AIM： To evaluate the effcacy, effect of preventing cardio-vascular diseases and safety of statins-fbrates combination therapy in diabetic dyslipidemia patients.METHODS： We searched the databases of MEDLINE, EM-BASE,...AIM： To evaluate the effcacy, effect of preventing cardio-vascular diseases and safety of statins-fbrates combination therapy in diabetic dyslipidemia patients.METHODS： We searched the databases of MEDLINE, EM-BASE, web of knowledge and Cochrane central register of Controlled Trials for literatures about the coadministration of statins and fibrates as the treatment of patients with dyslipidemia and type 2 diabetes mellitus. We included re-lated randomized controlled trials, controlled clinical trials and cross-sectional studies and excluded animal trials and clinical observations. The primary endpoints outcomes were the concentration of plasma total cholesterol （TC）, triglyc-eride （TG）, high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C）. The secondary outcomes were cardiovascular diseases （CVD） and adverseevents.RESULTS： Ten studies were included in this meta-analysis. For lipid modifying efficacy, the combination of statins and fibrates therapy had more significant effecton reducing TC [ P = 0.004, weighted mean difference （WMD） = -8.19, 95%CI： -13.82--2.56] and TG concentra-tion （P 〈 0.001, WMD = -47.29, 95%CI： -68.66--25.92） and increasing HDL-C concentration （P 〈 0.00001, WMD = 3.79, 95%CI： 2.25-5.33） when compared with statins monotherapy, while the effect of reducing LDL-C concen-tration （ P = 0.50, WMD = -2.52, 95%CI： -9.76-4.72） was insignificant. To fibrates monotherapy, the combination therapy was more effective on reducing TC （ P 〈 0.00001, WMD = -48.51, 95%CI： -57.14--39.89）, TG （ P 〈 0.00001, WMD = -26.07, 95%CI： -30.96--21.18）, LDL-C concentra-tion （ P 〈 0.00001, WMD = -45.74, 95%CI： -53.35--38.13） and increasing HDL-C concentration （ P = 0.04, WMD = 1.38, 95%CI： 0.04-2.73）. For cardiovascular diseases, the coad-ministration therapy had no signifcant effect on reducing the incidence of these events when compared with mono-therapy （For primary clinical endpoints, P = 0.12, OR = 0.61, 95%CI： 0.33-1.14）; for secondary clinical endpoints, P =0.13, OR = 0.66, 95%CI： 0.38-1.14）. For adverse events happened during the follow-up, both the incidence of hepatic-related （alanine aminotransferase and/or aspartate aminotransferase of patients were ≥ 3 times of upper limit of normal） （ P = 0.38, OR = 0.55, 95%CI： 0.15-2.06） and muscular-related （myopathy and/or creatine phosphokinase ≥ 3 times of upper limit of normal） adverse events （P = 0.10, OR = 1.62, 95%CI： 0.91-2.86） had no signifcant dif-ference between these two therapies.CONCLUSION： The results showed statins-fbrates com-bination therapy was more effective on lipid modification and well tolerated but there was no significant effect on preventing cardiovascular diseases.展开更多
For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of H...For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.展开更多
Cardiovascular disease(CVD)remains a major cause of morbidity and mortality worldwide.Currently,it is well established that dyslipidemia is one of the major risk factors leading to the development of atherosclerosis a...Cardiovascular disease(CVD)remains a major cause of morbidity and mortality worldwide.Currently,it is well established that dyslipidemia is one of the major risk factors leading to the development of atherosclerosis and CVD.Statins remain the standard-of-care in the treatment of hypercholesterolemia and their use has significantly reduced cardiovascular morbidity and mortality.In addition,recent advances in lipid-modifying therapies,such as the development of proprotein convertase subtilisin/kexin type 9 inhibitors,have further improved cardiovascular outcomes in patients with hypercholesterolemia.However,despite significant progress in the treatment of dyslipidemia,there is still considerable residual risk of recurring cardiovascular events.Furthermore,in some cases,an effective therapy for the identified primary cause of a specific dyslipidemia has not been found up to date.Thus,a number of novel pharmacological interventions are under early human trials,targeting different molecular pathways of lipid formation,regulation and metabolism.This editorial aims to discuss the current clinical and scientific data on new promising lipidmodifying therapies addressing unmet needs in CVD,which may prove beneficial in the near future.展开更多
Introduction: Since the advent of antiretroviral therapy, the vital prognosis of people living with HIV (PLWHA) has improved significantly. However, the risk of metabolic complications is high, thus making the bed of ...Introduction: Since the advent of antiretroviral therapy, the vital prognosis of people living with HIV (PLWHA) has improved significantly. However, the risk of metabolic complications is high, thus making the bed of cardiovascular disease. Our objective was to compare the prevalence of metabolic abnormalities among PLWHA receiving ARVs to that observed in those who are not treated. Methods: We conducted a cross-sectional study (January to April 2010) at the PLWHA ambulatory care center of national university hospital (CNHU-Hubert K. Maga) in Cotonou, Bénin. We recruited 420 PLWHA (210 treated for at least 6 months and 210 untreated). We determined the prevalence of metabolic syndrome (MS) defined by the criteria of NCEP-ATP III, and the prevalence of abnormal glucose and lipid, and lipodystrophy. Association between metabolic syndrome and ARVs used was analyzed by binomial regression. Confidence intervals were calculated at 95% and 5% alpha level. Results: The prevalence of MS was 16% (18% of patients treated vs. 13% of non-treated, p = 0.18). That of hyperglycemia was 18% (30% of patients treated vs. 6% of untreated;p < 0.001) and of diabetes 7% (12% of patients treated vs 2% of untreated;p < 0.0001). The total cholesterol prevalence was 29% (44% of treated vs 13% of untreated;p <0.02). That of lipodystrophy in 210 patients was 29% (lipoatrophy16%, lipohypertrophy 8%, mixed form 6%). Factors associated with metabolic syndrome were age, hypertension, diabetes (personal or family), BMI, exposure to stavudine (OR = 1.59 [1.02 to 2.47], p = 0.04) and indinavir booted with ritonavir (OR = 2.23 [1.11 to 4 46], p = 0.02). Conclusion: The metabolic abnormalities are more common in PLWHA treated with ARVs. Preventing these anomalies should be made to the initiation of antiretroviral therapy and during the therapeutic monitoring.展开更多
BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction(AMI)patients,which are crucial for secondary prevention.AIM To evaluate the lipid treatment practices and lipid levels in post-myocar...BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction(AMI)patients,which are crucial for secondary prevention.AIM To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction(MI)patients at a tertiary care hospital in Pakistan.METHODS In this cross-sectional study,we analyzed patients who had experienced their first AMI event in the past 3 years.We assessed fasting and non-fasting lipid profiles,reviewed statin therapy prescriptions,and examined patient compliance.The recommended dose was defined as rosuvastatin≥20 mg or atorvastatin≥40 mg,with target total cholesterol levels set at<160 mg/dL and target low-density lipoprotein cholesterol(LDL-C)at<55 mg/dL.RESULTS Among 195 patients,71.3%were male,and the mean age was 57.1±10.2 years.The median duration since AMI was 36(interquartile range:10-48)months and 60% were diagnosed with ST-segment elevation MI.Only 13.8% of patients were advised to undergo lipid profile testing after AMI,88.7% of patients were on the recommended statin therapy,and 91.8% of patients were compliant with statin therapy.Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range.Hospital admission in the past 12 months was reported by 14.4%,and the readmission rate was significantly higher among non-compliant patients(37.5%vs 5.6%).Subsequent AMI event rate was also significantly higher among non-compliant patients(43.8%vs 11.7%).CONCLUSION Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose,the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.展开更多
基金Supported by The National Scientific Foundation of China,No.81270946,No.81170758,No.30670988
文摘AIM： To evaluate the effcacy, effect of preventing cardio-vascular diseases and safety of statins-fbrates combination therapy in diabetic dyslipidemia patients.METHODS： We searched the databases of MEDLINE, EM-BASE, web of knowledge and Cochrane central register of Controlled Trials for literatures about the coadministration of statins and fibrates as the treatment of patients with dyslipidemia and type 2 diabetes mellitus. We included re-lated randomized controlled trials, controlled clinical trials and cross-sectional studies and excluded animal trials and clinical observations. The primary endpoints outcomes were the concentration of plasma total cholesterol （TC）, triglyc-eride （TG）, high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C）. The secondary outcomes were cardiovascular diseases （CVD） and adverseevents.RESULTS： Ten studies were included in this meta-analysis. For lipid modifying efficacy, the combination of statins and fibrates therapy had more significant effecton reducing TC [ P = 0.004, weighted mean difference （WMD） = -8.19, 95%CI： -13.82--2.56] and TG concentra-tion （P 〈 0.001, WMD = -47.29, 95%CI： -68.66--25.92） and increasing HDL-C concentration （P 〈 0.00001, WMD = 3.79, 95%CI： 2.25-5.33） when compared with statins monotherapy, while the effect of reducing LDL-C concen-tration （ P = 0.50, WMD = -2.52, 95%CI： -9.76-4.72） was insignificant. To fibrates monotherapy, the combination therapy was more effective on reducing TC （ P 〈 0.00001, WMD = -48.51, 95%CI： -57.14--39.89）, TG （ P 〈 0.00001, WMD = -26.07, 95%CI： -30.96--21.18）, LDL-C concentra-tion （ P 〈 0.00001, WMD = -45.74, 95%CI： -53.35--38.13） and increasing HDL-C concentration （ P = 0.04, WMD = 1.38, 95%CI： 0.04-2.73）. For cardiovascular diseases, the coad-ministration therapy had no signifcant effect on reducing the incidence of these events when compared with mono-therapy （For primary clinical endpoints, P = 0.12, OR = 0.61, 95%CI： 0.33-1.14）; for secondary clinical endpoints, P =0.13, OR = 0.66, 95%CI： 0.38-1.14）. For adverse events happened during the follow-up, both the incidence of hepatic-related （alanine aminotransferase and/or aspartate aminotransferase of patients were ≥ 3 times of upper limit of normal） （ P = 0.38, OR = 0.55, 95%CI： 0.15-2.06） and muscular-related （myopathy and/or creatine phosphokinase ≥ 3 times of upper limit of normal） adverse events （P = 0.10, OR = 1.62, 95%CI： 0.91-2.86） had no signifcant dif-ference between these two therapies.CONCLUSION： The results showed statins-fbrates com-bination therapy was more effective on lipid modification and well tolerated but there was no significant effect on preventing cardiovascular diseases.
基金financially supported in the our laboratory with resources from The National Council of Technological and Scientific Developmentthe State of Sao Paulo Research Foundationthe National Institute of Science and Technology of Complex Fluids.
文摘For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.
文摘Cardiovascular disease(CVD)remains a major cause of morbidity and mortality worldwide.Currently,it is well established that dyslipidemia is one of the major risk factors leading to the development of atherosclerosis and CVD.Statins remain the standard-of-care in the treatment of hypercholesterolemia and their use has significantly reduced cardiovascular morbidity and mortality.In addition,recent advances in lipid-modifying therapies,such as the development of proprotein convertase subtilisin/kexin type 9 inhibitors,have further improved cardiovascular outcomes in patients with hypercholesterolemia.However,despite significant progress in the treatment of dyslipidemia,there is still considerable residual risk of recurring cardiovascular events.Furthermore,in some cases,an effective therapy for the identified primary cause of a specific dyslipidemia has not been found up to date.Thus,a number of novel pharmacological interventions are under early human trials,targeting different molecular pathways of lipid formation,regulation and metabolism.This editorial aims to discuss the current clinical and scientific data on new promising lipidmodifying therapies addressing unmet needs in CVD,which may prove beneficial in the near future.
文摘Introduction: Since the advent of antiretroviral therapy, the vital prognosis of people living with HIV (PLWHA) has improved significantly. However, the risk of metabolic complications is high, thus making the bed of cardiovascular disease. Our objective was to compare the prevalence of metabolic abnormalities among PLWHA receiving ARVs to that observed in those who are not treated. Methods: We conducted a cross-sectional study (January to April 2010) at the PLWHA ambulatory care center of national university hospital (CNHU-Hubert K. Maga) in Cotonou, Bénin. We recruited 420 PLWHA (210 treated for at least 6 months and 210 untreated). We determined the prevalence of metabolic syndrome (MS) defined by the criteria of NCEP-ATP III, and the prevalence of abnormal glucose and lipid, and lipodystrophy. Association between metabolic syndrome and ARVs used was analyzed by binomial regression. Confidence intervals were calculated at 95% and 5% alpha level. Results: The prevalence of MS was 16% (18% of patients treated vs. 13% of non-treated, p = 0.18). That of hyperglycemia was 18% (30% of patients treated vs. 6% of untreated;p < 0.001) and of diabetes 7% (12% of patients treated vs 2% of untreated;p < 0.0001). The total cholesterol prevalence was 29% (44% of treated vs 13% of untreated;p <0.02). That of lipodystrophy in 210 patients was 29% (lipoatrophy16%, lipohypertrophy 8%, mixed form 6%). Factors associated with metabolic syndrome were age, hypertension, diabetes (personal or family), BMI, exposure to stavudine (OR = 1.59 [1.02 to 2.47], p = 0.04) and indinavir booted with ritonavir (OR = 2.23 [1.11 to 4 46], p = 0.02). Conclusion: The metabolic abnormalities are more common in PLWHA treated with ARVs. Preventing these anomalies should be made to the initiation of antiretroviral therapy and during the therapeutic monitoring.
文摘BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction(AMI)patients,which are crucial for secondary prevention.AIM To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction(MI)patients at a tertiary care hospital in Pakistan.METHODS In this cross-sectional study,we analyzed patients who had experienced their first AMI event in the past 3 years.We assessed fasting and non-fasting lipid profiles,reviewed statin therapy prescriptions,and examined patient compliance.The recommended dose was defined as rosuvastatin≥20 mg or atorvastatin≥40 mg,with target total cholesterol levels set at<160 mg/dL and target low-density lipoprotein cholesterol(LDL-C)at<55 mg/dL.RESULTS Among 195 patients,71.3%were male,and the mean age was 57.1±10.2 years.The median duration since AMI was 36(interquartile range:10-48)months and 60% were diagnosed with ST-segment elevation MI.Only 13.8% of patients were advised to undergo lipid profile testing after AMI,88.7% of patients were on the recommended statin therapy,and 91.8% of patients were compliant with statin therapy.Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range.Hospital admission in the past 12 months was reported by 14.4%,and the readmission rate was significantly higher among non-compliant patients(37.5%vs 5.6%).Subsequent AMI event rate was also significantly higher among non-compliant patients(43.8%vs 11.7%).CONCLUSION Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose,the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.
