RESUMO
The effectiveness and safety of simvastatin in reducing low-density lipoprotein cholesterol (LDL-C) to target levels in patients with coronary heart disease (CHD) were evaluated in the GOALLS (Getting to Appropriate LDL-C Levels with Simvastatin) study. This multinational, multicentre, prospective, open-label, study consisted of a six-week diet washout period followed by a 14-week titrate-to-goal treatment period with simvastatin. One hundred and ninety-eight men and women with documented CHD and a fasting LDL-C level between 115 mg/dl (3.0 mmol/l) and 180 mg/dl (4.7 mmol/l) and triglycerides (TGs) < or = 400 mg/dl (4.5 mmol/l) were enrolled. The patients were started on 20 mg simvastatin with dose titration up to 80 mg if the LDL-C remained above 100 mg/dl at weeks 6 and 10. The key efficacy parameters were the percentage of patients achieving US and European LDL-C goals [< or = 100 mg/dl (2.6 mmol/l) and < or = 115 mg/dl (3.0 mmol/l), respectively]. Safety was evaluated by monitoring laboratory tests and recording adverse events. After 14 weeks of simvastatin (20-80 mg) treatment, approximately 90% of the patients achieved LDL-C goals according to US (87%) and European (94%) guidelines. Most patients (72-93%) achieved target LDL-C levels on 20 mg simvastatin. An estimated 14% of the patients required titration to the 80 mg dose. Treatment with simvastatin (20-80 mg) produced statistically significant improvements in all measured lipid variables by the end of the study. The mean reductions in total cholesterol and LDL-C, and the median reduction in TG, were 28%, 41% and 16%, respectively. The increase in high-density lipoprotein cholesterol and apolipoprotein A-1 were 5% and 4%, respectively. Simvastatin was well tolerated across the dosage range. In conclusion, simvastatin, 20-80 mg/day, was safe and highly effective at reducing LDL-C levels. The recommended US and European LDL-C treatment goals were achieved in approximately 90% of the patients. These goals were similarly achieved for a variety of high-risk sub-groups (hypertensives, diabetics and elderly patients).
Assuntos
Anticolesterolemiantes/uso terapêutico , LDL-Colesterol/efeitos dos fármacos , Hipercolesterolemia/tratamento farmacológico , Sinvastatina/uso terapêutico , Idoso , Anticolesterolemiantes/farmacologia , Colesterol/sangue , Qualidade de Produtos para o Consumidor , Doença das Coronárias/sangue , Doença das Coronárias/complicações , Europa (Continente) , Feminino , Guias como Assunto , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Sinvastatina/farmacologia , Estados UnidosRESUMO
The influence of the physical exercise at high altitude on the endocrine function was studied in 8 normal native men of sea level and in 8 natives men of high altitude. The sea level dwellers were studied both, at sea level, during an acute exposure to low barometric pressure and after 3 months of acclimatization to altitudes over 3,500 meters above the sea level. The experiments at high altitude were conducted at an altitude of 4,500 meters above the sea level. Two types of exercise were carried out, sub-maximal and maximal, at fasting state, between 8 and 10 a.m. During an acute exposure to altitude the physical exercise produced a marked rise of glucose, cortisol and growth hormone and a fall in the insulin content of plasma. In the sea level dwellers, acclimatized to altitude during 3 months, an elevation of growth hormone was observed only during maximal physical effort. Marked variation in glucose and cortisol were observed during both types of exercise. This shows that in these subjects some adaptative changes have ocurred but of lesser extent as those observed in altitude natives. In the high altitude native higher basal concentrations of growth hormone and glucagón as well as a lower glucose concentration in blood, were found. During exercise the high altitude dweller showed no significant changes in somatotropin, meanwhile an important elevation of cortisol occurred. These findings indicate that the high altitude native has metabolic and endocrine responses to exercise similar to those found in well fitted atletes of sea level. The exposure to altitude provoked a rise in glucagon concentration directly proportional to the time of exposition ot altitude. The physical exercise did not elucidate any change in the glucagon content of blood.
Assuntos
Altitude , Glicemia/análise , Hormônios/metabolismo , Esforço Físico , Adulto , Glucagon/sangue , Hormônio do Crescimento/sangue , Humanos , Hidrocortisona/sangue , Insulina/sangue , Masculino , DescansoRESUMO
Adrenal response to tolbutamide-induced hypoglycemia was studied in 23 normal men born and living at high altitude (Morococha, Perú, 4,540 m) and compared to 23 men born and living near sea level. Fasting blood sugar was significantly lower in the high altitude dwellers (HAD) and this difference persisted throughout the test period. The blood glucose decrement at 30 min was significantly less in the HAD. Plasma cortisol response was significantly higher at 30 and 60 min in the HAD. Peak cortisol level occurred earlier in the HAD than in men living at sea level. The absolute cortisol increment at 30 min was significantly greater in the HAD.