RESUMEN
BACKGROUND: Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. METHODS: A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. RESULTS: Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. CONCLUSION: High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.
Asunto(s)
Enfermedades Cardiovasculares , Dislipidemias , Guías de Práctica Clínica como Asunto , Humanos , Dislipidemias/tratamiento farmacológico , Dislipidemias/terapia , Enfermedades Cardiovasculares/prevención & control , Conducta de Reducción del RiesgoRESUMEN
INTRODUCTION: A new cardiovascular risk (CVR) calculator that incorporates Lipoprotein(a) [Lp(a)] levels has recently been designed. AIMS: To estimate CVR using the new score and to identify the reduction in low-density lipoprotein cholesterol (LDL-C) or systolic blood pressure (SBP) necessary to balance the risk attributable to Lp(a). METHODS: CVR throughout life and at 10 years was estimated with the new score in patients in primary prevention, both considering and not considering the value of Lp(a). When the estimated risk considering Lp(a) levels exceeded the baseline risk, the reduction in LDL-C levels or SBP necessary to balance the risk attributable to Lp(a) was calculated. RESULTS: In total, 671 patients (mean age 54.2 years, 47.2% women) were included. Globally, 22.7% of the population had high Lp(a) values (> 50 mg/dL or > 125 nmol/L). When calculating CVR throughout life and considering the Lp(a) value, the global risk increased in 66.7% of cases (median 19.3%). Similar results were observed when we assessed the 10-year risk. The risk associated with Lp(a) could be completely compensated by decreasing LDL-C (average 21 mg/dL) or SBP (average 6.3 mmHg) in 79.2% and 74.7% of cases, respectively. CONCLUSION: When calculating the CVR with the new score, two-thirds and one-third of the population were bidirectionally recategorized as 'up' or 'down,' respectively. The decrease in LDL-C or SBP mitigated the increased risk caused by Lp(a) levels across a substantial proportion of patients.
Asunto(s)
Biomarcadores , Presión Sanguínea , Enfermedades Cardiovasculares , LDL-Colesterol , Factores de Riesgo de Enfermedad Cardiaca , Lipoproteína(a) , Valor Predictivo de las Pruebas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/diagnóstico , LDL-Colesterol/sangre , Técnicas de Apoyo para la Decisión , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/epidemiología , Dislipidemias/tratamiento farmacológico , Lipoproteína(a)/sangre , Prevención Primaria , Pronóstico , Medición de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Statins are the main strategy to reduce dyslipidemia-related cardiovascular risk. Nevertheless, there is scarce evidence on the real-world statins use in primary care settings in low-middle-income countries. OBJECTIVE: We conducted a cross-sectional retrospective study using anonymized data routinely collected by community health workers in Brazil aimed to evaluate statin use and associated factors in a primary prevention population with cardiovascular risk enhancers. METHODS: Study population consisted of adults with hypertension, diabetes, and/or dyslipidemia. The primary and secondary outcomes were the proportion of individuals self-reporting statins use on any dose and high-dose statins/high-intensity lipid-lowering therapy (LLT), respectively. RESULTS: Of the 2,133,900 adult individuals in the database, 415,766 (19.5%) were included in the study cohort. From this cohort, 89.1% had hypertension, 28.9% diabetes, and 5.5% dyslipidemia. The mean age was 61.5 (standard deviation 14.5) years, 63.4% were female, and 61.0% were of mixed-race. Only 2.6% and 0.1% of individuals self-reported the use of statins and high-dose statins/high-intensity LLT, respectively. Older age (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.88, 2.05, p < 0.001), living in the South region of Brazil (OR 4.39; 95% CI 3.97, 4.85, p < 0.001), heart failure (OR 2.60; 95% CI 2.33, 2.89, p < 0.001), chronic kidney disease (OR 1.49; 95% CI 1.35, 1.64, p < 0.001), and anti-hypertensive medications use (OR 4.38; 95% CI 4.07, 4.71, p < 0.001) were independently associated with statin use. CONCLUSION: In a real-world evidence study analyzing data routinely collected in a digitized primary care setting, we observed a very low use of statins in a primary prevention population with cardiovascular risk enhancers in Brazil. Socio-demographic factors and co-morbidities were associated with higher statins use rates.
Asunto(s)
Enfermedades Cardiovasculares , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Atención Primaria de Salud , Prevención Primaria , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Femenino , Masculino , Estudios Transversales , Brasil/epidemiología , Persona de Mediana Edad , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/epidemiología , Prevención Primaria/métodos , Estudios Retrospectivos , Anciano , Adulto , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiologíaRESUMEN
The aim of the present study was to assess the impacts of roasting and the type of extraction solvent (ethanol or water) on the hypolipidemic act ivity of xoconostle fruit peel extracts in a tyloxapol - induced model of hyperlipidemia. Water and ethanol extracts from raw and roasted Opuntia joconostle peels were obtained to quantify the phytochemicals contained within and assess their hypolipidemic ac tivity in rats (n=5) against tyloxapol - induced dyslipidemia (400 mg/kg). The raw ethanol and water extracts, as well as the roasted water extract (200 mg/kg), showed hypolipidemic activity in the tyloxapol - treated group ( p <0.05). In contrast, the roasted s ample extracted with ethanol did not show this effect. The concentrations of phenolic compounds (39.80 mg GAE/g) and flavonoids (16.42 ± 0.14 mg QE/g) were higher in the ethanolic extracts than in the aqueous extracts. Conversely, the concentration of beta lains (115.51 ± 1.66 mg/100 g) was higher in the water extracts than in the ethanol extracts. It was concluded that the roasting process modified the concentration of some phytochemicals and their antioxidant capacity in vitro , producing a hypolipidemic ef fect in tyloxapol - induced hyperlipidemic rats
El objetivo del presente estudio fue evaluar el impacto del tostado y del tipo de disolvente de e xtracción (etanol o agua) sobre la actividad hipolipidémica de los extractos de cáscara de frutos de xoconostle en un modelo de hiperlipidemia inducido por el tyloxapol. Se obtuvieron extractos acuosos y etanólicos de cáscara cruda y asada de Opuntia jocon ostle para cuantificar los fitoquímicos que contienen y evaluar su actividad hipolipidémica en ratas (n=5) contra la dislipidemia inducida por el tyloxapol (400 mg/kg). Los extractos acuosos y etanólicos crudos, así como el extracto acuoso tostado (200 mg/ kg), mostraron actividad hipolipidémica en el grupo tratado con tiloxapol ( p <0,05). En cambio, la muestra asada y extraída con etanol no mostró este efecto. Las concentraciones de compuestos fenólicos (39,80 mg GAE/g) y flavonoides (16,42 ± 0,14 mg QE/g) f ueron mayores en los extractos etanólicos que en los acuosos. Por el contrario, la concentración de betalaínas (115,51 ± 1,66 mg/100 g) fue mayor en los extractos acuosos que en los etanólicos. Se concluyó que el proceso de asado modificó la concentración de algunos fitoquímicos y su capacidad antioxidante in vitro , produciendo un efecto hipolipidémico en ratas hiperlipidémicas inducidas por el tyloxapol.
Asunto(s)
Animales , Ratones , Extractos Vegetales/administración & dosificación , Extractos Vegetales/química , Opuntia/química , Dislipidemias/tratamiento farmacológico , Hipolipemiantes/administración & dosificación , Fenoles/análisis , Flavonoides/análisis , Agua , Etanol , Betalaínas/análisis , Cromatografía Líquida con Espectrometría de Masas , Hipolipemiantes/química , AntioxidantesRESUMEN
BACKGROUND: Access to medicines is a serious problem globally and in Chile. Despite the creation of coverage policies, part of the population with chronic conditions of high prevalence, still does not have access to the medicines it requires and disease control continues to be low. The objective of the study was to estimate the medication use and effective coverage for diabetes, dyslipidemia and hypertension in Chile, analyzing them according to sociodemographic variables and social determinants of health. METHODS: Cross-sectional analytical study with information from the 2016-2017 National Health Survey (sample = 6,233 people aged 15 years or older, expanded = 14,518,969). Descriptive analyses of medication use and effective coverage for hypertension, diabetes and dyslipidemia were carried out, and multivariate logistic regression models were developed to analyze possible associations with variables of interest. RESULTS: 60% of people with hypertension or diabetes use medications and only 27.7% in dyslipidemia. While 54.2% of those with diabetes have their glycemia controlled, in hypertension and dyslipidemia the effective coverage drops to 33.3% and 6.6%, respectively. There are no differences in use by health system, but there are differences in the control of hypertension and diabetes, favoring beneficiaries of the private subsystem. Effective coverage of dyslipidemia and hypertension also increases in those using medications. The drugs coincide with the established protocols, although beneficiaries of the private sector report greater use of innovative drugs. CONCLUSION: A significant proportion of Chileans with hypertension, diabetes or dyslipidemia still do not use the required medications and do not control their conditions.
Asunto(s)
Diabetes Mellitus , Dislipidemias , Hipertensión , Cobertura del Seguro , Seguro de Salud , Medicamentos bajo Prescripción , Humanos , Chile/epidemiología , Enfermedad Crónica , Estudios Transversales , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/economía , Diabetes Mellitus/epidemiología , Dislipidemias/tratamiento farmacológico , Dislipidemias/economía , Dislipidemias/epidemiología , Hipertensión/tratamiento farmacológico , Hipertensión/economía , Hipertensión/epidemiología , Medicamentos bajo Prescripción/economía , Medicamentos bajo Prescripción/uso terapéutico , Prevalencia , Pueblos Sudamericanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/economíaRESUMEN
INTRODUCTION: In a recent study, we have shown that atorvastatin is clinically safe for dermatomyositis (DM) and antisynthetase syndrome (ASS) patients with dyslipidemia. Herein, we showed in an unprecedented way, the safety of atorvastatin on the muscular tissues of these patients. METHODS: Transcriptome analysis was performed on samples of the vastus lateralis muscle obtained at baseline and after 12 weeks of atorvastatin (20 mg/day) intervention in DM or ASS patients with dyslipidemia [6DM and 5ASS received atorvastatin, and 2DM and 3ASS received placebo]. The results were analyzed considering differences in expression fold change before and after treatment. Histological and histochemical analyses were also performed. RESULTS: In both groups, no significant changes were observed in genes related to the mitochondrial, oxidative, insulin, lipid, and fibrogenic pathways. Histological analysis showed a slight variability in the fiber size that was preserved after the intervention. In addition, the mosaic of muscle fibers was preserved in the internal architecture of the fibers and all histological regions. No fiber necrosis or atrophy, focal failures, subsarcolemmal accumulation, lipids, areas of fibrosis, or alterations in mitochondrial activity were observed. All muscle fibers were labeled for MHC I. CONCLUSION: Atorvastatin did not promote significant changes in the expression of genes related to mitochondrial, oxidative, insulin, lipid, and fibrogenic pathways in the muscle tissues of DM and ASS patients with dyslipidemia. Atorvastatin did not also promote histological and histochemical changes in muscle tissues. Our results reinforce the safety of the administration of atorvastatin to treat dyslipidemia in patients with DM and ASS.
Asunto(s)
Dermatomiositis , Dislipidemias , Insulinas , Miositis , Humanos , Atorvastatina/efectos adversos , Dermatomiositis/diagnóstico , Dermatomiositis/tratamiento farmacológico , Miositis/diagnóstico , Miositis/tratamiento farmacológico , Miositis/patología , Músculo Esquelético/patología , Dislipidemias/diagnóstico , Dislipidemias/tratamiento farmacológico , Dislipidemias/genética , Insulinas/uso terapéuticoRESUMEN
Many policosanols from different sources, such as sugar cane and rice bran, have been marketed worldwide to improve blood lipid profiles. But so far, no comparative study has commenced elucidating the effect of different policosanols to improve the blood lipid profile and other beneficial effects. This study compared the efficacy of four different policosanols, including one sugar cane wax alcohol from Cuba (Raydel®) and three policosanols from China (Xi'an Natural sugar cane, Xi'an Realin sugar cane, and Shaanxi rice bran), to treat dyslipidemia in hyperlipidemic zebrafish. After 12 weeks of consumption of each policosanol (final 0.1% in diet, wt/wt) and a high-cholesterol diet (HCD, final 4%, wt/wt), the Raydel policosanol group and the Xi'an Natural policosanol group showed the highest survivability, of approximately 81%. In contrast, the Xi'an Realin policosanol and the Shaanxi policosanol groups showed 57% and 67% survivability, respectively. Among the five HCD groups, the Raydel policosanol group showed the lowest serum total cholesterol (TC, p < 0.001 versus HCD control) and triglyceride (p < 0.001 versus HCD control), with the highest percentage of high-density lipoproteins-cholesterol in TC. The Raydel policosanol group also showed the lowest serum aspartate aminotransferase and alanine aminotransferase levels, with the least infiltration of inflammatory cells and interleukin-6 production in hepatocytes with a marked reduction in reactive oxygen species (ROS) production and fatty liver changes. In the ovary, the Raydel policosanol group also showed the highest content of mature vitellogenic oocytes with the lowest production of reactive oxygen species and cellular apoptosis in ovarian cells. In the testes, the Raydel policosanol group also showed the healthiest morphology for spermatogenesis, with the lowest interstitial area and reactive oxygen species production in testicular cells. Conclusively, among the tested policosanols, Cuba (Raydel®) policosanol exhibited a comparatively better effect in maintaining zebrafish body weight, survivability, blood lipid profile, hepatic function biomarkers, fatty liver changes, ROS generation, inflammation, and restoration of the cell morphology in ovaries and testes affected by the HCD consumption.
Asunto(s)
Dislipidemias , Alcoholes Grasos , Hígado Graso , Animales , Femenino , Masculino , Colesterol , Dislipidemias/tratamiento farmacológico , Hígado Graso/tratamiento farmacológico , Ovario , Especies Reactivas de Oxígeno , Testículo , Pez Cebra , Alcoholes Grasos/farmacologíaRESUMEN
Dyslipidemia presents high levels of serum cholesterol and is characterized as a risk factor for cardiovascular diseases, especially for the development of atherosclerosis. E. oleracea oil (OFEO), A. esculentus oil (OFAE), B. orellana oil (OFBO), and Chronic SM® granules (CHR) are rich in bioactive compounds with the potential to treat changes in lipid metabolism. This study investigated the effects of treatments with oils from A. esculentus, E. oleracea, B. orellana, and Chronic SM® on Cocos nucifera L. saturated-fat-induced dyslipidemia. The chromatographic profile showed the majority presence of unsaturated fatty acids in the tested oils. The quantification of tocotrienols and geranylgeraniol in OFBO and CHR was obtained. Treatments with OFEO, OFAE, OFBO, and CHR were able to significantly reduce glycemia, as well as hypertriglyceridemia, total cholesterol, and LDL-cholesterol, besides increasing HDL-cholesterol. The treatments inhibited the formation of atheromatous plaques in the vascular endothelium of the treated rats. The obtained results suggest that the OFEO, OFAE, OFBO, and CHR exhibit antidyslipidemic effects and antiatherogenic activity.
Asunto(s)
Abelmoschus , Aterosclerosis , Dislipidemias , Euterpe , Ratas , Animales , Ratas Wistar , Bixaceae , Aterosclerosis/tratamiento farmacológico , Aterosclerosis/etiología , Dislipidemias/tratamiento farmacológico , Dislipidemias/etiología , HDL-Colesterol , AceitesRESUMEN
ANTECEDENTES: un alto porcentaje de pacientes con dislipemia no alcanza los objetivos terapéuticos de colesterol unido a lipoproteínas de baja densidad (C-LDL) en el nivel primario de atención. Objetivo: Describir el manejo terapéutico de la dislipemia en pacientes sin enfermedad cardiovascular aterosclerótica (ECA) establecida, desde la perspectiva del médico de atención primaria en España. MATERIAL Y MÉTODOS: Estudio transversal mediante encuesta electrónica dirigida a médicos de atención primaria para explorar su manejo terapéutico farmacológico de la dislipemia en pacientes sin ECA, que se centraba en su conocimiento y adherencia a las guías de la Sociedad Europea de Cardiología/Sociedad Europea de Aterosclerosis (ESC/AES) de 2019 y su perspectiva con respecto a las barreras para alcanzar los objetivos de C-LDL. RESULTADOS: Un total de 279 médicos de atención primaria completaron la encuesta. La mayoría (80,65%) afirmaron que ya habían adoptado las guías de la ESC/EAS de 2019 en su práctica. Sin embargo, alrededor del 30% seguía los objetivos terapéuticos de las guías anteriores (2016) y muchos trataban a sus pacientes con estatinas en monoterapia y dosis menores a la máxima tolerada. Adicionalmente un 50,18% era poco adherente a las guías de la ESC/EAS de 2019, especialmente al algoritmo de tratamiento. Las barreras más importantes para alcanzar los objetivos de C-LDL eran la subestimación del riesgo cardiovascular y la reticencia a aumentar la dosis o a utilizar terapia combinada. Conclusiones: Aunque los médicos de atención primaria afirman que seguían las guías ESC/EAS de 2019, los resultados indican que no las habían integrado completamente en su práctica clínica.
BACKGROUND: Evidence suggests many dyslipidemic patients do not reach target low-density lipoprotein and cholesterol (LDL-C) levels in primary health care. OBJETIVE: We aimed to describe the pharmacologic therapeutic management of dyslipidemia in patients without established atherosclerotic cardiovascular diseases (ASCVD) from the primary care physician's perspective in Spain. Material and Methods: We conducted a cross-sectional study through an online survey directed to primary care physicians to explore their therapeutic management of dyslipidemia in patients without ASCVD, focusing on their knowledge and adherence to the 2019 European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guidelines and their perspective concerning the barriers to achieving LDL-C therapeutic targets. RESULTS: In total, 279 primary care physicians completed the survey. Most interviewees (80.65%) stated they had already adopted the 2019 ESC/EAS guidelines in their clinical practice. Nevertheless, around 30% adhered to therapeutic targets by previous ESC/EAS guidelines (2016), and most treated their patients mainly with statins in monotherapy, prescribing doses below the maximum tolerated. Additionally, 50.18% were classified as low adherence to the 2019 ESC/EAS guidelines, especially to the treatment algorithm. According to the physicians, the underestimation of patients' cardiovascular risk and the reluctance to increase doses or use combined therapy were the most critical barriers to achieving LDL-C targets. Conclusions: Although primary care physicians in our survey reported adherence to the 2019 ESC/EAS guidelines recommendations, our observations indicate they need to integrate them better into their clinical practice.
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Dislipidemias/tratamiento farmacológico , Médicos de Atención Primaria , Atención Primaria de Salud , España , Enfermedades Cardiovasculares/prevención & control , Estudios Transversales , Encuestas y Cuestionarios , Guías de Práctica Clínica como Asunto , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Aterosclerosis/tratamiento farmacológico , LDL-Colesterol/sangreRESUMEN
Hemostasis preserves blood fluidity and prevents its loss after vessel injury. The maintenance of blood fluidity requires a delicate balance between pro-coagulant and fibrinolytic status. Endothelial cells (ECs) in the inner face of blood vessels maintain hemostasis through balancing anti-thrombotic and pro-fibrinolytic activities. Dyslipidemias are linked to hemostatic alterations. Thus, it is necessary a better understanding of the underlying mechanisms linking hemostasis with dyslipidemia. Statins are drugs that decrease cholesterol levels in the blood and are the gold standard for treating hyperlipidemias. Statins can be classified into natural and synthetic molecules, approved for the treatment of hypercholesterolemia. The classical mechanism of action of statins is by competitive inhibition of a key enzyme in the synthesis pathway of cholesterol, the HMG-CoA reductase. Statins are frequently administrated by oral ingestion and its interaction with other drugs and food supplements is associated with altered bioavailability. In this review we deeply discuss the actions of statins beyond the control of dyslipidemias, focusing on the actions in thrombotic modulation, vascular and cardiovascular-related diseases, metabolic diseases including metabolic syndrome, diabetes, hyperlipidemia, and hypertension, and chronic diseases such as cancer, chronic obstructive pulmonary disease, and chronic kidney disease. Furthermore, we were prompted to delved deeper in the molecular mechanisms by means statins regulate coagulation acting on liver, platelets, and endothelium. Clinical evidence show that statins are effective regulators of dyslipidemia with a high impact in hemostasis regulation and its deleterious consequences. However, studies are required to elucidate its underlying molecular mechanism and improving their therapeutical actions.
Asunto(s)
Enfermedades Cardiovasculares , Dislipidemias , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Hiperlipidemias , Trombosis , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Células Endoteliales , Hemostasis , Trombosis/prevención & control , Enfermedades Cardiovasculares/tratamiento farmacológico , Colesterol , Dislipidemias/tratamiento farmacológicoRESUMEN
The aim of this systematic review and meta-analysis was to evaluate the effects of anthocyanins-interventions on oxidative stress, inflammation, and lipid profile in patients undergoing hemodialysis. This systematic review and meta-analysis were registered on the International Prospective Register of Systematic Reviews (PROSPERO CRD42020209742). The primary outcome was anthocyanins-rich intervention on OS parameters and secondary outcome was anthocyanins-rich intervention on inflammation and dyslipidemia. RevMan 5.4 software was used to analyze the effect size of anthocyanins-rich intervention on OS, inflammation and dyslipidemia. Meta-analysis effect size calculations incorporated random-effects model for both outcomes 1 and 2. Eight studies were included in the systematic review (trials enrolling 715 patients; 165 men and 195 women; age range between 30 and 79 years). Anthocyanin intervention in patients undergoing hemodialysis decrease the oxidant parameters (std. mean: -2.64, 95% CI: [-3.77, -1.50], P ≤ 0.0001, I2 = 97%). Specially by reduction of malondialdehyde products in favor of anthocyanins-rich intervention (std. mean: -14.58 µmol.L, 95% CI: [-26.20, -2.96], P ≤ 0.0001, I2 = 99%) and myeloperoxidase (std. mean: -1.28 ηg.mL, 95% CI: [-2.11, -0.45], P = 0.003, I2 = 77%) against placebo group. Decrease inflammatory parameters (std. mean: -0.57, 95% CI: [-0.98, -0.16], P = 0.007, I2 = 79%), increase HDL cholesterol levels (std. mean: 0.58 mg.dL, 95% CI: [0.23, 0.94], P = 0.001, I2 = 12%) against placebo group. Anthocyanins-rich intervention seems to reduce oxidative stress, inflammatory parameters and improve lipid profile by increasing HDL cholesterol levels in patients with chronic kidney disease undergoing hemodialysis.
Asunto(s)
Antocianinas , Dislipidemias , Inflamación , Estrés Oxidativo , Insuficiencia Renal Crónica , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antocianinas/uso terapéutico , HDL-Colesterol/análisis , Suplementos Dietéticos , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Inflamación/complicaciones , Inflamación/tratamiento farmacológico , Estrés Oxidativo/efectos de los fármacos , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapiaRESUMEN
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is now considered the most common chronic liver disease worldwide. NAFLD is related to changes in lipid metabolism and is characterized by the increase or accumulation of fat in hepatocytes that may progress to nonalcoholic steatohepatitis (NASH), which leads to the appearance of inflammatory processes. Treatment consists of changes in diet, physical activity, and weight control; however, these disorders represent a health problem and require the development of novel alternatives to treatment and prevention. NAFLD/NASH are strongly associated with other disorders, such as metabolic syndrome (MetS); in fact, NAFLD is considered the hepatic manifestation of MetS. These disorders are related to other components of MetS, including dyslipidemia, which is characterized by an imbalance in blood cholesterol and triglyceride levels. Prebiotics and probiotics benefit from treating and preventing several ailments, including liver diseases. Specifically, in dyslipidemia, NAFLD, and NASH, probiotics play a fundamental role in conducting the biotransformation of primary bile acids into secondary bile acids, which generally have important activity as immunomodulators and metabolism regulators. The mechanisms of action of pre and probiotics involve the activity of bile acid receptors, such as FXR and TGR-5, and the events resulting from their activation. Therefore, prebiotics and probiotics may be reasonable options to prevent and treat metabolic- related liver diseases.
Asunto(s)
Dislipidemias , Síndrome Metabólico , Enfermedad del Hígado Graso no Alcohólico , Probióticos , Humanos , Enfermedad del Hígado Graso no Alcohólico/terapia , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Prebióticos , Hígado/metabolismo , Probióticos/uso terapéutico , Síndrome Metabólico/metabolismo , Dislipidemias/tratamiento farmacológico , Dislipidemias/metabolismo , Ácidos y Sales Biliares/metabolismoRESUMEN
Introduction. Non-communicable chronic diseases represent the leading cause of death worldwide, and their prevalence is increasing due to the epidemiological transition. Despite the advances in their management, control rates are deficient, attributed to multiple factors like adherence to pharmacological treatment, one of the most significant and least studied in the Colombian population. Objective. To calculate adherence to treatment in Colombian patients with arterial hypertension, cerebrovascular disease, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and dyslipidemia between 2005 and 2022. Materials and methods. We performed a systematic literature review and a meta-analysis of studies identified through the Medline and LILACS databases to quantitatively synthesize treatment adherence percentage. Results. Fourteen studies met the inclusion criteria, and 5,658 patients were analyzed. The treatment adherence was 59%, with significant heterogeneity among the included studies (95% CI= 46- 71%; I2 = 98.8%, p< 0.001). Higher adherence rates were observed for diabetes mellitus (79%; 95% CI = 65- 90%) and dyslipidemia (70%; 95% CI = 66- 74%). Adherence to arterial hypertension treatment was 51% (95 %; CI = 31- 72%). Conclusions. This systematic review showed low adherence to recommendations regarding pharmacological management in non-communicable chronic diseases, which can have implications for long-term clinical outcomes and disease burden.
Introducción. Las enfermedades crónicas no transmisibles representan la principal causa de muerte en el mundo y su prevalencia va en aumento debido a la transición epidemiológica. A pesar de los avances en su manejo, las cifras de control son deficientes y esto se atribuye a múltiples factores, como el cumplimiento del tratamiento farmacológico, que es uno de los más representativos y menos estudiados en la población colombiana.Objetivo. Establecer la frecuencia de casos que cumplieron con el tratamiento farmacológico en pacientes colombianos con hipertensión arterial, enfermedad cerebrovascular, diabetes mellitus, asma, enfermedad pulmonar obstructiva crónica y dislipidemia, entre el 2005 y el 2022.Materiales y métodos. Se llevó a cabo una revisión sistemática de la literatura y un metaanálisis de los estudios identificados mediante las bases de datos Medline y LILACS para sintetizar cuantitativamente el porcentaje de cumplimiento del tratamiento.Resultados. Catorce estudios cumplieron los criterios de inclusión y se analizaron 5.658 pacientes. El cumplimiento del tratamiento fue del 59 %, con una heterogeneidad alta entre los estudios incluidos (IC95 % = 46-71 %; I2 = 98,8 %, p<0,001). Se obtuvo un mayor cumplimiento para la diabetes mellitus (79 %; IC95 % = 65-90 %) y la dislipidemia (70 %; IC 95 % = 66-74 %). En los pacientes con hipertensión arterial el cumplimiento fue del 51 % (IC 95 % = 31-72 %).Conclusiones. La revisión sistemática muestra un bajo cumplimiento de las recomendaciones sobre el manejo farmacológico de enfermedades crónicas no transmisibles, lo que puede repercutir en los resultados clínicos y en la carga de la enfermedad a largo plazo.
Asunto(s)
Enfermedades no Transmisibles , Humanos , Enfermedad Crónica , Colombia/epidemiología , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Enfermedades no Transmisibles/tratamiento farmacológico , Enfermedades no Transmisibles/epidemiología , Cumplimiento de la MedicaciónRESUMEN
BACKGROUND: Evidence suggests many dyslipidemic patients do not reach target low-density lipoprotein and cholesterol (LDL-C) levels in primary health care. OBJECTIVE: We aimed to describe the pharmacologic therapeutic management of dyslipidemia in patients without established atherosclerotic cardiovascular diseases (ASCVD) from the primary care physician's perspective in Spain. MATERIAL AND METHODS: We conducted a cross-sectional study through an online survey directed to primary care physicians to explore their therapeutic management of dyslipidemia in patients without ASCVD, focusing on their knowledge and adherence to the 2019 European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guidelines and their perspective concerning the barriers to achieving LDL-C therapeutic targets. RESULTS: In total, 279 primary care physicians completed the survey. Most interviewees (80.65%) stated they had already adopted the 2019 ESC/EAS guidelines in their clinical practice. Nevertheless, around 30% adhered to therapeutic targets by previous ESC/EAS guidelines (2016), and most treated their patients mainly with statins in monotherapy, prescribing doses below the maximum tolerated. Additionally, 50.18% were classified as low adherence to the 2019 ESC/EAS guidelines, especially to the treatment algorithm. According to the physicians, the underestimation of patients' cardiovascular risk and the reluctance to increase doses or use combined therapy were the most critical barriers to achieving LDL-C targets. CONCLUSIONS: Although primary care physicians in our survey reported adherence to the 2019 ESC/EAS guidelines recommendations, our observations indicate they need to integrate them better into their clinical practice.
Asunto(s)
Dislipidemias , Adhesión a Directriz , Médicos de Atención Primaria , Pautas de la Práctica en Medicina , Humanos , Estudios Transversales , Dislipidemias/tratamiento farmacológico , Masculino , Femenino , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Persona de Mediana Edad , España , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Adulto , Encuestas y Cuestionarios , LDL-Colesterol/sangre , Enfermedades Cardiovasculares/prevención & control , Aterosclerosis/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Atención Primaria de SaludRESUMEN
The purposes of the present study were to analyze liver inflammation and endothelial dysfunction in an experimental model of metabolic syndrome (MS) induced by chronic administration of a sucrose-rich diet (SRD) and to evaluate the effects of chia seed as a therapeutic strategy. Male Wistar rats were fed with a reference diet (RD) for 6 months or a SRD for 3 months. Then, the latter group was randomly divided into two subgroups. One subgroup continued receiving the SRD for up to 6 months and the other was fed with a SRD where whole chia seed was incorporated as a source of dietary fat for the next 3 months (SRD + CHIA). Results showed that rats fed a SRD for a long period of time developed dyslipidemia, hyperglycemia, inflammation and endothelial dysfunction. Hepatic NAS, IL-1ß, NFκB p65, PAI-1, and F4-80 expression, as well as MPO activity were significantly increased and IL-10 expression was significantly decreased; this was accompanied by increased plasma IL-6 and TNF-α levels in rats fed a SRD. In addition, serum and liver nitric oxide (NO) levels and nitric oxide synthase (NOS) were significantly increased in the SRD group. In addition, a significant increase in hepatic iNOS expression and a positive correlation of this with liver NFκB p65 was found. We observed a significant increase in hepatic intercellular adhesion molecule (ICAM), and a negative correlation of this with liver Nrf2 was found. The administration of chia seed for 3 months reversed dyslipidemia, hyperglycemia, inflammation and endothelial dysfunction. In the liver tissue, NAS, IL-1ß, IL-10, NFκB p65, PAI-1, and F4-80 expression and MPO activity were normalized. Serum and liver NO and NOS levels and hepatic iNOS expression were decreased and this last one was associated with a decrease in liver NFκB p65 levels. Hepatic ICAM-1 was normalized and negatively correlated with liver NrF2 levels. This study showed new aspects of liver inflammation and endothelial dysfunction in dyslipidemic insulin resistant rats chronically fed with a sucrose-rich diet. In addition, we demonstrated new properties and molecular mechanisms associated with beneficial effects on inflammation and endothelial dysfunction of chia seed as a therapeutic strategy.
Asunto(s)
Dislipidemias , Hepatitis , Hiperglucemia , Síndrome Metabólico , Salvia , Ratas , Masculino , Animales , Interleucina-10/metabolismo , Salvia hispanica , Factor 2 Relacionado con NF-E2/metabolismo , Síndrome Metabólico/tratamiento farmacológico , Síndrome Metabólico/genética , Síndrome Metabólico/metabolismo , Ratas Wistar , Inhibidor 1 de Activador Plasminogénico/metabolismo , Semillas/metabolismo , Dislipidemias/tratamiento farmacológico , Dislipidemias/genética , Dislipidemias/metabolismo , Hígado/metabolismo , Inflamación/tratamiento farmacológico , Inflamación/metabolismo , Hepatitis/metabolismo , Sacarosa/metabolismo , Modelos Teóricos , Hiperglucemia/metabolismoRESUMEN
Alterations in lipid and lipoprotein metabolism are factors that trigger several negative metabolic complications. Hyperlipidemia is the starting point for the development of comorbidities of the cardiovascular system, such as atherosclerosis. The search for compounds that reduce high levels of total cholesterol and triglycerides has been widely reported in several publications in the literature. Phthalimide derivatives have been extensively researched with various biological actions. In this study we evaluated the antihyperlipidemic ability of three phthalimide derivatives (FGT-2, FGT-3 and FGT-4) on a model of obesity and insulin resistance in mice. The animals were submitted to a hyperlipid diet for 60â days. On the thirtieth day they were treated with phthalimides (20â mg/kg). The positive control group was treated with Simvastatin (20â mg/kg) and the negative control received only the carboxymethylcellulose vehicle. Biochemical and histological analyzes of all groups were analyzed. The animals treated with phthalimidic derivatives had a reduction in total cholesterol, low density and very low density lipoproteins (LDL-c and VLDL-c), triglycerides and fasting glycemia when compared to the negative control group. The treated animals also showed good results when analyzing the atherogenic indexes Castelli i and II and the ratio Triglycerides/HDL-c. In the oral glucose tolerance test and in the insulin tolerance test, animals treated with phthalimides were more sensitive to the action of the hormone regulating carbohydrate uptake. In the evaluation of the transaminases (AST/ALT), the animals of the group treated with phthalimides presented a lower elevation than the other groups of the experiment, the same observed with the uric acid evaluation. Histological analyzes were performed on liver, kidney, heart and pancreas samples. The groups treated with the compounds FGT-2 and FGT3 presented discrete alterations in the liver and kidney. FGT-4 did not present histological alterations for both tissues and the three phthalimide derivatives did not cause alterations in the other organs. These results suggest that the phthalimides tested can act as antihyperlipidemic agents and have a pleiotropic action, by acting also reducing glycemia in insulin resistance model mimicking diabetes mellitus typeâ 2. These compounds may appear as a new approach in the treatment of obesity and complications, which are multifaceted.
Asunto(s)
Diabetes Mellitus Tipo 2 , Dislipidemias , Resistencia a la Insulina , Insulinas , Ratones , Animales , Hipolipemiantes/farmacología , Hipolipemiantes/uso terapéutico , LDL-Colesterol , Ácido Úrico , Carboximetilcelulosa de Sodio , Triglicéridos , Dislipidemias/tratamiento farmacológico , Ftalimidas/farmacología , Lipoproteínas VLDL , Obesidad/tratamiento farmacológico , Simvastatina , Hormonas , TransaminasasRESUMEN
We investigated the effect of dietary supplementation with kinkan orange on growth, adiposity, metabolic parameters, and oxidative stress in rats with diet-induced hypercholesterolemia. Female Wistar rats (6-8 weeks) were fed a AIN-93M diet (Control); AIN-93M diet containing 5% kinkan orange (CTkinkan); Hypercholesterolemic diet, containing 1% cholesterol and 25% fat (Hyper); or Hypercholesterolemic diet containing 5% kinkan orange (Hyperkinkan). Hypercholesterolemic diet increased body weight, adiposity, serum alanine transaminase (ALT), creatinine, cholesterol and triglycerides, hepatic total lipids, cholesterol, and triglycerides, and hepatic oxidative stress. Supplementation with kinkan reduced the serum and hepatic lipid content, decreased serum ALT, besides improving the antioxidant status in liver tissue of hypercholesterolemic animals. Moreover, HDL-cholesterol increased in both groups supplemented with kinkan orange (CTkinkan and Hyperkinkan). Our data suggest that diet supplementation with kinkan orange may consist of a valid strategy to prevent or reduce dyslipidemia and oxidative stress in hypercholesterolemic rats.
Asunto(s)
Citrus sinensis , Dislipidemias , Alanina Transaminasa , Animales , Colesterol , Citrus sinensis/metabolismo , Dislipidemias/tratamiento farmacológico , Dislipidemias/metabolismo , Dislipidemias/prevención & control , Femenino , Hígado , Obesidad/metabolismo , Estrés Oxidativo , Ratas , Ratas Wistar , TriglicéridosRESUMEN
INTRODUCTION AND OBJECTIVES: Practicing physicians often hesitate to use statins and/or other lipid-lowering therapies in NAFLD due to concern for hepatotoxicity. The aim of this study is to examine the safety of lipid lowering therapies in NAFLD patients. MATERIALS AND METHODS: Data from randomized control trials (RCT) among NAFLD patients were pooled to examine the effect of lipid-lowering therapies on liver chemistry, lipid profile, and liver histology. Results are reported as the mean difference of the change (pretreatment-posttreatment) between the treatment and control group. RESULTS: A total of 21 placebo-controlled RCT on 1900 patients (304 receiving statins, 520 other lipid-lowering therapies, and 61 combinations) were treated for 26 weeks [Interquartile range (IQR): 17.5-52 weeks]. Pooled data showed an improved lipid profile without any worsening of ALT, AST, total bilirubin, or alkaline phosphatase at the end of the treatment period. NAFLD activity score improved with other lipid-lowering agents but not with statins. There was no change in individual components of NAFLD activity score or fibrosis stage. CONCLUSION: This meta-analysis of randomized controlled trials examining statins and/or other lipid-lowering therapies in NAFLD patients showed no evidence of worsening liver chemistry. Studies with longer use of lipid-lowering therapies are suggested to examine the benefit of liver histology among patients with NAFLD.
Asunto(s)
Dislipidemias , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Enfermedad del Hígado Graso no Alcohólico , Humanos , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Lípidos , Enfermedad del Hígado Graso no Alcohólico/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
The aim of this study was to analyze the liver injury and oxidative stress in an experimental model of Metabolic Syndrome (MS) induced by chronic administration of a sucrose-rich diet (SRD) and to evaluate the effects of chia seed as a therapeutic strategy. Male Wistar rats were fed with a reference diet (RD) -6 months- or a SRD -3 months. Then, the latter group was randomly divided into two subgroups. One subgroup continued receiving the SRD for up to 6 months and the other was fed with a SRD where whole chia seed was incorporated as a source of dietary fat for the next 3 months (SRD+CHIA). The results showed that rats fed with a SRD for a long period of time developed dyslipidemia, hyperglycemia, hepatic lipid accumulation, liver injury, hepatic lipid peroxidation and oxidative stress. Hepatic NrF2 expression was significantly decreased. In addition, a significant increase in hepatic NFκB p65 expression and a positive correlation of this with plasma TNFα levels were found. The administration of chia seed for 3 months reversed dyslipidemia, hyperglycemia, lipid accumulation, liver injury, lipid peroxidation and oxidative stress. In the liver tissue, NrF2 expression was normalized and NFκB p65 expression was decreased, the latter was associated with a decrease in plasma TNFα levels. The present study showed new aspects of liver damage, lipid peroxidation and oxidative stress in dyslipidemic insulin resistant rats chronically fed with a sucrose-rich diet. However, we demonstrated new properties and molecular mechanisms associated with the beneficial anti-oxidant effects of chia seed consumption.
Asunto(s)
Dislipidemias , Hiperglucemia , Salvia , Animales , Dieta , Dislipidemias/tratamiento farmacológico , Dislipidemias/genética , Hiperglucemia/metabolismo , Lípidos , Hígado/metabolismo , Masculino , Factor 2 Relacionado con NF-E2/genética , Factor 2 Relacionado con NF-E2/metabolismo , FN-kappa B/genética , FN-kappa B/metabolismo , Estrés Oxidativo , Ratas , Ratas Wistar , Salvia/metabolismo , Salvia hispanica , Semillas/metabolismo , Sacarosa/metabolismo , Factor de Necrosis Tumoral alfa/metabolismoRESUMEN
BACKGROUND: HIV infection affects millions of people globally. Currently, although several drugs have brought an improvement in the quality and life expectancy of these individuals, they are accompanied by several adverse effects. OBJECTIVE: To conduct a systematic review of studies examining the relationship between antiretroviral therapy (ART) uses and secondary dyslipidemia. METHODS: The review followed the criteria defined by PRISMA. Only articles that completely evaluated the lipid profile were included, which consisted of total cholesterol (TC), triglycerides (TG), and LDL cholesterol (LDL-c), HDL cholesterol (HDL-c). RESULTS: It was observed that the use of nucleoside and non-nucleoside reverse transcriptase inhibitor (NNRTI and NNRTI respectively) drugs and protease inhibitors are the most used in ART and are associated with changes in lipid profiles. The main changes observed were increases in TC, TG, and LDL-c in addition to a decrease in HDL-c. These patients had a higher risk of developing cardiovascular disease not only due to the use of therapy, but also due to the presence of other comorbidities evaluated in these studies, such as obesity, diabetes, and hypertension. The increase in age, the difference between genders, CD4 T-cell count, and viral load, were observed as risk factors for worsening dyslipidemia. CONCLUSION: According to the findings of this study, anti-HIV therapy is linked to dyslipidemia, which may or may not be the primary cause, and is frequently connected with a number of metabolic problems that can exacerbate the illness.