1.02 ± 2.20 vs. 1.00 ± 2.27; p = 0.0068). Conclusion: Compared to treatment with aspirin alone, treatment with aspirin plus cilostazol is more effective for preventing progression of carotid plaques for 6 months after stroke onset.

Factors that influence basal insulin requirement in type 2 diabetes

In clinical practice, basal insulin dosage (BID) for the treatment for type 2 diabetes given as slow-acting analogues or NPH insulin varies widely when adjusted for body weight (UI/kg). In this study, we investigated the interrelationship between BID and anthropometric, laboratory and clinical parameters. A total of 681 type 2 diabetic patients, treated with bedtime insulin in association with other antidiabetic drugs (preprandial insulin and/or oral agents), were studied. Anthropometric, clinical and biochemical parameters, as well as micro- and macrovascular complications, were evaluated. Non-alcoholic fatty liver disease (NAFLD) was assessed by liver ultrasound. BID was titrated to achieve a fasting blood glucose target of ≤6.7 mmol/L (120 mg/dL). In the multivariate analysis, BID was significantly associated with waist circumference (p = 0.04) and the insulin treatment duration (p = 0.004) as the type of insulin treatment ("basal-bolus" regimen vs. basal insulin only, p < 0.0001), the use of lipid-lowering drugs (p = 0.0003) and insulin sensitizers (p = 0.005). Several glycometabolic parameters were strongly associated with BID (HbA1c p = 0.01, FPG p < 0.0001, HDL p = 0.02, triglycerides p = 0.03). Moreover, the presence of severe NAFLD resulted in a higher BID (p = 0.03). We concluded that when starting and titrating the basal insulin in type 2 diabetes, certain anthropometric, laboratory and clinical factors can be useful to find optimal BID more quickly and appropriately.

Abstract 17894: Factors Associated with Cardiac Rehabilitation Attendance in Patients with Coronary Heart Disease in Europe: Results from EUROASPIRE III Survey

Objective: To describe patient characteristics and lifestyle and risk factor management in coronary patients participating in cardiac rehabilitation programme (CRP) compared to those who do not. Methods: The EUROASPIRE III survey was conducted in 2006-2007 in 76 centres from 22 European countries. Consecutive patients aged ≤ 80 years with the following diagnoses - coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction, and acute myocardial ischaemia- were identified from hospital records and interviewed and examined at least 6 months after their coronary event. Results: A total of 13,935 medical records were reviewed and 8,966 patients interviewed (participation rate 73%). Overall, 44.8% of patients were advised to participate in a CRP and 81.4% of these patients attended at least one session; (36.5% of the whole study population). There were wide variations between countries and diagnostic categories, ranging from 0% in Greece to 85.4% in Lithuania, and from 15.9% in the Ischaemia group to 68.1% in the CABG group. Characteristics associated with participation in a CRP included younger age, male sex, higher educational level, CABG as a recruiting index event and a history of previous PCI or angina pectoris. Those who were smokers at the time of their coronary event were less likely to attend a CRP. Patients participated in a CRP had significantly lower prevalence of smoking, better control of total cholesterol and LDL-cholesterol and higher use of beta-blockers, ACE inhibitors/ARBs and lipid-lowering drugs. There was no association between participation in a CRP, the prevalence of obesity and glucose and blood pressure control. Conclusions: Only one third of all coronary patients reported attending a CRP. Although the control of smoking, cholesterol and the use of cardioprotective medication was better in those who attended a CPR many patients had not achieved the lifestyle and risk factor targets. There is an urgent need of comprehensive, multidisciplinary rehabilitation programmes addressing all aspects of the lifestyle, other risk factors and therapeutic management and a health care system which invests in prevention.

Lipid Lowering Drugs and Gallstones: A Therapeutic Option?

Cholelithiasis is a common disease worldwide. The majority of gallstones can occur when the bile is supersaturated with cholesterol. Dyslipidaemia, obesity, insulin resistance are associated with an increased risk for cholesterol gallstone formation as well as with vascular risk. Statins and ezetimibe are used to treat dyslipidaemia and appear to have some effect on bile composition and cholesterol gallstone formation. Statin (e.g. pravastatin, simvastatin, fluvastatin and lovastatin) monotherapy or combined with ursodeoxycholic acid (UDCA) have shown reductions in bile cholesterol saturation, preventing gallstone formation and even dissolving pre-existing stones. However, this effect was not consistently reported in all studies. Statin use has also been associated with a reduced risk for cholecystectomy in 2 large epidemiological studies. Ezetimibe was shown to have a beneficial action against cholelithiasis in animal studies but data in humans - although promising - are very limited. The effect of these drugs on gallstone disease warrants further investigation in large human trials. We also consider the links between cholelithiasis, vascular risk and the use of lipid lowering drugs.

Maternal Heterozygous Familial Hypercholesterolemia and Its Consequences for Mother and Child

During a normal pregnancy serum lipids (total, low-density lipoprotein [LDL]-cholesterol and high-density lipoprotein cholesterol, and triglycerides) rise steadily1 and take months to fall postpartum.2 LDL-cholesterol can increase by ≈66% and triglycerides can rise 3-fold, and it has been suggested that elevated cholesterol during pregnancy may be associated with spontaneous preterm delivery.3 Article see p 1606 It is known that women with heterozygous familial hypercholesterolemia (FH) who become pregnant have very high levels of LDL-cholesterol early in pregnancy (260 mg/dL or 6.7 mmol/L) that rise to even higher levels near term (330 mg/dL or 8.6 mmol/L).4 These very high lipid levels raise the question of the potential risks of pregnancy to the mother and fetus. FH is caused by mutations in the low-density lipoprotein receptor. In this issue of Circulation , in a study linking the Medical Birth Registry of Norway (1967–2006) and the Medical Genetics Laboratory at Oslo University Hospital that has established the molecular diagnosis in 4400 patients, 2319 births of 1093 women were identified.5 The serum levels of cholesterol in the nonpregnant, nontreated FH women were 370 mg/dL (9.59 mmol/L). In this study, no maternal cardiovascular deaths were observed. In addition, the children of mothers with FH were no more likely than the general population to be born prematurely, have low birth weight, or have congenital malformations. Furthermore, even though the sample size was small, no congenital malformations were observed in the 19 pregnancies associated with the use of lipid-lowering drugs during pregnancy. Although this is a retrospective, registry-based study, the data likely reflect the birth outcomes of a representative cohort of childbearing FH …

CEPHEUS SA: a South African survey on the undertreatment of hypercholesterolaemia.

The aim of the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) was to evaluate the current use and efficacy of lipidlowering drugs (LLDs), and to identify possible patient and physician characteristics associated with failure, if any, to achieve low-density lipoprotein cholesterol (LDL-C) targets. The survey was conducted in 69 study centres in South Africa and recruited consecutive consenting patients who had been prescribed LLDs for at least three months. One visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Physicians and patients completed questionnaires regarding their knowledge, awareness and perceptions of hypercholesterolaemia and the treatment thereof. Of the 3 001 patients recruited, 2 996 were included in the final analyses. The mean age was 59.4 years, and 47.5% were female. Only 60.5 and 52.3% of patients on LLDs for at least three months achieved the LDL-C target recommended by the NCEP ATP III/2004 updated NCEP ATP III and the Fourth JETF/South African guidelines, respectively. Being male, older than 40 years, falling into the lower-risk categories, compliance with the medication regimen, and patient knowledge that the LDL-C goal had been reached, were associated with the highest probability of attaining LDL-C goals. The results of this survey highlight the sub-optimal lipid control achieved in many South African patients taking lipid-lowering therapy.

Cancer mortality according to lipid-lowering drugs and lipoproteins in a general population

Objective:The beneficial effect of lipid-lowering drugs (LLD) on cardiovascular risk is established, but long term safety data remain scarce. Our aim was to assess 10-year risk of cancer mortality according to blood lipoprotein levels and LLD exposure, in a general population.Methods:Our analysis was based on the Third French MONICA survey on cardiovascular risk factors (1994–1997). Participants were randomly recruited from the general population of three French areas and were aged 35–64 years. Subjects with a history of cancer at baseline were excluded from the analysis. Vital status and cause of mortality were obtained 10 years after inclusion.Results:There were 3262 participants and 177 deaths were recorded over the 10-year period (78 due to a cancer). The sample comprised 64% of normolipidaemic, 25% of untreated dyslipidaemic and 11% of dyslipidaemic subjects treated with LLD (4% statins, 6% fibrates and 1% other hypolipidaemic drugs). After adjustment for centre, age, gender, smoking, gamma-glutamyl transpeptidase and mean corpuscular volume, the hazard ratios (HR) for cancer mortality in subjects with non-HDL cholesterol <3.5 mmol/L (135 mg/dL) and in those with HDL cholesterol <0.90 mmol/L (35 mg/dL) were 2.74 (95% confidence interval: 1.66–4.52, p < 0.001) and 2.83 (1.62–4.96, p < 0.001), respectively. The adjusted HR for cancer mortality was 0.31 (0.11–0.86, p = 0.025) in people on LLD compared to untreated subjects.Conclusions:In the present study, we confirm the significant association between low cholesterol and cancer mortality without finding any harmful signal regarding cancer risk associated with the use of LLD. The main limitations are remaining baseline differences between treated and untreated subjects (due to the observational design but minimized by the use of extensive adjustments and propensity score methods), and the lack of re-assessment of LLD exposure and cholesterol levels during follow-up, possibly leading to a misclassification bias.

Effects of Hepatitis C virus on cardiovascular risk in infected patients: A comparative study

The role of hepatitis C virus (HCV) in the pathogenesis of atherosclerosis and cardiovascular events is unclear. The aim of this study was to evaluate the direct effect of HCV on cardiovascular risk and correlate it with pro and anti-inflammatory cytokines in patients with HCV. HCV monoinfected patients, genotype 1, naive, non-obese (BMI<30) and non-diabetics were included and compared to controls (blood donors). Patients with prior diagnosis of cardiovascular diseases, hypertension, chronic renal failure, cancer and chronic use of lipid-lowering drugs or immunosuppressants were excluded. Age, BMI, systolic blood pressure (SBP) and diastolic (DBP), fasting glucose and lipid levels were determined. Serum cytokines (IL-6, IL-10 and TNF-α) and Framingham score were also evaluated. 62 HCV patients, 34 (54.8%) were males and none of them was smoking. The Framingham scores (median and 25th and 75th percentiles) were 12% (6.5–14%), showing an intermediate cardiovascular risk in patients with HCV. There was significant direct correlation between Framingham and total cholesterol (p=0.043) and DBP (p=0.007). HDL-C (p=0.002) was inversely correlated with the Framingham score. HCV patients had higher levels of proinflammatory cytokines (IL-6 and TNF-α) compared to controls (p<0.0001) and the relation of proinflammatory/anti-inflammatory TNF-α/IL10 and IL-6/IL10 were higher in HCV patients (p<0.01). The Framingham score was directly correlated to IL-6 and TNF-α, but differences were not statistically significant. Patients with HCV monoinfected, nonobese, naïve and non diabetic have an intermediate cardiovascular risk, as measured by the Framingham score and high levels of proinflammatory cytokines (IL-6 and TNF).

Triglyceride–high-density lipoprotein cholesterol is associated with microvascular complications in type 2 diabetes mellitus

The purpose of this study was to evaluate whether a high triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio is associated with an increased incidence of retinopathy and chronic kidney disease (CKD) in type 2 diabetes mellitus. Individuals with type 2 diabetes mellitus (n = 979) with an estimated glomerular filtration rate greater than 60 mL/min and without retinopathy and cardiovascular disease at baseline were followed up for the incidence of diabetic retinopathy (diagnosed by retinography) and CKD (diagnosed by estimated glomerular filtration rate ≤60 mL/min/1.73 m 2). On follow-up (mean, 4.9 years), 217 (22.2% of total) subjects experienced CKD and/or diabetic-specific retinal lesions (microvascular complication). Of these, 111 subjects developed isolated retinopathy, 85 developed CKD alone, and 21 developed both complications. The TG/HDL-C ratio was positively associated with an increased risk of incident retinopathy and/or CKD (composite microvascular end point) independently of age, sex, body mass index, diabetes duration, hemoglobin A 1c, hypertension, smoking history, low-density lipoprotein cholesterol, albuminuria, and current use of hypoglycemic, antihypertensive, lipid-lowering, or antiplatelet drugs (multivariable-adjusted odds ratio, 2.15; 95% confidence intervals, 1.10-4.25; P = .04). These findings suggested that the TG/HDL-C ratio was associated with an increased incidence of microvascular complications in individuals with type 2 diabetes mellitus without prior cardiovascular disease, independently of several potential confounders.

Dyslipidaemia: integration between primary and secondary care

It implementation of guidelines, not the guidelines themselves, that change clinical practice. This session examined some of the issues that were faced when interpreting national guidelines for local implementation. Local guidelines for the use of lipid lowering drugs have been in place and