Use Of Lipid-lowering Drugs Research Articles

Antihypertensive therapy, new-onset diabetes, and cardiovascular disease.

Type 2 diabetes mellitus is a worldwide epidemic with considerable health and economic consequences. Diabetes is an important risk factor for cardiovascular disease, which is the leading cause of death in diabetic patients, and decreasing the incidence of diabetes may potentially reduce the burden of cardiovascular disease. This article discusses the clinical trial evidence for modalities associated with a reduction in the risk of new-onset diabetes, with a focus on the role of antihypertensive agents that block the renin–angiotensin system. Lifestyle interventions and the use of antidiabetic, anti-obesity, and lipid-lowering drugs are also reviewed. An unresolved question is whether decreasing the incidence of new-onset diabetes with non-pharmacologic or pharmacologic intervention will also lower the risk of cardiovascular disease. A large ongoing study is investigating whether the treatment with an oral antidiabetic drug or an angiotensin-receptor blocker will reduce the incidence of new-onset diabetes and cardiovascular disease in patients at high risk for developing diabetes.

Patient characteristics are associated with prescription of sitagliptin vs. other oral antihyperglycaemic agents based on an electronic medical record database from Us

aims: This study examined differences in patient characteristics between patients with type 2 diabetes (T2DM) treated with sitagliptin (SITA) vs other oral antihyperglycemic agents (OAHA) in real-world practice in the US. Methods: The General Electric Centricity electronic medical record database, covering 9 million US patients of all ages from 49 states, was used to select patients with T2DM, aged >=30 years, who received their first SITA, metformin, sulfonylureas, or thiazolidinediones prescriptions (Rx) as index Rx between Oct 2006 and June 2008. Included patients were new to OAHA mono, dual or triple therapy. Patient’s demographics, diagnoses, Rxs, and lab results were extracted for the 1 year period (baseline) prior to index Rx. Baseline characteristics were stratified by mono, dual, or triple therapy and were compared between regimens with and without SITA. Adjusted logistic regression analyses were used to estimate odds ratio (OR) associated with SITA use in relation to patient characteristics. results: Among 45418 patients new to OAHA monotherapy, 1091 (2.4%) received SITA. Compared to patients initiating other OAHA, patients on SITA were older (64 vs 61 years), had higher HbA1c (7.4% vs 7.1%) with fewer patients at HbA1c <7% (46% vs 58%), had higher serum creatinine (106 vs 88 mmol/L), and had higher prevalence of macro(18.1% vs 12.7%) and microvascular (15.1% vs 6.8%) conditions (all p<0.0001). Adjusted logistic regression shows that significant predictors of prescribing SITA were older age (OR 1.01, 95% CI 1.00, 1.02), higher HbA1c level (OR 1.13, 95% CI 1.08, 1.18), and presence of retinopathy (OR 2.29, 95% CI 1.38, 3.80) or renal insufficiency (OR 2.65, 95% CI 2.20, 3.19). Of 24806 patients new to dual therapy, 2261 (9.1%) were on SITA regimens. Relative to patients on other dual regimens, patients prescribed SITA dual regimens were older, had higher serum creatinine, had higher prevalence of macroand micro-vascular conditions, and greater use of lipid lowering and antihypertensive drugs (all p<0.0001). Among 10774 patients new to triple therapy, 3194 (29.6%) were on triple SITA regimens. Relative to patients on other triple regimens, patients on SITA triple regimens were older, had higher serum creatinine and greater use of antihypertensive or lipid-lowering drugs (all p<0.0001). Lipid lowering Rx was associated with higher adjusted likelihood of prescribing SITA dual and triple therapy. conclusion: This study found that patients with T2DM who were prescribed SITA were older and likely to have more preexisting diabetic complications and comorbidities compared to patients who received other common OAHA in real-world practice. This has important implications for future observational studies, in that estimated outcome measures may be biased.

Risk factor control in patients with Type 2 diabetes and coronary heart disease: findings from the Swedish National Diabetes Register (NDR)

Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). In patients with CHD 1-2 years before follow-up, the achievement of cardiovascular risk factor targets (follow-up 2002/follow-up 2005) was: HbA(1c) < 7%, 47%/54% (P < 0.01); blood pressure < or = 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low-density lipoprotein-cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid-lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) > or = 25 kg/m(2)], 86%/85%; obesity (BMI > or = 30 kg/m(2)), 41%/42%; smokers in age group < 65 years, 16-23%/18-19%; as well as waist circumference > or = 102 cm (men) or > or = 88 cm (women), 68% in 2005. Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid-lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence-based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients.

Statins are detrimental to human placental development and function; use of statins during early pregnancy is inadvisable

The rapid rise in obesity, metabolic syndrome and type 2 diabetes is one of the major healthcare problems of the Western world. Affected individuals are often treated with statins (HMG CoA reductase inhibitors) to reduce circulating cholesterol levels and the risk of developing cardiovascular disease [1]; given the evolving demographic profile of these conditions, such drugs are increasingly prescribed to women of reproductive age. Cholesterol is essential for normal foetal development and therefore the use of lipid-lowering drugs, including statins, is contraindicated during pregnancy. However, a recent study suggests that the detrimental effects of statins may be restricted to the more lipophilic compounds as there have been no reports of foetal congenital abnormalities in association with the relatively hydrophilic statins, for example pravastatin [2]. The actions of statins are not limited to modulation of cholesterol levels, as inhibition of HMG CoA reductase also interferes with the production of dolichol and isoprenoids; dolichol is involved in the N-linked glycosylation of membrane-targeted glycoproteins, whereas isoprenoids are necessary for the optimal function of numerous intracellular signalling molecules. Previous studies indicate that the insulin-like growth factor (IGF) system – a key system in the control of foetal growth – is particularly sensitive to such modulation by statins [3]. IGFs mediate their effect on foetal growth, at least in part, by promoting normal placental development; thus maternal IGF can enhance the growth, survival and differentiation of the placental trophoblast cell layer [4], which is responsible for maintaining the nutrient/waste exchange barrier between mother and foetus. We therefore investigated if statins affect IGF action in the human placenta, using pravastatin as an example of a hydrophilic statin that is potentially compatible with use in pregnancy and the potent lipohilic compound, cerivastatin, which is no longer clinically available but is known to abrogate IGF effects in other cell models. We have used an explant model of early pregnancy placental villous tissue that can be maintained in a viable state for several days [4], representing a much more physiologically relevant system for toxicology studies than cell culture. In particular, cell proliferation is maintained, the vectorial relationship between maternal and foetal blood compartments is preserved and test compounds may be supplied to the maternal surface of the placenta to faithfully recapitulate in vivo exposure. As expected,

Smoking, inflammatory patterns and postprandial hypertriglyceridemia

Background Smoking is associated with increased postprandial hypertriglyceridemia (PPT). Inflammation and insulin resistance are potential “drivers” for this phenomenon. We tested whether inflammatory patterns and/or insulin resistance explain the effect of smoking on PPT. Methods and results Men and women in the NHLBI Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN) study ( n = 1036, age 49 ± 16 y) were included. Each participant was asked to suspend use of lipid-lowering drugs for 3 weeks and was given a high-fat milkshake (83% fat and 700 kcal/m 2). Triglyceride concentrations at 0, 3.5 and 6 h after the fat load were measured. Inflammatory markers were measured at baseline. Principal component analysis was used to derive inflammatory patterns from individual inflammatory markers (hsCRP, IL2 soluble receptor-α, IL6, TNF-α and MCP1). Insulin resistance (IR) was estimated using the HOMA equation. Repeated measures-ANOVA was used for analyses. Two inflammatory patterns, namely CRP-IL6 pattern and MCP1-TNF-α pattern, were derived. We found significant main (smoking and time) and interaction (smoking × time) effects ( P < 0.01) for triglycerides. The multivariate-adjusted triglyceride (mg/dL) concentrations (mean ± S.E.M.) for never, past and current smokers were 127.38 ± 1.04, 119.82 ± 1.05 and 134.92 ± 1.08 at 0 h; 229.42 ± 1.04, 238.39 ± 1.05 and 293.94 ± 1.08 at 3.5 h; and 194.63 ± 1.04, 208.38 ± 1.05 and 248.27 ± 1.08 at 6 h after the fat load, respectively. Smoking remained significant after adjusting for HOMA-IR and/or inflammatory patterns which showed independent associations with PPT ( P < 0.05). Conclusions These data confirm impaired metabolism of fat among smokers and suggest that mechanisms other than inflammation or insulin resistance may explain the observed hypertriglyceridemia among smokers.

Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study

Evidence of a relation between use of lipid lowering drugs and cognitive outcomes is mixed. This study aimed to test the association between use of statins and incidence of dementia and cognitive impairment without dementia (CIND) over 5 years of follow-up. Data were from a population-based cohort study comprising 1,789 older Mexican Americans. All participants had cognitive and clinical evaluations performed every 12 to 15 months. Participants who fell below specified cutpoints on cognitive tests were then evaluated clinically. Dementia diagnoses were finalized by an adjudication team. A total of 1,674 participants free of dementia/CIND at baseline were included in these analyses. Statin use was verified at each participant's home by medicine cabinet inspection. Cox proportional hazards models were used to evaluate the association between statin use and incidence of dementia/CIND. Overall, 452 of 1,674 participants (27%) took statins at any time during the study. Over the 5-year follow-up period, 130 participants developed dementia/CIND. In Cox proportional hazards models adjusted for education, smoking status, presence of at least one APOE epsilon4 allele, and history of stroke or diabetes at baseline, persons who had used statins were about half as likely as those who did not use statins to develop dementia/CIND (HR = 0.52; 95% CI 0.34, 0.80). Statin users were less likely to have incident dementia/cognitive impairment without dementia during a 5-year follow-up. These results add to the emerging evidence suggesting a protective effect of statin use on cognitive outcomes.

HDL: Close to Our Memories?

The last decade has witnessed an explosion in studies of the role of lipoproteins in brain function. Neurons require a continuous supply of lipids for membrane synthesis and acetylcholine production. Indeed, the brain is a site of intense lipid turnover—even though the central nervous system (CNS) accounts for only 2.1% of body weight, it contains 23% of total body cholesterol.1 Lipid metabolism in the brain is tightly controlled locally, as plasma lipoproteins are shielded from the brain by the blood-brain barrier. Although neuronal cells are capable of de novo synthesis of a wide spectrum of molecular species of lipids, they rely heavily on exogenous sources and readily bind and internalize lipoproteins of the extracellular fluid.2 Equally, neurons need to dispose of excess lipids; lipoprotein-mediated lipid transport is therefore bidirectional and includes cellular efflux of cholesterol.3 See accompanying article on page 1556 Human cerebrospinal fluid (CSF) primarily contains spherical lipoproteins of approximately 10 to 12 nm in diameter with hydrated density in the range 1.063 to 1.25 g/mL, thereby resembling HDL in human plasma.3,4⇓ Lipid concentrations in CSF are however much lower (eg, 300- to 400-fold for total cholesterol and phospholipids) as compared to the plasma compartment.4 Apolipoproteins (apo) E and A-I are the major apolipoproteins in human CSF (typical concentration range: 0.1 to 0.4 mg/dL3,4⇓), with apoA-II, A-IV, J, D, C-II, C-III, C-IV, and H equally present.3,4⇓ Importantly, CSF lipoproteins carry amyloid-β (Aβ), a 39- to 43-aa peptide produced in neuronal cells, which is the major component of senile amyloid plaques.5 The metabolism of CSF lipoproteins remains poorly characterized but seems to be distinct from that of plasma lipoproteins. ApoE-rich HDL are synthesized locally in CNS and secreted by astrocytes as discoidal complexes enriched in free cholesterol.6 High …

Growth Hormone Treatment on Atherosclerosis: Results of a 5-Year Open, Prospective, Controlled Study in Male Patients with Severe Growth Hormone Deficiency

Severe GH deficiency (GHD) is associated with, increased cardiovascular risk and intima-media thickness (IMT) at major arteries. The objective of the study was to investigate the 5-yr effects of GH replacement on common carotid IMT and insulin resistance syndrome (IRS) (at least two of the following: triglycerides levels > or = 1.7 mmol/liter, high-density lipoprotein-cholesterol levels < or = 1.0 mmol/liter, blood pressure above 130/85 mm Hg, fasting glucose 6.1-7 or 2 hr after glucose 7.7-11.1 mmol/liter). This was an interventional, open, prospective, controlled study. Patients included 35 men with severe GHD and 35 age-matched healthy men as controls. All patients received standard replacement therapy; GH replacement was added in 22 patients (group A) and refused by 13 others (group B). Five-year changes in IMT and IRS prevalence were measured. At baseline, IMT was higher in the patients with (P < 0.001) and without IRS (P = 0.004) than in controls. Eighteen patients (51.4%) and two controls (5.7%; P < 0.0001) had IRS. At study end, use of lipid-lowering drugs (92.3, vs. 13.6 and 34.3%, P < 0.0001), glucose-lowering drugs (69.2 vs. 31.4 and 22.7%; P = 0.016), and antihypertensive drugs (61.5 vs. 20.0 and 4.5%; P < 0.0001) was higher in group B patients than controls and group A patients. IGF-I levels normalized in all group A patients and remained lower than -1 sd score in 77% of group B patients. IMT significantly decreased only in group A and significantly increased in controls and nonsignificantly in group B patients. IRS prevalence significantly reduced only in group A patients. Severely hypopituitary GHD men have more frequently increased IMT at common carotid arteries and IRS than controls. After 5 years, only in GH replaced patients, IMT and prevalence of IRS decreased.

Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction.

Because of the known relationship between exposure to combination antiretroviral therapy and cardiovascular disease (CVD), it has become increasingly important to intervene against risk of CVD in human immunodeficiency virus (HIV)-infected patients. We evaluated changes in risk factors for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow-up for 33,389 HIV-infected patients from December 1999 through February 2006. The proportion of patients at high risk of CVD increased from 35.3% during 1999-2000 to 41.3% during 2005-2006. Of 28,985 patients, 2801 (9.7%) initiated lipid-lowering therapy; initiation of lipid-lowering therapy was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors for CVD, the rate decreased over time (relative rate in 2003 [compared with 1999-2000], 0.73 cases per 100 PY [95% CI, 0.50-1.05 cases per 100 PY]; in 2004, 0.64 cases per 100 PY [95% CI, 0.44-0.94 cases per 100 PY]; in 2005-2006, 0.36 cases per 100 PY [95% CI, 0.24-0.56 cases per 100 PY]). Further adjustment for lipid levels attenuated the relative rates towards unity (relative rate in 2003 [compared with 1999-2000], 1.06 cases per 100 PY [95% CI, 0.63-1.77 cases per 100 PY]; in 2004, 1.02 cases per 100 PY [95% CI, 0.61-1.71 cases per 100 PY]; in 2005-2006, 0.63 cases per 100 PY [95% CI, 0.36-1.09 cases per 100 PY]). Although the CVD risk profile among patients in the Data Collection on Adverse Events of Anti-HIV Drugs Study has decreased since 1999, rates have remained relatively stable, possibly as a result of a more aggressive approach towards managing the risk of CVD.

Serum lipids, blood pressure and body weight around the age of the menopause

Of previous studies, some have indicated an adverse development of serum lipids, blood pressure and body weight in women around the menopause. We sought to study these associations in data collected before the widespread use of lipid lowering drugs and hormone therapy. Population-based cohort study. We analysed data from population-based cardiovascular surveys in Norway. During 1985--1988, all women aged 40-54 years in three counties were invited, 83% participated and 24,085 nonusers of hormone therapy were studied, of whom 12,736 had attended similar surveys 5 and 10 years earlier (1974--1978 and 1977--1983). Serum lipids, blood pressure, height and weight were measured, and menopausal status was registered by interview. Analyses were made in cross-sectional data and by comparing changes in serum lipids, body weight and blood pressure between the surveys according to menopausal exposure. Total cholesterol (TC), triglycerides and the TC/high-density lipoprotein (HDL)-cholesterol ratio increased from premenopausal to postmenopausal status. The HDL-cholesterol concentration seemed to increase slightly in the perimenopause. In women who had entered the postmenopausal phase most recently, the increases of TC and triglycerides since 5 years earlier were more than twice the levels of premenopausal women. The results were consistent in subgroups by age. Menopausal status was not associated with adverse development of blood pressure or body weight. The menopausal transition may be associated with an accelerated increase of TC and triglyceride concentrations and of the TC/HDL-cholesterol ratio.

Lipid-lowering drug use in Italian primary care: effects of reimbursement criteria revision

To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after reimbursement criteria revision in a general practice in southern Italy. From the Caserta-1 Local Health Service database, 93 general practitioners (GPs) who had consistently sent data about their patients during the years 2003-2005 were recruited. Prevalence of use and incidence of new treatments were calculated for each year, stratified by three drug cohorts: statins, omega-3 fatty acids, and fibrates. Subanalyses by gender, age, and indication of use were performed. Overall, 1-year prevalence of LLD use increased from 2003 to 2004. After reimbursement criteria revision (November 2004), a slight decrease was observed for statins, from 41.1 (95% CI: 39.9-42.2) per 1,000 inhabitants in 2004 to 40.3 (39.2-41.5) in 2005, while omega-3 utilization fell markedly: 14.6 (13.9-15.3) vs. 5.4 (5.0-5.8). The use of both statins and omega-3 fatty acids was reduced particularly for primary prevention. On the other hand, utilization of statins increased in diabetic patients and as secondary prevention from 2004 to 2005. Concerning individual molecules, 1-year prevalence of use of any statin declined from 2004 to 2005, except for rosuvastatin. Revision of reimbursement criteria led to significant changes in the trend in LLD use in general practice in southern Italy: (1) statin utilization was slightly reduced in 2005, although it increased in certain categories, such as diabetic patients, and (2) omega-3 fatty acid use was strongly reduced even though a higher use in postinfarction cases was reported.

Dyslipidemia in children with type 2 diabetes vs. obesity

To compare the frequency and severity of dyslipidemia between subjects with type 2 diabetes (T2DM) and non-diabetic obese group (OB) subjects, followed in a pediatric subspecialty clinic. One hundred and four OB subjects seen consecutively by one physician and 67 pediatric subjects diagnosed with T2DM (negative antibodies) were screened from an institutional review board-approved database. Fifty-two T2DM and 75 OB subjects with fasting lipid profiles measured at one hospital's laboratory were included. Both OB and T2DM subjects were predominantly Mexican American. Comparing T2DM at diagnosis or uncontrolled (UC) and OB, mean +/- SD age was 14.3 +/- 2.3 and 11.4 +/- 3.7 with body mass index-Z score of 2.02 +/- 0.67 and 2.46 +/- 0.45, respectively (both p < 0.01). Comparing lipid levels in T2DM to OB and National Health and Nutrition Examination Survey III, the percentage of subjects, respectively, with cholesterol >200 mg/dL (5.17 mmol/L) were 55.8, 22.7, and 10%; with low-density lipoprotein >130 mg/dL (3.36 mmol/L) were 39.4, 12.5, and 10%; with triglycerides >150 mg/dL (1.68 mmol/L) were 65.1, 38.7, and 12.5%; and with high-density lipoprotein <35 mg/dL (0.91 mmol/L) were 40, 22.2, and 10%. Over 80% of the T2DM subjects improved their lipid profile with improved glycemic control as hemoglobin A1c decreased from 10.85 +/- 2.17 to 7.6 +/- 2%. Dyslipidemia is a frequent comorbidity of obesity and T2DM, starting in childhood, and poses a major public health risk. Dyslipidemia in pediatric subjects with UC T2DM is significantly worse than in OB subjects but is similar to OB subjects when diabetes was better controlled. Earlier use of lipid-lowering drugs should be considered in pediatric T2DM patients who achieve tight glycemic control, yet their dyslipidemia persists.

Gender-based treatment outcomes in diabetic hypertension

In developing countries, gender-based treatment disparities in cardiovascular preventive therapy have received little attention. To evaluate the gender-based differences in cardiovascular disease risk profile, drug prescribing pattern, and blood pressure (BP) and glycemic control rates in diabetic hypertensives treated at primary care setting in Bahrain. A retrospective study at primary care setting. An audit of the medical records of 392 diabetic hypertensives (127 men, 265 women). BP and glycemic targets were achieved in < 10% and < 13% of diabetic hypertensives, respectively. Angiotensin converting enzyme inhibitors monotherapy was more often prescribed in males. Apart from this, no significant differences in prescribing pattern were observed between male and female diabetic hypertensives treated with either antihypertensive mono or multidrug therapies. With the exception of insulin which was more often prescribed to females, a similar prescribing pattern and rank order of antidiabetics, either as monotherapy or combinations, was observed in both genders. The majority of diabetic hypertensives were at high cardiovascular risk. The body mass index and total cholesterol level were greater in females. Prescribing lipid-lowering drugs and aspirin were suboptimal; aspirin was more often prescribed to males. There was no gender-based difference with regard to the use of lipid-lowering drugs. BP and glycemic controls were suboptimal in both male and female diabetic hypertensives treated by primary care physicians. Cardiovascular disease preventive strategies have received little attention regardless of gender or other risk factors. Gender-based treatment inequities also need to be addressed.

Guidelines improve general trend of lowered cholesterol levels in type 2 diabetes patients in spite of low adherence

New guidelines were introduced in Sweden in 1999 to reduce the risk of cardiovascular disease among diabetes patients. The impact of the new guidelines on lipid levels in a diabetes patient population has not been extensively studied. Our aim was to study whether the introduction of treatment goals for dyslipidaemia was reflected in lower cholesterol levels in patients with diabetes in a general population. In a population of 59,338 individuals, 971 (1.6%) had diabetes. All subjects were 40, 50 or 60 years of age and participated in the Vasterbotten Intervention Programme in 1995-2004. Cholesterol levels and use of lipid-lowering drugs were measured, and trends in cholesterol levels were analysed before and after the guidelines were introduced in 1999. In this effectiveness study, there was a marked decrease in mean plasma total cholesterol levels among patients with diabetes (5.79 (+/- 1.21) mmol/1 in 1995-1999 and 5.07 (+/- 1.00) mmol/1 in 2000-2004 (p<0.001)) as well as in the non-diabetic population (5.79 (+/-1.15) mmol/1 and 5.41 (+/-1.07) mmol/1 (p<0.001)). The trend in diabetes patients was influenced by increased use of lipid-lowering agents, even though only 25.3% (male/female 26.8%/23.2%) of the diabetes patients received lipid-lowering treatment after the introduction of the new guidelines. Since the introduction of the guidelines, an increasing number of diabetes patients are receiving lipid-lowering drugs, which enhance a strong general trend of lowered cholesterol levels. Yet, the vast majority of diabetes patients with hypercholesterolaemia still do not receive medical treatment in accordance with the guidelines.

Use of Statins and the Risk of Parkinson???s Disease

Case reports have related the use of HMG-CoA reductase inhibitors ('statins') to Parkinson's disease (PD). Paradoxically, however, statins may have potentially beneficial effects on neurodegenerative diseases due to their anti-inflammatory properties. To explore the risk of the development of PD in association with untreated hyperlipidaemia and with hyperlipidaemia treated with lipid-lowering drugs in the UK primary care setting. We conducted a case-control analysis using the UK-based General Practice Research Database (GPRD). Cases were incident PD cases > or =40 years of age between 1994 and 2005. One control was matched to each PD case based on age, sex, general practice and index date. Lipid-lowering drug use was assessed by exposure timing (current vs past use) and by exposure duration (1-9, 10-29 or > or =30 prescriptions) prior to the index date for both cases and controls. Odds ratios (OR) were calculated using conditional logistic regression, adjusted for body mass index, smoking and various cardiovascular, metabolic and psychiatric co-morbidities. We identified 3637 cases with an incident idiopathic PD diagnosis, and the same number of controls. Compared with patients without hyperlipidaemia, those with untreated hyperlipidaemia did not have an altered relative PD risk (adjusted OR 0.98, 95% CI 0.74, 1.30). The adjusted ORs for current use of > or =30 prescriptions for statins or fibrates compared with non-use of statins or fibrates were 1.06 (95% CI 0.75, 1.51) and 1.25 (95% CI 0.51, 3.06), respectively. In this observational study, the long-term use of statins or fibrates was not associated with a substantially altered relative risk of developing PD.

Lipid elevations in the ARTEMIS and TITAN trials: effects of demographics, HIV disease stage, treatment arm and lipid-lowering drugs

Methods Lipid parameters included total cholesterol, LDL (calculated, for samples with triglycerides below 4.52 mmol/L), HDL, triglycerides, apolipoprotein A1, Apo B, glucose and insulin. Analysis of covariance was used to correlate changes in each lipid parameter with baseline lipid levels, age, gender, and race, baseline CD4 count, HIV-RNA, treatment arm (LPV/r vs. DRV/r), and use of NNRTI (TITAN trial only) and lipid-lowering drugs (fibrates/statins). Numbers in brackets show the size of effects of factors on lipid elevations at week 48 – these effects were all statistically significant (p < 0.01).

Association between copayment and adherence to statin treatment initiated after coronary heart disease hospitalization: A longitudinal, retrospective, cohort study

Background: Despite substantial evidence supporting the effectiveness of statin treatment, when administered regularly for the secondary prevention of coronary heart disease (CHD), many patients are not adherent. Objective: The objective of this study was to examine the relationship between copayment and adherence to statin treatment among patients who initiated statin treatment after discharge from a CHD hospitalization. Methods: Databases containing inpatient admission, outpatient, enrollment, and pharmacy claims from 1999 to 2003 were utilized for this study. The sample consisted of adults who initiated statin treatment after hospitalization directly related to CHD. Adherence to statins was measured by medication possession ratio (MPR), a surrogate marker of adherence calculated as a percentage of days with statins on hand during a 1-year observation period. The relationship between copayment and adherence to statin treatment was examined using multivariate logistic regression models. Demographic and clinical characteristics were selected as control variables based on modified versions of the Andersen health services utilization model as well as previous study findings. Results: A total of 5548 patients met the study entry criteria and were included in the analysis. Of this number, 3404 patients (61.4%) had an MPR of ≥80% and were considered adherent to statins. Compared with those who had a copayment <$10, patients with a copayment ≥$20 were significantly less likely to be adherent to statins (odds ratio, 0.42; 95% CI, 0.36−0.49). Other relevant factors significantly associated with low adherence were younger age ( P < 0.001), female sex ( P < 0.001), absence of dyslipidemia diagnosis ( P < 0.001), presence of depression ( P = 0.010), and concomitant use of nonstatin lipid-lowering drugs ( P < 0.001). Conclusions: Adherence during the 1-year period after statin initiation among CHD hospitalized patients was suboptimal, with more than one third of the patients not adherent to statin treatment. High prescription copayment appeared to be a significant barrier to statin adherence, even after adjusting for demographic and clinical variables.

Five-Year Impact of a Continuous Quality Improvement Effort Implemented by a Network of Diabetes Outpatient Clinics

To evaluate the impact of a continuous quality improvement effort implemented by a network of diabetes outpatient clinics in Sicily, Italy. Twenty-two clinics adopted the same electronic medical record system. Process and intermediate outcomes indicators were identified and software was developed, enabling the extraction of the information needed for the profiling of quality of care. Data were centrally analyzed anonymously every year, and results were discussed in meetings with the participants. The performances of the different centers were ranked against the "best performers," and the reasons for variation were discussed. From 2001 to 2005, a total of 26,782 patients aged >or=18 years have been seen in the participating clinics. Rates of monitoring of A1C, blood pressure, lipid profile, and microalbuminuria constantly increased over the years. The percentage of individuals with A1C values <or=7.0% increased by 16.6%, while the proportion of patients with blood pressure <or=130/85 mmHg increased by 10.7%. The percentage of individuals with LDL cholesterol levels <100 mg/dl had a marked increase from 19.4 to 44.1%. Rates of use of lipid-lowering drugs, antihypertensive drugs, and aspirin also substantially raised over the years. We found a strong consistency between increasing rates of monitoring, increasing drug prescription, and better levels of intermediate outcomes. Despite the satisfactory achievements, a substantial room for improvement in the care of diabetes still persists.

Trends in cardiovascular risk factor prevalence (1995-2000-2005) in northeastern Spain

High prevalence of cardiovascular risk factors has been observed in Spain along with low incidence of acute myocardial infarction. Our objective was to determine the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain. Comparison of cross-sectional studies were conducted in random population samples in 1995, 2000, and 2005 at Gerona, Spain. An electrocardiogram was obtained, along with standardized measurements of body mass index, lipid profile, systolic and diastolic blood pressure, glycaemia, energy expenditure in physical activity, smoking, use of lipid-lowering and antihypertensive medications, and cardiovascular risk. Prevalence of diabetes, hypertension, and obesity was calculated and standardized for age. A total of 7571 individuals (52.0% women) were included (response rate 72%). Low-density lipoprotein cholesterol >3.4 mmol/l (130 mg/dl) (49.7%) and hypertension (39.1%) were the most prevalent cardiovascular risk factors. In 1995, 2000 and 2005, low-density lipoprotein cholesterol decreased in both men and women: 4.05-3.91-3.55 mmol/l (156-151-137 mg/dl) and 3.84-3.81-3.40 mmol/l (148-147-131 mg/dl), respectively. Increases were observed in lipid-lowering drug use (5.7-6.3-9.6% in men and 4.0-5.8-8.0% in women), controlled hypertension (14.8-35.4-37.7% in men and 21.3-36.9-45.0% in women); (all P-trends <0.01), and obesity (greatest for men: 17.5-26.0-22.7%, P-trends=0.020). Prevalence of myocardial infarction or possibly abnormal Q waves in electrocardiogram also increased significantly (3.9-4.7-6.4%, P-trends=0.018). The cardiovascular risk factor prevalence change in Gerona was marked in this decade by a shift of total cholesterol and low-density lipoprotein cholesterol distributions to the left, independent of the increase in lipid-lowering drug use, and better hypertension control with increased use of antihypertensive drugs.

Treatment potential for cholesterol management in patients with coronary heart disease in 15 European countries: Findings from the EUROASPIRE II survey

BackgroundDuring the last decade, the evidence of beneficial effects of cholesterol lowering in patients with coronary heart disease (CHD) has been proven in several clinical trials. This has prompted international guidelines on prevention of CHD to include recommendations on dietary and pharmacological treatment of hyperlipidaemia with set goals on total- and LDL-cholesterol. MethodsThe first EUROASPIRE survey performed in 1995/1996 showed poor adherence to the European recommendations on lipid-lowering in patients with CHD. The second survey was carried out in 1999/2000 in 15 European countries and enrolled 8181 patients with CHD. Medical records were assessed and clinical examinations of risk factors including serum lipids were performed. The aim of this survey is to describe the treatment of hyperlipidaemia among CHD patients in Europe. ResultsThe proportion of patients not reaching the target of 5.0mmol/l was 58.3% with significant variations between countries. The use of lipid-lowering drugs was relatively high (60.9%). However, the most frequently used doses of lipid-lowering agents were much lower than the doses of proven effect used in clinical trials. ConclusionsAlthough the treatment of hyperlipidaemia in CHD patients seems to be improving as compared to the first survey, a significant number of patients do not reach treatment goals. If the full potential of lipid-lowering therapy was utilised with all eligible patients treated and doses titrated correctly, more patients would benefit in terms of reduced morbidity and mortality of CHD.