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1
Shevko, V. G., M. A. Galas, T. L. Galankin, and A. S. Kolbin. "Evaluation of the effectiveness of lipid-lowering agents." Scientific Notes of the Pavlov University 26, no. 3 (February 4, 2020): 78–85. http://dx.doi.org/10.24884/1607-4181-2019-26-3-78-85.
Повний текст джерелаАнотація:
Introduction. Nowadays, lipid-lowering therapy is considered an essential strategy for primary and secondary prevention of cardiovascular outcomes, which is confirmed by numerous studies. Nevertheless, researches are often guided by analysis of surrogate endpoints, which becomes not just everyday practice, but also an actual problem. Surrogate endpoints are wellknown sources of bias that can distort the risk-benefit analysis.The objective of the study was to assess the significance of lipid-lowering therapy with statins in relation to mortality.Methods and materials. The analysis of prospective controlled trials was carried out with a sample of 2000 patients and more, in which mortality rate was assessed for 2 or more years of statin therapy, as well as systematic literature reviews with a meta-analysis of mortality rates. The search was carried out on websites of the Russian scientific electronic libraries eLibrary and сyberleninka , English-language works – on the PubMed website.Results. An increase in survival during treatment with statins in case of secondary prevention of cardiovascular diseases reached about 2 % after five years’ treatment and was absent after ten years’ treatment. The average increase in life expectancy was only 4.1 days. Primary prevention with statins has not been shown to increase survival significantly.Conclusion. Effectiveness of lipid-lowering therapy with statins as a part of secondary prevention of cardiovascular outcomes assessed by surrogate endpoints could be greatly exaggerated. A biased approach to selecting surrogate endpoints can lead to incorrect results. Similarly, the encouraging results of therapy with statins in the prevention of cardiovascular mortality may be biased when the effect of statins on other causes of death is not considered. Mortality refers to a universal endpoint that characterizes both the effectiveness and safety of a drug.
2
Kim, Kyuho, Henry N. Ginsberg, and Sung Hee Choi. "New, Novel Lipid-Lowering Agents for Reducing Cardiovascular Risk: Beyond Statins." Diabetes & Metabolism Journal 46, no. 4 (July 31, 2022): 517–32. http://dx.doi.org/10.4093/dmj.2022.0198.
Повний текст джерелаАнотація:
Statins are the cornerstone of the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). However, even under optimal statin therapy, a significant residual ASCVD risk remains. Therefore, there has been an unmet clinical need for novel lipid-lowering agents that can target low-density lipoprotein cholesterol (LDL-C) and other atherogenic particles. During the past decade, several drugs have been developed for the treatment of dyslipidemia. Inclisiran, a small interfering RNA that targets proprotein convertase subtilisin/kexin type 9 (PCSK9), shows comparable effects to that of PCSK9 monoclonal antibodies. Bempedoic acid, an ATP citrate lyase inhibitor, is a valuable treatment option for the patients with statin intolerance. Pemafibrate, the first selective peroxisome proliferator-activated receptor alpha modulator, showed a favorable benefit-risk balance but the large clinical phase 3 trial (Pemafibrate to Reduce Cardiovascular OutcoMes by Reducing Triglycerides IN patiENts With diabe- Tes [PROMINENT]) was recently stopped due to the underperformance from interim analysis. High dose icosapent ethyl, a modified eicosapentaenoic acid preparation, shows cardiovascular benefits. Evinacumab, an angiopoietin-like 3 (ANGPTL3) monoclonal antibody, reduces plasma LDL-C levels in patients with refractory hypercholesterolemia. Novel antisense oligonucleotides targeting apolipoprotein C3 (apoC3), ANGPTL3, and lipoprotein(a) have significantly attenuated the levels of their target molecules with beneficial effects on associated dyslipidemias. Apolipoprotein A1 (apoA1) is considered as a potential treatment to exploit the athero-protective effects of high-density lipoprotein cholesterol (HDL-C), but solid clinical evidence is necessary. In this review, we discuss the mode of action and clinical outcomes of these novel lipid-lowering agents beyond statins.
3
Mostovoy, Y. M., and T. D. Danilevych. "PULMONARY ADVERSE REACTIONS OF CARDIOVASCULAR DRUGS." Ukrainian Pulmonology Journal 30, no. 1 (2022): 15–24. http://dx.doi.org/10.31215/2306-4927-2022-30-1-15-24.
Повний текст джерелаАнотація:
PULMONARY ADVERSE REACTIONS OF CARDIOVASCULAR DRUGS Y. M. Mostovoy, T. D. Danilevych Abstract Diagnosis and treatment of chronic obstructive pulmonary disease, bronchial asthma, pneumonia, idiopathic pulmonary fibrosis is an actual problem in medicine and pulmonology. These diseases are quite often combined with common diseases of the cardiovascular system, in particular, coronary artery disease, hypertension, and heart failure. The supervision of such patients is a difficult problem for the physicians. This review focuses on published data regarding the use of common drugs for the treatment of the cardiovascular diseases, such as angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, antiplatelet agents, statins, antiarrhythmic drugs, etc. Special emphasis has been made on pulmonary adverse reaction of these medications. Key words: amiodarone, angiotensin-converting enzyme inhibitors, beta-blockers, acetylsalicylic acid, statins, pulmonary adverse reactions.
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Ginsberg, Henry N. "REVIEW: Efficacy and Mechanisms of Action of Statins in the Treatment of Diabetic Dyslipidemia." Journal of Clinical Endocrinology & Metabolism 91, no. 2 (February 1, 2006): 383–92. http://dx.doi.org/10.1210/jc.2005-2084.
Повний текст джерелаАнотація:
Context: The Adult Treatment Panel III recommends 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, as first-line lipid-altering therapy for all adult patients with diabetes mellitus. This is based on the well-characterized efficacy and safety profiles of this class of agents as well as several clinical trials demonstrating that statin treatment reduces the risk of cardiovascular events. Evidence Acquisition: This review provides an overview of the effectiveness and mechanisms of action of statins in patients with diabetes mellitus using small efficacy trials and large clinical outcomes trials as well as studies of the effects of statins on apolipoprotein B (apoB) metabolism. Evidence Synthesis: The major findings presented are a review of mechanistic studies of selected subjects with diabetes mellitus and dyslipidemia and a compilation of results from large-scale clinical trials of patients with diabetes. Conclusions: Statins are highly efficacious as low-density lipoprotein cholesterol-lowering agents and have more modest effects on very low-density lipoprotein triglyceride and high-density lipoprotein cholesterol levels. The effects of statins on plasma lipids and lipoproteins result from their ability to both increase the efficiency with which very low-density lipoprotein and low-density lipoprotein are cleared from the circulation and reduce the production of apoB-containing lipoproteins by the liver. Additional investigations are needed to clarify the mechanisms by which statins reduce apoB secretion from the liver.
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Živanović, Željko. "Hypolipidemic agents in the secondary prevention of the stroke." Galenika Medical Journal 1, no. 4 (2022): 96–102. http://dx.doi.org/10.5937/galmed2204109z.
Повний текст джерелаАнотація:
Stroke is one of the leading causes of morbidity, mortality and disability in the world, and fat metabolism disorder is one of the most significant risk factors for its occurrence. Numerous studies have confirmed that lowering LDL cholesterol with the use of statins significantly reduces the risk of ischemic stroke (AIS). Therefore, their use is advised in all patients who have survived IMU or transient ischemic attack (TIA). Although in these patients the use of statins may increase the risk for intracerebral hemorrhage (ICH), the overall clinical benefit of reducing ischemic cardiovascular risks and mortality is far greater. The significance of the use of statins is greatest if atherosclerosis of the large arteries is the basis of AIS or TIA. Treatment should most often be started with high-intensity statins aiming to achieve an LDL cholesterol level of <1.8 mmol/l. If this goal is not achieved with statins, ezetimibe should be added to the therapy, which lowers the LDL cholesterol level more effectively, which at the same time further reduces the ischemic risk. PCSK9 inhibitors are a new therapeutic option for lowering LDL cholesterol if even the previous combination does not achieve the target result. The importance of treating hypertriglyceridemia in the prevention of stroke is still not completely clear, but the recommendations clearly state that after adequate treatment of hypercholesterolemia this residual atherogenic risk must also be actively treated. Despite the lack of sufficient evidence to restrict the use of statins after a hemorrhagic stroke, in these patients, the therapeutic approach must be individualized and carefully evaluated, due to the risk-benefit ratio of long-term statin use.
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Pereverzeva, К. G., and S. S. Yakushin. "Aspirin and statins: possibilities for joint improvement of prognosis in cardiovascular disease." Medical Council, no. 21 (January 20, 2019): 28–33. http://dx.doi.org/10.21518/2079-701x-2018-21-28-33.
Повний текст джерелаАнотація:
Today, cardiovascular diseases (CVDs) are the main cause of death in all countries of the world, which is largely due to the low adherence of patients with CVDs to treatment. According to the RECVASA register, the average adherence of patients of one of the polyclinics in the city of Ryazan to treatment (n = 1,165) in 2012 was 62.4%, adherence to beta-adrenergic blocking agent (BABs) was 70.8%, to angiotensin-converting enzyme inhibitors (ACEs) – 62.2%, to angiotensin II (ARB) receptor blockers – 57.1%, to statins – 46.8%, and to antiplate agents – 70.0%. The average adherence to treatment in survivors of the same group (n = 918) in 4 years in 2016 was significantly lower (p<0.001) and amounted to 47.8%. Patient adherence to BABs, ACEs also became statistically significantly lower (p<0.0001), at 43.8% and 50.0%, respectively; adherence to ARB was statistically insignificantly lower by 3.6% compared to the original level. The highest level of adherence to the use of antiplatelet agents was 63.9%, although it was significantly lower compared to the initial data (p = 0.0037), and the initially low adherence to the use of statins for 4 years has statistically significantly decreased (p<0.0001) and amounted to only 28.2%. The data obtained determine one of the possible ways to increase adherence to statins a fixed combination of them with other drugs affecting the prognosis, such as antiplatelet drugs.
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Markowska, Anna, Michał Antoszczak, Janina Markowska, and Adam Huczyński. "Statins: HMG-CoA Reductase Inhibitors as Potential Anticancer Agents against Malignant Neoplasms in Women." Pharmaceuticals 13, no. 12 (November 25, 2020): 422. http://dx.doi.org/10.3390/ph13120422.
Повний текст джерелаАнотація:
Statins, also known as HMG-CoA inhibitors, are a class of bioactive small molecules that efficiently reduce the levels of cholesterol, and therefore are commonly used to manage and prevent various cardiovascular diseases. With respect to their original medical indications, statins are currently in the group of the most prescribed drugs worldwide. Of note is that statins are perceived actually rather as agents that have pleiotropic activities; in addition to their inhibitory activity on the production of endogenous cholesterol. Statins may also affect cell proliferation, angiogenesis and/or migration (metastasis) of different cancer cells, and play a positive role in the chemoprevention of cancer, thus being the excellent candidates to be repurposed in oncology. Particularly intriguing in this context seems to be the promising role of statins on both the incidence and course of common malignant neoplasms in women. In this article, we review and discuss the effect of the use of statins in the treatment of three types of cancer, i.e., breast, endometrial and ovarian cancer, with the highest mortality among gynecological cancers.
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Vavuranakis, Manolis, Maria Kariori, Gerasimos Siasos, Konstantinos Kalogeras, and Dimitris Tousoulis. "Statins in Acute Coronary Syndromes." Current Pharmaceutical Design 23, no. 46 (February 1, 2018): 7086–98. http://dx.doi.org/10.2174/1381612823666170816114403.
Повний текст джерелаАнотація:
Background: Patients with acute coronary syndrome (ACS) frequently experience recurrent adverse events from the cardiovascular system comparing to either healthy individuals or individuals with stable coronary artery disease. This is attributed to the inflammatory cascade that is activated during ACS resulting in increased risk for rupture of vulnerable plaques. </P><P> Objective: Therefore, it is of great importance to avoid recurrent events with treatment aiming at secondary prevention which includes the management of lipid profile besides alteration in the lifestyle and habits. </P><P> Methods: This review will present current data concerning present status of treatment with statins, and refer to non-statin strategies as well as novel and promising agents for the secondary prevention therapy after ACS. A thorough search of PubMed and the Cochrane Database was conducted in order to identify the majority of trials, studies, current guidelines and novel articles related to the subject. </P><P> Results: Statins have been proved to play very significant role in the part of secondary prevention since they decrease the burden of atherosclerotic plaques, the risk of adverse events and the need for revascularization in symptomatic patients with CAD. Therefore, they were established and suggested by both European and American guidelines as first-line treatment option for lipid-lowering management. Several clinical trials, meta- analyses and randomized trials strongly recommended the application of early and intensive treatment with statins in patients with ACS. Nevertheless, a vast majority of individuals neither tolerated statins nor achieved the optimal value for LDL-C with the highest tolerated dose of statins resulting in poor clinical outcome. Furthermore, recent clinical trials indicated further benefit of combined treatment of statins with non-statins drugs on the decrease of cardiovascular events as well as progress of coronary artery plaque. Finally, novel agents that are still evaluated with ongoing clinical trials have been turned into a very promising treatment option. </P><P> Conclusion: In conclusion, statins are established as the first-line treatment for the secondary prevention after acute coronary syndromes in order to avoid the recurrence of thrombotic events. However, the research field on the field of lipid-lowering therapies is still ongoing and very promising for the future.
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Ferreira, Carlos Eduardo dos Santos, Francisco Antônio Helfenstein Fonseca, and Cristóvão Luis Pitangueira Mangueira. "PCSK9 and its clinical importance with the new therapeutic targets against dyslipidemia." Einstein (São Paulo) 10, no. 4 (December 2012): 526–27. http://dx.doi.org/10.1590/s1679-45082012000400024.
Повний текст джерелаАнотація:
This is a remarkable progress; since the finding of statins, there was no new way of reducing, significantly, cholesterol and LDL fraction. It is also clear that this decrease, by statins, is related to future cardiovascular lesions, being useful in its primary and secondary prophylaxis. The authors presented studies on research to promote the falling of blood cholesterol by means of antibodies, which inhibit the pro-protein PCSK9, as well as agents that act performing the RNA interference. We had two advantages immediately: for patients with myopathy associated with statins, and the fact of being injected every 15 days, that may contribute to better treatment adherence.
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Burnett, John R., and Samuel D. Vasikaran. "Cardiovascular disease and osteoporosis: is there a link between lipids and bone?" Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 39, no. 3 (May 1, 2002): 203–10. http://dx.doi.org/10.1258/0004563021902134.
Повний текст джерелаАнотація:
Atherosclerotic heart disease and osteoporosis are both diseases of old age. Evidence is accumulating for a link between vascular and bone disease. Calcification is a common feature of atherosclerotic plaques, and osteoporosis is associated with both atherosclerosis and vascular calcification. However, the relationship of vascular calcification to the pathogenesis of atherosclerosis remains incompletely understood. Hormone replacement therapy has beneficial effects in the prevention of both atherosclerosis and osteoporosis. Bisphosphonates inhibit bone resorption and are used in the treatment of osteoporosis, whereas the statins inhibit cholesterol biosynthesis and are used for the treatment of atherosclerosis. We have reviewed recent advances in the knowledge of the actions of bisphosphonates and statins at the cellular, molecular and end-organ levels in order to examine the relationship between cardiovascular disease and osteoporosis and to explore the link between lipids and bones. These studies suggest that the mechanism of actions of these two classes of drugs at the cellular level may not be mutually exclusive. There are some early clinical data to complement these findings, suggesting that statins increase bone density and bisphosphonates may have a beneficial effect in vivo on plasma lipid levels and on the atherosclerotic process. Properly designed prospective studies that examine the effect of statins on bone density and fractures, as well as the effects of bisphosphonates on lipid profiles, atherosclerotic progression and cardiovascular morbidity and mortality are needed to define clearly the clinical effects and potential new roles for these agents.
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Thornley, Simon, Roger Marshall, Wing Cheuk Chan, Andrew Kerr, Jeff Harrison, Gary Jackson, Sue Crengle, Craig Wright, Sue Wells, and Rod Jackson. "Four out of ten patients are not taking statins regularly during the 12 months after an acute coronary event." European Journal of Preventive Cardiology 19, no. 3 (March 14, 2011): 349–57. http://dx.doi.org/10.1177/1741826711403069.
Повний текст джерелаАнотація:
Background: In New Zealand, a setting in which national guidelines recommend statins for all patients with coronary heart disease (CHD) and cost barriers are low, patterns of use of these drugs are unknown. We investigated dispensing rates after hospital discharge for acute CHD event. Design: Retrospective cohort study. Methods: Drug dispensing, hospital diagnosis, and mortality records were linked by unique identifier for all New Zealanders aged 35–84 years after discharge following acute CHD event in 2007. We defined the statin dispensing ratio (SDR) as the proportion of days that 15,506 patients aged 35–84 years were dispensed such agents during the 12 months post discharge. An SDR ≥0.8 (80% or more days covered) was considered optimal. Results: Overall, 59% of the cohort had an SDR ≥0.8. Of patients dispensed statins in the 3 months before admission ( n = 5506), almost all (99%; 5466) continued treatment during follow up and 82% had an SDR ≥0.8. In contrast, for patients not dispensed statins before admission ( n = 8014), only two–thirds started statins during follow up and only 44% had an SDR ≥0.8. Of all patients with low statin dispensing (SDR <0.8), about one–quarter were not dispensed any lipid-lowering drugs, one-quarter received alternative lipid-lowering drugs, one-quarter stopped statins, and the remaining quarter were intermittent statin users. Conclusion: In a setting with few barriers to statin treatment, about 40% of patients had suboptimal statin dispensing during the year after hospital treatment for CHD. This study has identified four significant categories of suboptimal adherence that could inform quality improvement programmes.
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Ruscica, Massimiliano, Cesare Riccardo Sirtori, Nicola Ferri, and Alberto Corsini. "New players in the treatment of hypercholesterolaemia: focus on bempedoic acid and inclisiran." European Heart Journal Supplements 23, Supplement_E (October 1, 2021): E59—E62. http://dx.doi.org/10.1093/eurheartj/suab090.
Повний текст джерелаАнотація:
Abstract Dyslipidaemias and in particular elevated plasma low-density lipoprotein cholesterol (LDL-C) levels are major risk factors for atherosclerotic cardiovascular disease (ASCVD). Indeed, the more LDL-C is reduced the larger will be the ASCVD risk reduction. Although statins represent the first-line intervention to reduce the atherosclerotic burden driven by raised levels of LDL-C, adherence is not optimal and most patients do not follow guidelines and recommended doses. Thus, to achieve optimal LDL-C goals, especially in very high-risk patients, there is a need for new and safe agents, more tolerable than statins with low risk of myalgia. Thus, the present review will address the most recent clinical trials with bempedoic acid and inclisiran. Bempedoic acid is an oral drug acting at a biochemical step preceding hydroxymethylglutaryl-CoA reductase and not associated with muscular side effects. Inclisiran, the first-in-class small interfering RNA-based approach, has the ability to effectively reduce LDL-C by inhibiting the hepatic synthesis of proprotein convertase subtilisin/kexin type 9, with the advantage of requiring subcutaneous of a single dose on Day 1, Day 90, and every 6 months thereafter.
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Turkiewicz, Aleksandra, Pavlos Stamatis, and Aladdin J. Mohammad. "Cardiovascular drug treatment, statins and biopsy-confirmed giant cell arteritis: a population-based case–control study." RMD Open 6, no. 2 (August 2020): e001285. http://dx.doi.org/10.1136/rmdopen-2020-001285.
Повний текст джерелаАнотація:
ObjectiveTo determine whether exposure to cardiovascular medications and statins is associated with increased risk of giant cell arteritis (GCA).DesignThe population-based case–control study comprised a cohort of patients with biopsy-confirmed GCA linked to the Swedish Prescribed Drug Register to identify all exposure to drugs prior to diagnosis of GCA. Ten controls per GCA case, matched for age, sex and residential area, were included. Using corresponding Anatomical Therapeutic Chemical codes, ACE inhibitors, angiotensin II receptor blockers, beta-blocking agents, calcium antagonists, diuretics, statins and cardiac therapy drugs were investigated from July 1, 2005 to the diagnosis/index date. A conditional logistic regression model was fitted adjusted for income, education level and marital status. We repeated the analyses including only new drug users excluding those with any prescription during the year from July 1, 2005 to July 1, 2006.Results574 cases (29% men) of diagnosed GCA and 5740 controls (29% men) were included. The mean age at diagnosis is 75 years (SD 8). Of the GCA cases, 71% had at least one dispensation of a cardiovascular drug prior to the index date, compared to 74% of controls. The ORs for the association of target drug exposure with GCA were <1 for most drugs, but close to 1 in the analysis of new users. Statins were consistently associated with lower risk of GCA, OR 0.74 (95% CI 0.61 to 0.90).ConclusionStatins may be associated with lower risk of incident biopsy-confirmed GCA. No association was evident for other studied drugs.
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Ezhov, M. V., T. E. Kolmakova, M. M. Matveeva, and I. A. Alekseeva. "Atorvastatin: old friend in the light of novel coronavirus infection’s pandemia." Meditsinskiy sovet = Medical Council, no. 4 (April 6, 2022): 82–88. http://dx.doi.org/10.21518/2079-701x-2022-16-4-82-88.
Повний текст джерелаАнотація:
The COVID-19 (COronaVIrus Disease 2019) pandemic caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2) continues to be a global threat to people and health systems. As of March 21, 2022, there are more than 460 million cases and more than 6 million deaths worldwide, and more than 17 million and 360,000 respectively in the Russian Federation. Due to the rapid spread of the new coronavirus infection, since the beginning of the pandemic, tremendous efforts have been made to create new pharmacological agents to reduce morbidity and mortality, and tactics have been used to repurpose existing medications in treatment regimens for patients with COVID-19, particularly statins. Statins represent one of the most widely used and prescribed classes of drugs in the world. The hypolipidemic properties of statins are actively used to treat hyperlipidemia and primary and secondary prevention of cardiovascular diseases and their complications. Statins have a known safety profile, are inexpensive and accessible. In addition to their hypolipidemic effects, statins have a wide range of pleiotropic anti-inflammatory, antiviral, and antithrombotic effects potentially useful in the treatment of COVID-19. Presumably, the use of statins can reduce SARS-CoV-2-induced organ and tissue damage and improve lung function. The use of statins, particularly atorvastatin, as one of the most effective, widely prescribed and studied drugs in this class, as a safe, affordable and relatively inexpensive therapy may be a promising therapeutic approach in the fight against a new coronavirus infection.
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Florentin, Matilda, George Ntaios, and Haralampos Milionis. "Ischemic stroke in patients with atrial fibrillation – do we need to treat with statins?" Journal of Atherosclerosis Prevention and Treatment 12, no. 3 (September 3, 2021): 84–91. http://dx.doi.org/10.53590/japt.02.1027.
Повний текст джерелаАнотація:
The relationship of dyslipidemia with atrial fibrillation (AF)-related stroke is not clear. The question whether patients with AF-related stroke should receive lipid lowering agents unanimously remains unanswered. Treatment with statins does not appear to be as protective as initially thought in terms of AF prevention; however, certain groups of patients may benefit from statin use. There is evidence that statins favorably affect stroke severity, in-hospital mortality, prognosis and survival of patients with AF-related stroke. Statin pretreatment is associated with better collateral circulation in patients with cardioembolic stroke. Importantly, AF frequently co-exists with several cardiovascular comorbidities, while patients with AF-related stoke may be prone to other cardiovascular events. The overall cardiovascular risk should be assessed in AF patients experiencing a stroke and treated in accordance with the proposed low density lipoprotein cholesterol (LDL-C) targets.
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Kottoor, Santhosh J., and Rohit R. Arora. "The Utility of Anti-Inflammatory Agents in Cardiovascular Disease." Journal of Cardiovascular Pharmacology and Therapeutics 23, no. 6 (May 21, 2018): 483–93. http://dx.doi.org/10.1177/1074248418778548.
Повний текст джерелаАнотація:
Approximately 40% of heart attack survivors remain at increased risk of recurrent cardiovascular events, despite the current treatment options showing that atherothrombosis is not exclusively a disorder of lipoprotein aggregation in the arterial wall. Clinical and experimental data suggest that inflammation plays an important role in atherothrombosis independent of the cholesterol level. Acute-phase reactants, such as C-reactive protein, increase in patients with coronary artery disease and are known to predict adverse outcomes in such patients. The recent CANTOS trial published in The New England Journal of Medicine provides evidence that interleukin-1β along with other cytokines play central roles in the inflammatory reaction that drives the interleukin-6 signaling pathway and have profound effects on cardiovascular outcomes. Several other ongoing studies are focused on multiple immune mediators involved in this process to support the inflammatory hypothesis of cardiovascular diseases. These new classes of drugs could represent the biggest breakthrough in cardiovascular medicine, which could have the greatest impact on cardiovascular mortality since the advent of statins. The drug canakinumab has shown promise in lowering atherosclerosis, and other drugs, such as colchicine and methotrexate, are gaining interest and are being investigated in multiple ongoing trials. A major concern is the affordability of these drugs, as most cardiovascular diseases are noted among people of lower socioeconomic statuses. The LoDoCo trial showed some benefits of colchicine, and whether this old drug can be marketed with a new label for cardiovascular disease remains in question. Therefore, a clear understanding of the different inflammatory pathways involved in atherosclerosis is needed to help develop more effective treatment modalities that will benefit humankind.
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Gales, Laurentia, Leyla Forsea, Diana Mitrea, Irina Stefanica, Irina Stanculescu, Radu Mitrica, Mihai Georgescu, Oana Trifanescu, Rodica Anghel, and Luiza Serbanescu. "Antidiabetics, Anthelmintics, Statins, and Beta-Blockers as Co-Adjuvant Drugs in Cancer Therapy." Medicina 58, no. 9 (September 7, 2022): 1239. http://dx.doi.org/10.3390/medicina58091239.
Повний текст джерелаАнотація:
Over the last years, repurposed agents have provided growing evidence of fast implementation in oncology treatment such as certain antimalarial, anthelmintic, antibiotics, anti-inflammatory, antihypertensive, antihyperlipidemic, antidiabetic agents. In this study, the four agents of choice were present in our patients’ daily treatment for nonmalignant-associated pathology and have known, light toxicity profiles. It is quite common for a given patient’s daily administration schedule to include two or three of these drugs for the duration of their treatment. We chose to review the latest literature concerning metformin, employed as a first-line treatment for type 2 diabetes; mebendazole, as an anthelmintic; atorvastatin, as a cholesterol-lowering drug; propranolol, used in cardiovascular diseases as a nonspecific inhibitor of beta-1 and beta-2 adrenergic receptors. At the same time, certain key action mechanisms make them feasible antitumor agents such as for mitochondrial ETC inhibition, activation of the enzyme adenosine monophosphate-activated protein kinase, amelioration of endogenous hyperinsulinemia, inhibition of selective tyrosine kinases (i.e., VEGFR2, TNIK, and BRAF), and mevalonate pathway inhibition. Despite the abundance of results from in vitro and in vivo studies, the only solid data from randomized clinical trials confirm metformin-related oncological benefits for only a small subset of nondiabetic patients with HER2-positive breast cancer and early-stage colorectal cancer. At the same time, clinical studies confirm metformin-related detrimental/lack of an effect for lung, breast, prostate cancer, and glioblastoma. For atorvastatin we see a clinical oncological benefit in patients and head and neck cancer, with a trend towards radioprotection of critical structures, thus supporting the role of atorvastatin as a promising agent for concomitant association with radiotherapy. Propranolol-related increased outcomes were seen in clinical studies in patients with melanoma, breast cancer, and sarcoma.
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Burger, Achim Leo, Edita Pogran, Marie Muthspiel, Christoph Clemens Kaufmann, Bernhard Jäger, and Kurt Huber. "New Treatment Targets and Innovative Lipid-Lowering Therapies in Very-High-Risk Patients with Cardiovascular Disease." Biomedicines 10, no. 5 (April 22, 2022): 970. http://dx.doi.org/10.3390/biomedicines10050970.
Повний текст джерелаАнотація:
The effective and fast reduction of circulating low-density lipoprotein cholesterol (LDL-C) is a cornerstone for secondary prevention of atherosclerotic disease progression. Despite the substantial lipid-lowering effects of the established treatment option with statins and ezetimibe, a significant proportion of very-high-risk patients with cardiovascular disease do not reach the recommended treatment goal of <55 mg/dL (<1.4 mmol/L). Novel lipid-lowering agents, including the proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies alirocumab and evolocumab, the small interfering ribonucleotide acid (si-RNA) inclisiran, as well as the recently approved bempedoic acid, now complete the current arsenal of LDL-C lowering agents. These innovative therapies have demonstrated promising results in clinical studies. Besides a strong reduction of LDL-C by use of highly effective agents, there is still discussion as to whether a very rapid achievement of the treatment goal should be a new strategic approach in lipid-lowering therapy. In this review, we summarize evidence for the lipid-modifying properties of these novel agents and their safety profiles, and discuss their potential pleiotropic effects beyond LDL-C reduction (if any) as well as their effects on clinical endpoints as cardiovascular mortality. In addition to a treatment strategy of “the lower, the better”, we also discuss the concept of “the earlier, the better”, which may also add to the early clinical benefit of large LDL-C reduction after an acute ischemic event.
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Anghel, Daniela, Lucian Ciobîcă, Silviu Stanciu, Ciprian Jurcuț, Gabriela Stoicescu, Ioana Răduță, and Ancuța Coca. "Ankylosing spondylitis and cardiovascular risc - Case report." Romanian Journal Of Military Medicine 119, no. 3 (December 1, 2016): 39–42. http://dx.doi.org/10.55453/rjmm.2016.119.3.8.
Повний текст джерелаАнотація:
Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints associated with HLA B27 antigen and with the predominance of the male gender (with an average between 20 and 30 years old). Case presentation A 48 years old male patient was admitted to our clinic, having a long history regarding this disease since he was 16. This patient has switched 3 therapies with anti TNF alpha agents until now, and we hope to obtain a good response for a long time. During the treatment with Etanercept he presented an acute anterior uveitis which had a good response to therapy. Conclusion: The ankylosing spondylitis management is complicated when we have the possibility to choose only three anti TNF alpha agents. If a patient does not respond to the first or second agent we are constrained to follow the last one. Therefore the principal problem regarding this special case is that the patient is non responder at the last agent. So the question that arises is witch will be the next therapy for this patient.
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Maliachova, Olga, and Stella Stabouli. "Familial Hypercholesterolemia in Children and Adolescents: Diagnosis and Treatment." Current Pharmaceutical Design 24, no. 31 (January 2, 2019): 3672–77. http://dx.doi.org/10.2174/1381612824666181010145807.
Повний текст джерелаАнотація:
Familial hypercholesterolemia is a hereditary genetic disorder predisposing in premature atherosclerosis and cardiovascular complications. Early diagnosis as well as effective treatment strategies in affected children are challenges among experts. Universal screening and cascade screening among families with familial hypercholesterolemia are being controversially discussed. Diagnosis of familial hypercholesterolemia in children and adolescents is usually based on clinical phenotype upon LDL-C levels and family history of premature cardiovascular and/or elevated LDL-C. Treatment approaches for familial hypercholesterolemia in the pediatric population are multidisciplinary and aim to reduce total cardiovascular risk. The most widely recommended and effective pharmacotherapy in the pediatric age group is currently statins. Ezetimibe and bile acid sequestrants are usually used as second-line agents. New therapeutic approaches, such as mipomersen and PCSK9 inhibitors seem promising. The main gap of evidence remains the lack of longitudinal follow up studies investigating cardiovascular outcomes, side effects, and effectiveness of treatment starting from childhood. Evidence would be expected in the near future by cohort and registry studies.
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Paraskevas, Kosmas I., Dimitri P. Mikhailidis, Frank J. Veith, and J. David Spence. "Definition of Best Medical Treatment in Asymptomatic and Symptomatic Carotid Artery Stenosis." Angiology 67, no. 5 (December 31, 2015): 411–19. http://dx.doi.org/10.1177/0003319715624526.
Повний текст джерелаАнотація:
Implementation of best medical treatment (BMT) is the cornerstone of the management of patients with either asymptomatic or symptomatic carotid artery stenosis. We review the literature to define the components of BMT. Smoking cessation, maintaining a healthy body weight, moderate exercise, and a Mediterranean diet are essential lifestyle measures. Moderate alcohol consumption may also be beneficial but recommending it to patients may be hazardous if they consume too much. The importance of lifestyle measures is largely underestimated by both physicians and patients. Blood pressure and diabetes control, antiplatelet agents, and lipid-lowering treatment with statins/ezetimibe comprise the pharmacological components of BMT. Initiation of an intensive regimen of BMT is a sine qua non for patients with carotid artery stenosis whether or not they are offered or undergo an invasive revascularization procedure.
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Vinci, Pierandrea, Emiliano Panizon, Letizia Maria Tosoni, Carla Cerrato, Federica Pellicori, Filippo Mearelli, Chiara Biasinutto, Nicola Fiotti, Filippo Giorgio Di Girolamo, and Gianni Biolo. "Statin-Associated Myopathy: Emphasis on Mechanisms and Targeted Therapy." International Journal of Molecular Sciences 22, no. 21 (October 28, 2021): 11687. http://dx.doi.org/10.3390/ijms222111687.
Повний текст джерелаАнотація:
Hyperlipidemia is a major risk factor for cardiovascular morbidity and mortality. Statins are the first-choice therapy for dyslipidemias and are considered the cornerstone of atherosclerotic cardiovascular disease (ASCVD) in both primary and secondary prevention. Despite the statin-therapy-mediated positive effects on cardiovascular events, patient compliance is often poor. Statin-associated muscle symptoms (SAMS) are the most common side effect associated with treatment discontinuation. SAMS, which range from mild-to-moderate muscle pain, weakness, or fatigue to potentially life-threatening rhabdomyolysis, are reported by 10% to 25% of patients receiving statin therapy. There are many risk factors associated with patient features and hypolipidemic agents that seem to increase the risk of developing SAMS. Due to the lack of a “gold standard”, the diagnostic test for SAMS is based on a clinical criteria score, which is independent of creatine kinase (CK) elevation. Mechanisms that underlie the pathogenesis of SAMS remain almost unclear, though a high number of risk factors may increase the probability of myotoxicity induced by statin therapy. Some of these, related to pharmacokinetic properties of statins and to concomitant therapies or patient characteristics, may affect statin bioavailability and increase vulnerability to high-dose statins.
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Pereverzeva, K. G., S. S. Yakushin, A. I. Gracheva, M. M. Lukyanov, and O. M. Drapkina. "Post-myocardial infarction patients: a comparison of management by a physician and a cardiologist according to the REGATA register." Cardiovascular Therapy and Prevention 19, no. 3 (July 3, 2020): 2525. http://dx.doi.org/10.15829/1728-8800-2020-2525.
Повний текст джерелаАнотація:
Aim. To assess the quality of diagnostics and treatment of outpatients with a history of myocardial infarction (MI) according to REGATA register.Material and methods. In 2012-2013, 481 patients with a MI history who sought help in ambulatory care clinic were included in the study. In 87,5% of cases, the reference visit was to a physician or cardiologist, in 12,5% — to other specialist. The median age was 72 [62; 78] years (men — 51,4% (n=247)). The median time of previous MI was 5 [2; 9] years before the inclusion date.Results. A total of 23,5% of patients with previous MI had never visited a cardiologist before, 37% of patients visited a cardiologist in the last 12 months before being included in the registry. The use of diagnostic tests was insufficient, regardless of specialty of a doctor managing a patient. In patients managed by a cardiologist, electrocardiography, 24-hour Holter ECG monitoring, echocardiography, exercise tolerance test were much more often used. Cardiovascular agents were prescribed at the last visit to a physician and/or cardiologist in 91,9% of cases. Angiotensin converting enzyme inhibitors were used in 49,6% of patients, sartan medicines — 25,6%, beta-blockers — 57,7%, calcium channel antagonists — 21,7%, long-acting nitrates — 20,0%, statins — 45,1 %, antiplatelet agents — 67,3%. In patients who visited/not visited a cardiologist, the frequency of prescribing cardiovascular agents did not significantly differ, except for statins (50,0% vs 23,9%, respectively (p<0,0001)).Conclusion. The results obtained indicate that quality of managing outpatients after MI is higher by cardiologists than by physicians. However, the use of diagnostic tests and cardiovascular agents is insufficient, regardless of specialty of a doctor managing a patient.
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Патеюк, И. В. "Statins and COVID-19: Review of Recommendations and Clinical Practice." Рецепт, no. 4 (September 13, 2022): 443–56. http://dx.doi.org/10.34883/pi.2022.25.4.001.
Повний текст джерелаАнотація:
Согласно последним международным клиническим рекомендациям, статины остаются основной группой лекарственных средств, эффективных для лечения дислипидемий и профилактики сердечно-сосудистых заболеваний (ССЗ) и осложнений. В статье рассмотрены звенья патогенеза и механизмы поражения сердечно-сосудистой системы, проанализирована связь с коморбидностью, обоснована необходимость поиска эффективных и доступных терапевтических агентов в лечении COVID-19. Статины обладают механизмами действия, которые могут влиять на проникновение вируса в клетки человека, оказывать противовоспалительный эффект, способствовать улучшению функционального состояния эндотелия сосудов и снижать риск развития осложнений. В реальной клинической практике приоритет должен отдаваться эффективным и безопасным статинам. Розувастатин обладает высокой эффективностью и безопасностью, включая низкий риск межлекарственных взаимодействий, является оптимальным терапевтическим агентом на всех этапах кардиоваскулярной профилактики. According to the latest international clinical guidelines, statins remain the main group of drugs effective for the treatment of dyslipidemia and the prevention of cardiovascular disease (CVD) and complications. The article discusses the links of pathogenesis and mechanisms of damage to the cardiovascular system, analyzes the relationship with comorbidity, substantiates the need to search for effective and affordable therapeutic agents in the treatment of COVID-19. Statins have mechanisms of action that can affect the penetration of the virus into human cells, have an anti-inflammatory effect, improve the functional state of the vascular endothelium and reduce the risk of complications. The effectiveness of statins in patients with COVID-19 and high cardiovascular risk suggests that they need to be continued. In real clinical practice, priority should be given to effective and safe statins. Rosuvastatin is highly effective and safe, including a low risk of drug-drug interactions, and is the optimal therapeutic agent at all stages of cardiovascular prophylaxis.
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Sanna, Fabio, Marios Margaritis, and Charalambos Antoniades. "Perivascular Adipose Tissue as an Endocrine Organ: The Role of Statins." Current Pharmaceutical Design 23, no. 46 (February 1, 2018): 7055–60. http://dx.doi.org/10.2174/1381612823666170926133843.
Повний текст джерелаАнотація:
Adipose tissue (AT), aside from being an energy storage site, functions as a source of cytokines, adipokines and other vasoactive molecules. Dysfunctional AT contributes to the development of cardiovascular disease by shifting to a pro-oxidant, pro-inflammatory phenotype. Perivascular AT (PVAT) is of particular importance to the development of vascular disease, due to its close proximity to the vascular wall. Molecules released from PVAT can exert both pro- and anti-contractile effects, the balance of which plays a role in controlling vascular tone. Recent evidence supports the existence of reciprocal, two-way interactions between PVAT and the vascular wall. Statins, with their pivotal role in cardiovascular disease prevention, have been shown to exert lipidlowering independent, pleiotropic effects on the vascular wall, some of which may be mediated by modulatory effects on PVAT inflammation and secretome. These effects of statins provide a paradigm for the development of new therapeutic agents aimed at modulating PVAT function, as a novel treatment strategy against cardiovascular disease.
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Tursunova, N. V., M. G. Klinnikova, O. A. Babenko, and E. L. Lushnikova. "Molecular mechanisms of the cardiotoxic action of anthracycline antibiotics and statin-induced cytoprotective reactions of cardiomyocytes." Biomeditsinskaya Khimiya 66, no. 5 (2020): 357–71. http://dx.doi.org/10.18097/pbmc20206605357.
Повний текст джерелаАнотація:
The manifestation of the side cardiotoxic effect of anthracycline antibiotics limits their use in the treatment of malignant processes in some patients. The review analyzes the main causes of the susceptibility of cardiomyocytes to the damaging effect of anthracyclines, primarily associated with an increase in the processes of free radical oxidation. Currently, research is widely carried out to find ways to reduce anthracycline cardiotoxicity, in particular, the use of cardioprotective agents in the complex treatment of tumors. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) have been shown to improve the function and metabolism of the cardiovascular system under various pathological impacts, therefore, it is proposed to use them to reduce cardiotoxic complications of chemotherapy. Statins exhibit direct (hypolipidemic) and pleiotropic effects due to the blockade of mevalonic acid synthesis and downward biochemical cascades that determine their cardioprotective properties. The main point of intersection of the pharmacological activity of anthracyclines and statins is the ability of both to regulate the functioning of small GTPase from the Rho family, and their effect in this regard is the opposite. The influence of statins on the modification and membrane dislocation of Rho proteins mediates the indirect antioxidant, anti-inflammatory, endothelioprotective, antiapoptotic effect. The mechanism of statin inhibition of doxorubicin blockade of the DNA-topoisomerase complex, which may be important in preventing cardiotoxic damage during chemotherapy, is discussed. At the same time, it should be noted that the use of statins can be accompanied by adverse side effects: a provocation of increased insulin resistance and glucose tolerance, which often causes them to be canceled in patients with impaired carbohydrate metabolism, so further studies are needed here. The review also analyzes data on the antitumor effect of statins, their ability to sensitize the tumor to treatment with cytostatic drug. It has been shown that the relationship between anthracycline antibiotics and statins is characterized not only by antagonism, but also in some cases by synergism. Despite some adverse effects, statins are one of the most promising cardio- and vasoprotectors for use in anthracycline cardiomyopathy.
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Guo, Ming, Yue Liu, Zhu-Ye Gao, and Da-zhuo Shi. "Chinese Herbal Medicine on Dyslipidemia: Progress and Perspective." Evidence-Based Complementary and Alternative Medicine 2014 (2014): 1–11. http://dx.doi.org/10.1155/2014/163036.
Повний текст джерелаАнотація:
Dyslipidemia is an independent risk factor of cardiovascular diseases. The statins are a milestone in the primary and second prevention of cardiovascular diseases and significantly improved its prognosis. Along with the long-term treatment with statins in combination with other hypolipidemic drugs or alone, its safety has attracted a particular attention in clinic, such as the elevation of transaminase and rhabdomyolysis, which have raised an idea of developing the other types of lipid-lowering agents from botanic materials. Traditional Chinese medicine (TCM) has been used in clinical practice for more than 2000 years in China and showed some beneficial effects for human health and many diseases. Recently, many studies demonstrated a favorable effect of TCM for treating dyslipidemia; however, its mechanism remains unclear or totally unknown. The progress and perspective of studies on dyslipidemia with single Chinese herb and its monomers or effective extracts during the past 10 years are discussed in the present review.
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Purva, Arushi, Kalpesh Sharma, and Mohd Shahid Khan. "A Review on Dyslipidemia: Types, Risk Factors and Management." Asian Journal of Pharmaceutical Research and Development 8, no. 2 (April 13, 2020): 96–98. http://dx.doi.org/10.22270/ajprd.v8i2.682.
Повний текст джерелаАнотація:
Dyslipidemia is characterized by abnormally elevated cholesterol or fats (lipids) in the blood. Cardiovascular disease (CVD) is becoming more prevalent worldwide and is one of the leading causes of death. Dyslipidemia is an important risk factor for cardiovascular disease other factors are hypertension, diabetes mellitus, and smoking. Presently statins and fibrates are the major anti-hyperlipidemic agents for the treatment of elevated plasma cholesterol and triglycerides respectively, with remarkable side effects on the muscles and the liver.Lifestyle interventions remain a key component for the management of dyslipidemias. The present review will highlights types, risk factors and management available for dyslipidemia.
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Saito, Yasushi. "Treatment Options for Hypercholesterolemia and Combined Dyslipidemia: Focus on Pitavastatin." Clinical Medicine Insights: Therapeutics 3 (January 2011): CMT.S6565. http://dx.doi.org/10.4137/cmt.s6565.
Повний текст джерелаАнотація:
Pitavastatin is one of the most effective treatment agents for lowering serum low-density lipoprotein cholesterol (LDL-C) levels. Because pitavastatin is scarcely metabolized, the risk of drug-drug interactions during multidrug therapy is low, and the LDL-C target is achieved in the majority of patients. The incidence of adverse events associated with pitavastatin treatment has so far been comparable to or lower than that associated with other statins, and glucose metabolism is not affected by the drug. Pitavastatin promotes plaque regression and improves the plaque composition in patients with acute coronary syndrome. The serum level of high-density lipoprotein cholesterol (HDL-C) during treatment with pitavastatin was demonstrated to be inversely associated with the incidence of cardiovascular events. Because of its effective and sustained action to increase HDL-C, pitavastatin is expected to contribute to the prevention of cardiovascular events, in addition to its potent LDL-C lowering effect, especially in patients with low serum HDL-C levels.
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Chaulin, Aleksey M. "Review of Recent Laboratory and Experimental Data on Cardiotoxicity of Statins." Journal of Cardiovascular Development and Disease 9, no. 11 (November 19, 2022): 403. http://dx.doi.org/10.3390/jcdd9110403.
Повний текст джерелаАнотація:
Due to the fact that statins are among the most high-demand therapeutic agents used for the treatment and prevention of the most common cardiovascular diseases, a significant amount of research is focused on these drugs. As a result, the study and discovery of new effects in statin drugs continues. Research methods are constantly being improved in terms of their sensitivity and specificity, which leads to a change in ideas. In addition to the main lipid-lowering effect, statins have a number of additional effects, which can be conditionally divided into positive (pleiotropic) and negative (side effects). Moreover, information about many of the pleiotropic effects of statins is controversial and may subsequently change as new data become available. To a large extent, this is due to the introduction of new and the improvement of old methods of study: clinical, laboratory and morphological ones. Recent studies report the possibility of statins having potential cardiotoxic properties, which is expressed by an increase in the concentration of highly sensitive cardiac troponins, as well as various adverse changes in cardiac myocytes at the ultrastructural and molecular levels. This paper discusses possible mechanisms of statin cardiotoxicity. This narrative review is based on an analysis of publications in the Medline, PubMed, PubMed Central and Embase databases. The terms “statins”, “troponin”, “troponin I”, “troponin T” in combination with “cardiotoxicity”, “false positive”, “mechanisms of increase”, “pathophysiological mechanisms”, “oxidative stress” and “cardiomyocyte apoptosis” were used to search publications.
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Martsevich, S. Yu, S. N. Tolpygina, A. V. Zagrebelny, M. I. Chernysheva, V. P. Voronina, N. P. Kutishenko, N. A. Dmitrieva, et al. "Quality of medication therapy in patients after stroke depending on presence/absence of diabetes: data from the outpatient stage of REGION-M registry." Cardiovascular Therapy and Prevention 20, no. 5 (September 12, 2021): 2856. http://dx.doi.org/10.15829/1728-8800-2021-2856.
Повний текст джерелаАнотація:
Aim. To assess the quality of medication treatment in the polyclinic within 2 years after discharge, depending on presence/absence of diarecommended for patients with stroke before its development and betes.Material and methods. The study included 684 patients assigned to the City Polyclinic № 64 (Moscow), discharged from F.I. Inozemtsev City Clinical Hospital (Moscow) for a period from January 1, 2012 to April 30, 2017 with a diagnosis of stroke/transient ischemic attack, of which 122 were diagnosed with diabetes.Results. Before stroke, therapy was recommended for 67,3% of patients with diabetes and 54,7% without diabetes (p<0,01): statins — 15,5 and 14,4%, antiplatelet agents — 32,7 and 25,5%, angiotensinconverting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) — 41,4 and 37,9%, beta-blockers (BBs) — 9,1% and 7,8%, respectively. For the first 6 months after stroke, the rate of statin therapy increased to 39,6 and 39,2%, antiplatelet drugs — to 62,6 and 51,9%, ACE inhibitors/ARBs — to 68,2 and 66%, BBs — to 51,6 and 37,2%, respectively. Then, after 6 months it decreased again to 28,8 and 27,1% for statins, to 30,7 and 35,2% for antiplatelet agents, to 43,3 and 42,6% for ACE inhibitors/ARBs and remained the same for BBs, respectively. There were no significant differences in the prevalence of prescribing most drugs to patients with and without diabetes, both before and after stroke, with the exception of hypoglycemic medications.Conclusion. The therapy of patients with previous stroke, both with and without diabetes, recommended in the polyclinic, is characterized by an insufficient prescription rate of main drug classes necessary for secondary cardiovascular prevention at all follow-up stages.
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Cofán, Montserrat, and Emilio Ros. "Use of Plant Sterol and Stanol Fortified Foods in Clinical Practice." Current Medicinal Chemistry 26, no. 37 (December 17, 2019): 6691–703. http://dx.doi.org/10.2174/0929867325666180709114524.
Повний текст джерелаАнотація:
Plant sterols and stanols (PS) are natural, non-nutritive molecules that play a structural role in plant membranes similar to that of cholesterol in animal membranes and abound in seeds and derived oils. PS exert their physical effect of interference with micellar solubilization of cholesterol within the intestinal lumen and are marginally absorbed by enterocytes, with negiglible increases in circulating levels. The physiological role of PS in plants and their natural origin and non-systemic action, together with their cholesterol-lowering effect, make them an attractive option as non-pharmacological agents for the management of hypercholesterolemia. Recent meta-analyses have summarized the results of >100 controlled clinical trials and have firmly established that the consumption of PS-supplemented foods in different formats at doses of 2-3 g per day results in LDL-cholesterol reductions of 9-12%. PS are both effective and safe cholesterol-lowering agents and have many clinical applications: adjuncts to a healthy diet, treatment of common hypercholesterolemia, combination therapy with statins and other lipid-lowering drugs, and treatment of metabolic syndrome and diabetes. The cholesterol-lowering efficacy is similar in all clinical situations. PS are also useful agents for treatment of hypercholesterolemic children who are not yet candidates to statins or receive low-doses of these agents. In the setting of statin treatment, the average LDL-cholesterol reduction obtained with PS is equivalent to up- titrating twice the statin dose. However, information is still scarce on the efficacy of PS as an add-on therapy to ezetimibe, fibrates, omega- 3 fatty acids, or bile acid binding resins. The consistent scientific evidence on the cholesterollowering efficacy and safety of functional foods supplemented with PS has led several national and international scientific societies to endorse their use for the non-pharmacologic treatment of hypercholesterolemia as adjuncts to a healthy diet. There is, however, a lack of clinical trials of PS with outcomes on cardiovascular events.
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Li, Yongzhe. "Clinical study of Repatha: it does not affect patients’ cognitive function and significantly reduce blood lipid and prevent coronary atherosclerosis." Highlights in Science, Engineering and Technology 8 (August 17, 2022): 365–71. http://dx.doi.org/10.54097/hset.v8i.1180.
Повний текст джерелаАнотація:
Hyperlipidemia has always been one of the serious factors endangering human health. It is a high-risk factor for coronary heart disease, myocardial infarction, cerebral infarction and other diseases. Blood lipid management is very important for the control of cardiovascular and cerebrovascular diseases. Repatha, as a new type of hypolipidemic drug, has shown good effects and no serious adverse reactions in clinical trials. Although at present, drugs that reduce LDL-C, especially statins, play an important role in the prevention of cardiovascular disease, however, a considerable proportion of patients still failed to reach the LDL-C target value specified in the relevant guidelines. Amgen recently released phase III clinical trial data that shows the good curative effect of repatha in combination with statins on patients with hyperlipidemia. Repatha (evolocumab), a PCSK9 inhibitor, is a necessary adjunctive treatment option for patients with inherited high cholesterol who cannot control their high LDL-C with other lipid-lowering agents alone. This review focused on hyperlipidemia and its clinical manifestations. Repatha’s basic information, clinical trial process, data and results were also included.
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H.Al-Malki, Falah, Shatha H. Ali, and Gamal A.Abdulbari. "Role of Ezetimibe in Combination with Statins(Simvastatin and Atorvastatin) in Controlling Dyslipidemia." Iraqi Journal of Pharmaceutical Sciences ( P-ISSN: 1683 - 3597 , E-ISSN : 2521 - 3512) 18, no. 1 (March 30, 2017): 1–12. http://dx.doi.org/10.31351/vol18iss1pp1-12.
Повний текст джерелаАнотація:
Cardiovascular risk is independently increased by plasma lipids abnormalities (low- density and high density lipoprotein -cholesterol and triglycerides). Most patients have more than one lipid abnormality. Combination therapy with lipid-modifying agents could offer an important therapeutic option for improving the overall lipid profile. Combinations have demonstrated to provide additive efficacy and significant reductions in coronary events . This study was designed to evaluate the effect of ezetimibe, when used in combination with other hypolipidaemic agents ( statins) on lipid profile as well as on liver function ,renal function, oxidative stress, and platelets function when given to dyslipidaemic patients . Forty four patients (24 males and 20 females) with age ranged between 40-70 years (54 ±14.6) with dyslipidaemia on statins therapy for at least 6 month were involved in this clinical trials. They were randomized into two groups treated with either a combination of 20 mg/day simvastatin or a combination of 20mg/day atorvastatin and 10mg/day of ezetimibe.The study also included 22 apparently healthy subjects with age ranged (40-70years) and sex(11males and 11 females) matching that of the patients group. Serum lipid profile (total cholesterol -TC, triglycerides -TG, low density lipoprotein-cholesterol –LDL-C, very low density lipoprotein-cholesterol-VLDL-C, and high density lipoprotein-cholesterol –HDL-C), oxidative stress marker (Malondialdehyde-MDA), liver functions indices (Alanin aminotransferase -ALT,Aspartate aminotransferase- AST, total bilirubin), renal function parameters (urea, creatinine, and microalbuminuria) and platelets function test (bleeding time)were evaluated before and after 4 and 6 weeks of starting ezetimibe treatment . Treatment with ezetimibe plus simvastatin or atrovostatin resulted in significant lowering in TC, TG, LDL-C levels with elevation in HDL-C also the LDL/HDL ratio lowered significantly ( by 38.16%). This effect was associated with significant changes in liver function , and oxidative stress without changes in platelets function nor in renal function. The results presented in this study indicated that ezetimibe can be used in clinical practice for the treatment of dyslipidaemia, when combined with other hypolipidaemic agents like simvastatin and atorvastatin to improve the therapeutic profile with ameliorating some of their adverse effects.
Keywords : Ezetimibe , Statins , Dyslipidemia
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Young, Ian S. "Lipids for Psychiatrists - an overview." Journal of Psychopharmacology 19, no. 6_suppl (November 2005): 66–75. http://dx.doi.org/10.1177/0269881105058374.
Повний текст джерелаАнотація:
Serum cholesterol is a major risk factor for cardiovascular disease. Total cholesterol, LDL cholesterol and triglycerides are positively related to cardiovascular disease, while HDL cholesterol has an inverse relationship. Measurement of lipids is essential in individuals with established cardiovascular disease or type 2 diabetes, and may also be carried out in healthy individuals as part of cardiovascular risk assessment. Lifestyle measures are important in cardiovascular disease prevention, but the mainstay of lipid lowering therapy is appropriate use of lipid lowering drugs. Total and LDL cholesterol are the primary targets for treatment, but consideration should also be given to raising HDL cholesterol and lowering triglycerides where appropriate. Statins are the most frequently used lipid lowering agents, but there is an important place for other drugs, including ezetimibe, fibrates and nicotinic acid.
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Bubnova, Marina G. "Adverse effects of statin therapy: real evidence." CardioSomatics 10, no. 1 (March 15, 2019): 51–61. http://dx.doi.org/10.26442/22217185.2019.1.190264.
Повний текст джерелаАнотація:
Aim. To provide a current view on the tolerability and safety of statin therapy. Materials and methods. The data of 73 scientific sources from Russian and foreign literature published within 1996-2018 are considered. Results. It is generally accepted that statins are first-line therapeutic agents for hypercholesterolemia and combined hyperlipidemia. Today there in growing evidence that lowering of low-density lipoprotein cholesterol levels prevents atherosclerotic diseases and reduces a risk of cardiovascular and overall mortality. Main issues of current statin therapy include a use of inadequate dosage for atherosclerotic diseases prevention, low treatment compliance and drug intolerance. In recent years the issue of statin intolerance has become of great importance. Criteria were proposed for determining an inability to tolerate statins, some experts suggest replacing definition of “statin intolerance” with the term “statin-associated side-effects”. Most discussed adverse effects due to statins include muscle-related symptoms (myalgia/myopathy), hepatotoxicity (hepatic hyperenzymemia) new-onset diabetes, dementia and cognitive impairment. Mechanisms of development of these adverse effects are still unclear. Certain factors and conditions capable of triggering some adverse effects as well as absolute contraindications to statin therapy were established. Some factors and conditions capable of triggering some adverse effects as well as absolute contraindications to statin therapy were identified. Occurrence of statin-associated side-effects depends on statin dose, a patient's age, gender, comorbidity and concomitant therapy. Many adverse effects of statins are drug class effect. At the same time each of statins has specific features of its structure, metabolism, drug interactions and pharmacokinetics. Pitavastatin belongs to the last generation of statins and it has distinct pharmacological features and neutral diabetogenic effects, etc. Risk of adverse effects due to statins is often exaggerated while benefit from the use of statins for preventing atherosclerotic diseases outweighs potential risks. Real occurrence of some adverse effects due to statin therapy requires additional evidence. Conclusion. Overall, statins have a good tolerability profile and are approved for use in the vast majority of patients who required lipid-lowering therapy.
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Ognerubov, D. V., S. I. Provatorov, E. V. Merkulov, A. S. Merkulov, K. I. Kupina, O. A. Pogorelova, M. I. Tripoten, et al. "Analysis of radial artery occlusion causes and methods of its prevention after interventions using radial access. Results of the APRIORI study." Russian Journal of Cardiology 26, no. 12 (October 27, 2021): 4695. http://dx.doi.org/10.15829/1560-4071-2021-4695.
Повний текст джерелаАнотація:
Aim. To study predictors of radial artery occlusion (RAO) and ways to prevent it after interventions using radial access.Material and methods. The study consisted of prospective and retrospective parts. The total number of included patients was 2284. Patients undergoing interventions by radial access in various medical organizations were retrospectively considered. The prospective study included 1284 patients who were subject to interventional treatment. Patients were randomized into two groups as follows: in group 1, hemostasis was performed within 4 hours, in group 2 — >6 hours. All patients underwent a bedside Barbeau test with a pulse oximeter and an ultrasound of access arteries to determine the radial artery patency/occlusion.Results. The RAO rate in the retrospective part was 21,8%, while in the prospective one — 10,1% with long-term hemostasis and 1,4% with short-term hemostasis (p<0,001). Predictors of RAO were type 2 diabetes (odds ratio (OR), 1,9, 95% confidence interval (CI), 1,1-3,4, p=0,03) and an increase in hemostasis duration by 1 hour (OR, 1,2, 95% CI, 1,1-1,3, p<0,001). When analyzing the retrospective part, the predictors of RAO were body mass index (OR, 1,06, 95% CI, 1,02-1,09, p=0,002), female sex (OR, 0,6, 95% CI, 0,4-0,9, p=0,02), smoking (OR, 1,38, 95% CI, 1-1,91, p=0,047). The administration of statins in different dosages, as well as antihypertensive and anti-ischemic agents, did not have a significant effect on the RAO rate.Conclusion. The main predictors of RAO were type 2 diabetes, an increase in hemostasis duration, female sex, smoking, and the artery-to-introducer diameter ratio. Taking statins, anti-ischemic and antihypertensive agents does not have a protective effect on RAO rate.
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Lee, Sungjae, Seungwon Yang, and Min Jung Chang. "Antihypertensive effects of rosuvastatin in patients with hypertension and dyslipidemia: A systemic review and meta-analysis of randomized studies." PLOS ONE 16, no. 11 (November 24, 2021): e0260391. http://dx.doi.org/10.1371/journal.pone.0260391.
Повний текст джерелаАнотація:
Some studies have suggested the antihypertensive effects of statins, a class of lipid-lowering agents, particularly in patients with hypertension. However, the evidence for the role of statins in blood pressure (BP) lowering is controversial, and no meta-analysis of rosuvastatin therapy has been conducted to assess its BP-lowering effects. Therefore, the aim of this meta-analysis of randomized controlled trials (RCTs) was to investigate the effects of rosuvastatin on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension. We systematically searched the electronic databases MEDLINE, EMBASE, and Cochrane Library to identify RCTs in which patients were assigned to groups of rosuvastatin plus antihypertensive agents vs. antihypertensive agents. The three authors independently selected the studies, extracted data, and assessed methodological quality. We included five RCTs in this meta-analysis with 288 patients treated with rosuvastatin and 219 patients without rosuvastatin. The mean DBP in the rosuvastatin group was significantly lower than that in the non-rosuvastatin group by −2.12 mmHg (95% confidence interval (CI) −3.72 to −0.52; Pfixed-effects model = 0.009; I2 = 0%, Pheterogeneity = 0.97). Rosuvastatin treatment also lowered the mean SBP compared with the non-rosuvastatin treatment by −2.27 mmHg, but not significantly (95% CI − 4.75 to 0.25; Pfixed-effects model = 0.08; I2 = 0%, Pheterogeneity = 0.82). In this study, we reviewed the antihypertensive effects of rosuvastatin in patients with hypertension and dyslipidemia. We demonstrated a modest significant reduction of DBP and a trend toward a lowered SBP in patients with hypertension with rosuvastatin therapy. Rosuvastatin could be beneficial to control hypertension and, consequently, contribute toward reducing the risk of cardiovascular events in patients with hypertension and dyslipidemia.
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Ostroumova, O. D., A. I. Kochetkov, N. Yu Voevodina, and S. S. Sharonova. "THE POSSIBILITIES OF USING A NEW FIXED-DOSE COMBINATION OF ROSUVASTATIN AND ACETYLSALICYLIC ACID: FOCUS GROUPS OF PATIENTS." Rational Pharmacotherapy in Cardiology 14, no. 3 (July 5, 2018): 425–33. http://dx.doi.org/10.20996/1819-6446-2018-14-3-425-433.
Повний текст джерелаАнотація:
The review focuses on the impairment of the carotid, coronary arteries and lower-extremity arterial disease. Systemic involvement of various vascular beds in atherogenesis is emphasized. Epidemiological characteristics of morbidity and mortality from the main clinical manifestations of atherosclerosis - ischemic stroke, ischemic heart disease and lower-extremity arterial disease are given. The current principles of drug therapy are considered from the point of view of improving the prognosis and eliminating ischemia. The basic positions of International and Russian clinical recommendations on the management of patients with the presence of certain clinical manifestations of atherosclerosis are discussed. Detailed administration schemes and the preferred doses of statins and antiplatelet agents depending on the localization of atherosclerotic lesion and the severity of stenosis are described. The target blood lipids levels in the treatment with statins are given. The advantages of statins as drugs that reduce the risk of cardiovascular complications are presented. Current data on the pattern of antiplatelet use, including acetylsalicylic acid, in individuals with clinical manifestations of atherosclerosis are given. The principal tactic of dual antiplatelet therapy and schemes of its use in patients undergoing percutaneous coronary intervention, coronary artery bypass surgery and in individuals with a history of acute coronary disorders are considered.
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Andelova, Katarina, Barbara Szeiffova Bacova, Matus Sykora, Peter Hlivak, Miroslav Barancik, and Narcis Tribulova. "Mechanisms Underlying Antiarrhythmic Properties of Cardioprotective Agents Impacting Inflammation and Oxidative Stress." International Journal of Molecular Sciences 23, no. 3 (January 26, 2022): 1416. http://dx.doi.org/10.3390/ijms23031416.
Повний текст джерелаАнотація:
The prevention of cardiac life-threatening ventricular fibrillation and stroke-provoking atrial fibrillation remains a serious global clinical issue, with ongoing need for novel approaches. Numerous experimental and clinical studies suggest that oxidative stress and inflammation are deleterious to cardiovascular health, and can increase heart susceptibility to arrhythmias. It is quite interesting, however, that various cardio-protective compounds with antiarrhythmic properties are potent anti-oxidative and anti-inflammatory agents. These most likely target the pro-arrhythmia primary mechanisms. This review and literature-based analysis presents a realistic view of antiarrhythmic efficacy and the molecular mechanisms of current pharmaceuticals in clinical use. These include the sodium-glucose cotransporter-2 inhibitors used in diabetes treatment, statins in dyslipidemia and naturally protective omega-3 fatty acids. This approach supports the hypothesis that prevention or attenuation of oxidative and inflammatory stress can abolish pro-arrhythmic factors and the development of an arrhythmia substrate. This could prove a powerful tool of reducing cardiac arrhythmia burden.
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Merćep, Iveta, Dominik Strikić, Ana Marija Slišković, and Željko Reiner. "New Therapeutic Approaches in Treatment of Dyslipidaemia—A Narrative Review." Pharmaceuticals 15, no. 7 (July 7, 2022): 839. http://dx.doi.org/10.3390/ph15070839.
Повний текст джерелаАнотація:
Dyslipidaemia is a well-known risk factor for the development of cardiovascular disease, a leading cause of morbidity and mortality in developed countries. As a consequence, the medical community has been dealing with this problem for decades, and traditional statin therapy remains the cornerstone therapeutic approach. However, clinical trials have observed remarkable results for a few agents effective in the treatment of elevated serum lipid levels. Ezetimibe showed good but limited results when used in combination with statins. Bempedoic acid has been thoroughly studied in multiple clinical trials, with a reduction in LDL cholesterol by approximately 15%. The first approved monoclonal antibodies for the treatment of dyslipidaemia, PCSK9 inhibitors, are currently used as second-line treatment for patients with unregulated lipid levels on statin or statin combination therapy. A new siRNA molecule, inclisiran, demonstrates great potential, particularly concerning compliance, as it is administered twice yearly and pelacarsen, an antisense oligonucleotide that targets lipoprotein(a) and lowers its levels. Volanesorsen is the first drug that was designed to target chylomicrons and lower triglyceride levels, and olezarsen, the next in-line chylomicron lowering agent, is currently being researched. The newest possibilities for the treatment of dyslipidaemia are ANGPTL3 inhibitors with evinacumab, already approved by the FDA, and EMA for the treatment of familial hypercholesterolemia. This article provides a short summary of new agents currently used or being developed for lipid lowering treatment.
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Hoppe, Carolyn C., Kathryn R. Stewart, Annie Higa, Sandra Larkin, James K. Liao, Lori A. Styles, Elliott P. Vichinsky, and Frans A. Kuypers. "The Effect of Short-Term Simvastatin On Markers of Vascular Dysfunction in Patients with Sickle Cell Disease (SCD)." Blood 114, no. 22 (November 20, 2009): 260. http://dx.doi.org/10.1182/blood.v114.22.260.260.
Повний текст джерелаАнотація:
Abstract Abstract 260 Sickle cell disease (SCD) is characterized by frequent painful vaso-occlusive episodes, acute life-threatening complications, and progressive vascular injury resulting in multi-organ failure. Emerging data indicate that nitric oxide (NO) plays a central role in mediating the pathogenesis of sickle-induced vascular injury. Because antisickling agents only partially ameliorate the vasculopathy of SCD, therapeutic agents that modulate NO homeostasis are rational candidates for further exploration. Simvastatin and other HMG-CoA reductase inhibitors have been shown to exert NO-mediated vasculoprotective and anti-inflammatory effects in cardiovascular disease populations. Recent experimental and clinical studies have implicated the Rho/Rho-kinase (ROCK) signaling pathway as a principal mechanism by which statins increase NO availability. We enrolled twelve SCD patients in an ongoing FDA-approved dose-escalation study of the effect of simvastatin treatment on markers of vascular dysfunction and inflammation. Patients were treated at steady-state with low-dose oral simvastatin (20 mg/day) with serial blood samples obtained prior to treatment day 0, during treatment on days 7, 14, 21, 25 and after discontinuation of treatment on day 39. Plasma samples were assayed for nitrite/nitrate (NOx) concentration using NO chemiluminescence, and high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), tissue factor (TF), vascular endothelial growth factor (VEGF) and vascular cell adhesion molecule (VCAM1) by ELISA. The effect of simvastatin on leukocyte ROCK activity was assessed by Western blot analyses in a subset of patients. Changes in biomarker levels from baseline in response to simvastatin at 21 days were assessed using matched paired t-tests. The mean age of subjects was 31.4 years (range, 13–55); 7 males and 5 females. Four subjects experienced an uneventful vaso-occlusive pain episode during the study with an acute decrease in NO levels and these data points were removed from the analysis. Short-term simvastatin treatment resulted in a 24% increase in mean plasma NOx level (p=.02). Both hs-CRP (p=.01) and IL-6 levels (p=.05) decreased dramatically by 62% and 63%, respectively. There was no difference between baseline and day 21 levels of TF, VEGF and VCAM1. Although limited to qualitative assessment in a subset of patients, our pilot data also demonstrated a decrease in leukocyte ROCK activity after treatment with simvastatin. These preliminary data showing increased NO availability and anti-inflammatory effects of simvastatin treatment in SCD are consistent with studies in cardiovascular disease populations documenting the cholesterol-independent benefits of statins and provide a compelling rationale to further investigate the potential therapeutic efficacy of statins in SCD. Correlation of the effect of simvastatin on ROCK inhibition may provide further evidence for a possible mechanism by which statins modulate NO bioavailability in SCD. Disclosures: Off Label Use: Simvastatin (Zocor)is a cholesterol-lowering agent that has been shown to confer vascular protection beyond its lipid lowering effects. This drug is being studied in patients with sickle cell disease to obtain preliminary safety and efficacy data of its potential vasculoprotective effects.
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Afshari, Zohreh, Shabnam Tahamtan, and Farinaz Shirban. "The Effect of Statins on Orthodontic Tooth Movements: A Meta-analysis of Animal Studies." Avicenna Journal of Dental Research 13, no. 1 (March 30, 2021): 28–37. http://dx.doi.org/10.34172/ajdr.2021.06.
Повний текст джерелаАнотація:
Background: Statins are effective therapeutic agents for the treatment of cardiovascular diseases. Their favorable effects on various aspects of oral health including promising effects on bone metabolism and pleiotropic impacts such as anti-inflammatory properties made these drugs a current area of interest in the field of orthodontics. Therefore, the aim of this study was to evaluate the effects of statins on orthodontic tooth movement (OTM) in animals undergoing orthodontic treatments. Methods: Several databases were comprehensively searched for studies measuring the effects of statins on the OTM up to January 2020, including MEDLINE, ISI Web of Science, EMBASE, Scopus, and Cochrane. Animal studies evaluating the effects of statins on tooth movements in animals undergoing orthodontic treatments were selected based on the PICO model .Study selection, data extraction, risk of bias, and study quality assessment were independently performed by two reviewers. Finally, the data were analyzed using random-effects meta-analysis and the mean difference (MD) was used for comparing the outcome measures. Results: Three randomized trials were finally included in this meta-analysis. According to the Systematic Review Centre for Laboratory animal Experimentation Tool, all the included studies had at least one domain at a high risk of bias. The amount of the OTM was insignificantly lower in the statin group (MD = 0.134 mm, %95 confidence interval = -0.020-0.288, P>0.05). Conclusions: Due to the low quality and methodological inconsistencies among the included studies, conclusive confirmation regarding the effect of statins on the OTM remains debatable. Trail Registration: The protocol of this study was registered on PROSPERO (https://www.crd.york.ac.uk/ PROSPERO/) with the ID # CRD42020164155.
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Fiorentino, Riccardo, and Francesco Chiarelli. "Treatment of Dyslipidaemia in Children." Biomedicines 9, no. 9 (August 24, 2021): 1078. http://dx.doi.org/10.3390/biomedicines9091078.
Повний текст джерелаАнотація:
Childhood dyslipidaemia is one of the main traditional cardiovascular risk factors that initiate and exacerbate the atherosclerotic process. Healthcare providers may play a key role in the management of children with lipid abnormalities; however, they have to properly evaluate the normal lipid values and know the available treatment options in children and adolescents. Current guidelines recommend healthy behaviours as the first-line treatment for childhood dyslipidaemia. The therapeutic lifestyle changes should focus on dietary modifications, daily physical activity, reduction in body weight and tobacco smoking cessation. Parents play a key role in promoting their children’s healthy habits. In children with more severe forms of lipid abnormalities and in those who do not benefit from healthy behaviours, pharmacological therapy should be considered. Safe and effective medications are already available for children and adolescents. Statins represent the first-line pharmacological option, while ezetimibe and bile acid sequestrants are usually used as second-line drugs. Despite their limited use in children, other lipid-lowering agents (already approved for adults) are currently available or under study for certain categories of paediatric patients (e.g., familial hypercholesterolemia). Further studies are needed to evaluate the long-term efficacy, safety and tolerability of novel lipid-lowering drugs, especially in children.
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Lapa, Matthew E., Gretchen M. Swabe, Bruce L. Rollman, Matthew F. Muldoon, Rebecca C. Thurston, and Jared W. Magnani. "Assessment of Depression and Adherence to Guideline-Directed Medical Therapies Following Percutaneous Coronary Intervention." JAMA Network Open 5, no. 12 (December 12, 2022): e2246317. http://dx.doi.org/10.1001/jamanetworkopen.2022.46317.
Повний текст джерелаАнотація:
ImportanceDepression is associated with increased risk of primary and secondary cardiovascular events. Medication adherence may play an essential role.ObjectiveTo evaluate the association of depression and 12-month adherence to guideline-directed medical therapies (eg, antiplatelet agents, β-blockers, renin-angiotensin-aldosterone system inhibitors [ie, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers], and statins) following percutaneous coronary intervention.Design, Setting, and ParticipantsThis retrospective cohort study included individuals who underwent percutaneous coronary intervention from January 1, 2014, to December 31, 2019. Data were collected from a large US health claims database and analyzed between February and August 2022.Main Outcomes and MeasuresProportion of days covered (PDC) for classes of guideline-directed medical therapies, with 12-month adherence categorized as adequate (PDC ≥80% to &lt;90%) or optimal (PDC ≥90%). Multivariable-adjusted regression models were used to evaluate the association of depression with adherence; models incorporated demographic characteristics, comorbid medical and psychiatric conditions, depression treatment, and guideline-directed medical therapy treatment adjustment. The hypothesis was that those with depression would have lower odds of either adequate or optimal adherence to agents essential for guideline-directed medical therapy.ResultsOf 124 443 individuals (mean [SD] age, 69.3 [10.6] years; 41 430 [33.3%] female sex; 3694 [3.0%] Asian, 12 611 [10.1%] Black, and 12 337 [9.9%] Hispanic individuals) who received percutaneous coronary interventions, 20 711 (16.6%) had a diagnosis of depression. Those with depression were significantly less likely to obtain adequate 12-month adherence to antiplatelets (odds ratio [OR], 0.80; 95% CI, 0.77-0.85), β-blockers (OR, 0.84; 95% CI, 0.80-0.88), and statins (OR, 0.88; 95% CI, 0.85-0.93) than those without depression; there was no association between depression and adherence to renin-angiotensin-aldosterone system inhibitors (OR, 0.93; 95% CI, 0.85-1.00). Those with depression had similarly decreased likelihood of optimal 12-month adherence to antiplatelets, β-blockers, and statins as well as renin-angiotensin-aldosterone system inhibitors (OR, 0.87; 95% CI, 0.82-0.94).Conclusions and RelevanceIn this cohort study, patients with depression were less likely to achieve adequate or optimal adherence to medications essential to guideline-directed medical therapies following percutaneous coronary intervention compared with those without depression. Recognition of depression may facilitate targeted interventions to address medication adherence and thereby improve secondary cardiovascular disease prevention.
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Packard, Chris, M. John Chapman, Mahendra Sibartie, Ulrich Laufs, and Luis Masana. "Intensive low-density lipoprotein cholesterol lowering in cardiovascular disease prevention: opportunities and challenges." Heart 107, no. 17 (April 1, 2021): 1369–75. http://dx.doi.org/10.1136/heartjnl-2020-318760.
Повний текст джерелаАнотація:
Elevated levels of low-density lipoprotein cholesterol (LDL-C) are associated with increased risk of coronary heart disease and stroke. Guidelines for the management of dyslipidaemia from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) were updated in late 2019 in light of recent intervention trials involving the use of innovative lipid-lowering agents in combination with statins. The new guidelines advocate achieving very low LDL-C levels in individuals at highest risk, within the paradigm of ‘lower is better’. With the advent of combination therapy using ezetimibe and/or proprotein convertase subtilisin/kexin type 9 inhibitors in addition to statins, the routine attainment of extremely low LDL-C levels in the clinic has become a reality. Moreover, clinical trials in this setting have shown that, over the 5–7 years of treatment experience to date, profound LDL-C lowering leads to further reduction in cardiovascular events compared with more moderate lipid lowering, with no associated safety concerns. These reassuring findings are bolstered by genetic studies showing lifelong very low LDL-C levels (<1.4 mmol/L; <55 mg/dL) are associated with lower cardiovascular risk than in the general population, with no known detrimental health effects. Nevertheless, long-term safety studies are required to consolidate the present evidence base. This review summarises key data supporting the ESC/EAS recommendation to reduce markedly LDL-C levels, with aggressive goals for LDL-C in patients at highest risk, and provides expert opinion on its significance for clinical practice.
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Serhiyenko, V. A., and A. A. Serhiyenko. "Ezetimibe and diabetes mellitus:a new strategy for lowering cholesterol." INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine) 18, no. 5 (August 29, 2022): 302–14. http://dx.doi.org/10.22141/2224-0721.18.5.2022.1190.
Повний текст джерелаАнотація:
Diabetes mellitus is a well-recognized risk factor for cardiovascular diseases, so an “aggressive” therapeutic approach is necessary for some high-risk patients. Low-density lipoprotein (LDL) cholesterol is the leading modifiable risk factor for the development of atherosclerotic cardiovascular diseases (ACVD). It is known that statins are the gold standard to control LDL cholesterol and reduce the risks associated with ACVD; however, many patients do not achieve their LDL cholesterol target or are unable to use this class of drugs due to associated side effects. Recent studies of non-statin cholesterol-lowering drugs (ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors) have demonstrated benefits in the treatment of ACVD, and new drugs (bempedoic acid, inclisiran) have shown promising results in preclinical and clinical studies. New evidence suggests that prescription of ezetimibe as an addition to statins provides an additional cardioprotective effect. This review aims to discuss the role of ezetimibe in the treatment of patients with diabetes mellitus and dyslipoproteinemia and to consider its efficacy and safety. The combined use of low- or moderate-intensity therapy with statins and ezetimibe involves two complementary mechanisms: a decrease in the intracellular concentration of cholesterol with increased uptake of LDL cholesterol by hepatocytes and a decrease in cholesterol absorption in the intestines. These mechanisms act synergistically and can provide the same overall effect as when using high-intensity statin therapy. The safety of combined therapy is equivalent to that of monotherapy with HMG-CoA reductase inhibitors in similar doses. This combination is generally better tolerated than high doses of HMG-CoA reductase inhibitors and has advantages in patients at risk of myopathy and statin-induced type 2 diabetes. Thus, despite some caveats, ezetimibe remains the drug of choice in the arsenal of pharmacological agents.
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Hutcheson, Rebecca, and Petra Rocic. "The Metabolic Syndrome, Oxidative Stress, Environment, and Cardiovascular Disease: The Great Exploration." Experimental Diabetes Research 2012 (2012): 1–13. http://dx.doi.org/10.1155/2012/271028.
Повний текст джерелаАнотація:
The metabolic syndrome affects 30% of the US population with increasing prevalence. In this paper, we explore the relationship between the metabolic syndrome and the incidence and severity of cardiovascular disease in general and coronary artery disease (CAD) in particular. Furthermore, we look at the impact of metabolic syndrome on outcomes of coronary revascularization therapies including CABG, PTCA, and coronary collateral development. We also examine the association between the metabolic syndrome and its individual component pathologies and oxidative stress. Related, we explore the interaction between the main external sources of oxidative stress, cigarette smoke and air pollution, and metabolic syndrome and the effect of this interaction on CAD. We discuss the apparent lack of positive effect of antioxidants on cardiovascular outcomes in large clinical trials with emphasis on some of the limitations of these trials. Finally, we present evidence for successful use of antioxidant properties of pharmacological agents, including metformin, statins, angiotensin II type I receptor blockers (ARBs), and angiotensin II converting enzyme (ACE) inhibitors, for prevention and treatment of the cardiovascular complications of the metabolic syndrome.
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Smedberg, Christian, Rebecka Hultgren, Karin Leander, and Johnny Steuer. "Pharmacological treatment in patients with aortic dissection." Open Heart 9, no. 2 (November 2022): e002082. http://dx.doi.org/10.1136/openhrt-2022-002082.
Повний текст джерелаАнотація:
ObjectivesTo describe medical management in aortic dissection (AD) and to analyse the possible associations between antihypertensive, antithrombotic, anticoagulant and statin agents, respectively, and long-term survival.MethodsFrom Swedish medical registers, all patients diagnosed with AD in 2006–2015 were identified. Filled prescriptions prior to admission and within 1 year from discharge in patients discharged and alive at 30 days were registered. Associations between pharmacological treatment and long-term survival were analysed using Cox proportional hazards models.ResultsOf 3951 patients hospitalised with acute AD, 3046 (77%) were discharged and alive at 30 days. In hospitalised patients, mean age was 66 years (SD 13), and 36% (n=1098) were women. Within 1 year from discharge, 96% (n=2939) had at least one antihypertensive drug. Beta blocker was the most commonly used drug type (90%, n=2741). Statin treatment (47%, n=1418) was associated with higher long-term survival; HR 0.74 (95% CI 0.63 to 0.87, p<0.001). The positive association between statins and long-term survival remained, in subgroup analysis, in medically managed patients (HR 0.72 (95% CI 0.60 to 0.86, p<0.001)), but not in patients undergoing surgical repair (HR 0.82 (95% CI 0.58 to 1.14, p=0.230)). Beta blockers were associated with favourable long-term survival in surgically managed patients (HR 0.58 (95% CI 0.35 to 0.97, p=0.038)) but not in medically managed patients (HR 0.93 (95% CI 0.72 to 1.12, p=0.057)). Neither antiplatelet therapy nor anticoagulants were associated with long-term survival.ConclusionsStatin treatment was associated with favourable long-term outcome in medically managed AD patients, whereas treatment with beta blocker was associated with higher survival only in surgically managed AD patients. Statin use as well as optimal antihypertensive therapy in the chronic stage of the disease need to be further analysed, preferably in randomised controlled trials.
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Rousan, Talla A., and Udho Thadani. "Stable Angina Medical Therapy Management Guidelines: A Critical Review of Guidelines from the European Society of Cardiology and National Institute for Health and Care Excellence." European Cardiology Review 14, no. 1 (April 30, 2019): 18–22. http://dx.doi.org/10.15420/ecr.2018.26.1.
Повний текст джерелаАнотація:
Most patients with stable angina can be managed with lifestyle changes, especially smoking cessation and regular exercise, along with taking antianginal drugs. Randomised controlled trials show that antianginal drugs are equally effective and none of them reduced mortality or the risk of MI, yet guidelines prefer the use of beta-blockers and calcium channel blockers as a first-line treatment. The European Society of Cardiology guidelines for the management of stable coronary artery disease provide classes of recommendation with levels of evidence that are well defined. The National Institute for Health and Care Excellence (NICE) guidelines for the management of stable angina provide guidelines based on cost and effectiveness using the terms first-line and second-line therapy. Both guidelines recommend using low-dose aspirin and statins as disease-modifying agents. The aim of this article is to critically appraise the guidelines’ pharmacological recommendations for managing patients with stable angina.