RESUMO
RESUMEN INTRODUCCIÓN: El ACV es uno de los eventos cardiovasculares más prevalentes en el mundo, en Colombia es la segunda causa de muerte y la primera de discapacidad. Uno de los factores de riesgo más importantes para tener en cuenta es el control del colesterol, la reducción de los niveles de C-LDL, principalmente por medio del tratamiento con estatinas y otros fármacos hipolipemiantes. MATERIALES Y MÉTODOS: En esta revisión narrativa de la literatura se ha recogido la información más relevante sobre el uso y los beneficios de este tratamiento y algunas consideraciones adicionales. CONCLUSIÓN: Los hallazgos de esta revisión demuestran el efecto protector de esta terapia cuando se consiguen reducir los niveles de C-LDL y colesterol, además, las otras terapias como ezetimiba o inhibidores de PSCK9. Por otro lado, los estudios mencionan posibles efectos beneficiosos en el contexto de ACV pero se requieren más ensayos clínicos.
ABSTRACT INTRODUCTION: Stroke is one of the most prevalent cardiovascular events in the world, in Colombia it is the second cause of death and first in disability. One of the most important risk factors to consider is cholesterol control, the reduction of LDL-C and cholesterol levels, mainly through treatment with statins and other lipid-lowering drugs. MATERIALS AND METHODS: The most relevant information on the use and benefits of this treatment and some additional considerations have been collected in this narrative review of the literature. CONCLUSION: The results of this narrative review show the protective effect of this therapy when it is possible to reduce LDL-C and cholesterol levels, in addition to other therapies such as ezetimibe or PSCK9 inhibitors. On the other hand, studies mention possible beneficial effects in the context of stroke but more clinical trials are required.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Acidente Vascular Cerebral , LDL-Colesterol , HipolipemiantesRESUMO
BACKGROUND: Type 2 diabetes mellitus (T2DM) greatly increases cardiovascular risk. Primary and secondary cardiovascular prevention lead to lower cardiovascular events, improved quality of life and lower costs related to complications. OBJECTIVE: To estimate the proportion of patients with T2DM undergoing drug therapy for cardiovascular prevention (aspirin and statins) in Colombia and to describe the change in patterns of use between 2008 and 2018. METHODS: This was a cross-sectional study comparing prescriptions for aspirin and statins in 2008 and in 2018 in outpatients diagnosed with T2DM. Records were obtained from a national drug claim database. The proportion of use of cardiovascular prevention drugs and antidiabetic drugs, medications for comorbidities and sociodemographic variables were analyzed for both periods. RESULTS: In total, 26 742 patients in 2008 and 188 321 in 2018 with a diagnosis of T2DM treated with antidiabetic drugs were identified, among whom 57.5% and 44.2% received aspirin and 44.9% and 60.2% received statins, respectively. The use of high-intensity statins increased from 1.1% in 2008 to 95.2% in 2018. The probabilities of receiving drugs in 2008 and in 2018 were higher for men (OR: 1.12, 95% CI: 1.06-1.17 and OR: 1.26, 95% CI: 1.23-1.28, respectively), for those persons over 75 years of age (OR: 6.5, 95% CI: 5.3-7.9 and OR: 5.8, 95% CI: 5.4-6.2) and for those who also received clopidogrel (OR: 5.8, 95% CI: 4.4-7.6 and OR: 2.2, 95% CI: 2.1-2.4). CONCLUSIONS: The use of high-intensity statins in patients with T2DM has increased significantly in the last decade, which should reduce cardiovascular events, morbidity and mortality.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Inibidores de Hidroximetilglutaril-CoA Redutases , Preparações Farmacêuticas , Aspirina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Colômbia/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Prevalência , Qualidade de VidaRESUMO
Background: Statins have extensive hepatic metabolism and can have multiple pharmacological interactions. The aim was to identify the main pharmacokinetic interactions between statins and their comedications in a group of patients from Colombia.Research design and methods: A cross-sectional study of pharmacokinetic interactions in patients treated with statins who were identified from a population database. The interactions were documented using the Lexicomp® database.Results: A total of 123,026 patients with statin prescriptions were identified, with a mean age of 68.4 ± 11.5 years; 57.1% were women, and 81.6% received atorvastatin. A total of 19.4% (n = 23.831) of patients presented pharmacological interactions. Some 15,474 (12.6%) had interactions classified as category C, 7.4% (n = 9077) as category D, and 0.5% (n = 660) as category X. 36.8% of the patients with lovastatin prescriptions had some interaction. Age older than 65 years, male sex, residence in capital cities, comorbidities, endocrine pathologies and HIV were associated with an increase in the probability of having contraindicated or risky interactions.Conclusions: Important interactions between statins and other medications were more common in adults over 65 years of age and those with endocrine comorbidities or HIV infection. This knowledge should help when proposing solutions that reduce the risk of adverse reactions.
Assuntos
Atorvastatina/farmacocinética , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacocinética , Lovastatina/farmacocinética , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atorvastatina/administração & dosagem , Colômbia , Estudos Transversais , Bases de Dados Factuais , Interações Medicamentosas , Doenças do Sistema Endócrino/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Lovastatina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Adulto JovemRESUMO
BACKGROUND: A considerable amount of randomized controlled trials (RCTs) have been published on statins and/or fibrates for diabetic retinopathy, a clinical condition associated with high social and economic burden. Adherence to the CONSORT statement items is imperative to ensure transparency and reproducibility in clinical research. The aim of this study is to assess the reporting quality and the adherence to CONSORT of RCTs assessing statins and/or fibrates for diabetic retinopathy. METHODS: We conducted a critical appraisal study at Discipline of Evidence-based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). A sensitive literature search was performed to identify all relevant RCTs, with no time or language limits. Two authors independently evaluated the reporting quality of the selected RCTs using the CONSORT statement as a standard. RESULTS: Thirteen reports of RCTs were included in this study. The adherence of the reports to CONSORT items ranged from 24% to 68%. The median score was 11 (interquartile range (IQR) 8 to 13). When analyzed separately, the methods sections of the reports had a median of three items (IQR 2 to 4) judged adherent to the methods items of CONSORT (items 3 to 12). The most underreported items were those related to trial design, title and abstract, allocation concealment, implementation of the randomization sequence, and blinding. Other important items, such as the one related to the description of the inclusion criteria, also had low adherence. CONCLUSIONS: The overall adherence to the CONSORT checklist items was poor, especially in the items related to the methods section. RCT reports on statins and/or fibrates for diabetic retinopathy must be optimized to avoid reporting biases and to improve transparency and reproducibility.
Assuntos
Lista de Checagem/normas , Confiabilidade dos Dados , Retinopatia Diabética/tratamento farmacológico , Ácidos Fíbricos/uso terapêutico , Fidelidade a Diretrizes/normas , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/normas , Retinopatia Diabética/diagnóstico , Ácidos Fíbricos/efeitos adversos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: Lipid-lowering drugs, especially statins, have shown great relevance in preventing and treating cardiovascular diseases. OBJECTIVE: To determine the prescription patterns of lipid-lowering drugs and the variables associated with their use in a Colombian population. MATERIALS AND METHODS: This is a cross-sectional descriptive study. From a drug dispensing database of approximately 4.5 million Colombian health system affiliates, patients of all ages and both sexes treated with lipid-lowering agents (statins, fibrates, ezetimibe) were identified between January and March, 2017. Demographic, pharmacological and co-medication variables were included. RESULTS: In total, 103,624 patients were identified as being treated with lipid-lowering agents. The average age was 67.5 years, and 49.8% were 65 years or older. Women comprised 58.0% of the patients. Statins were the most used (n=96,910; 93.5%), and atorvastatin (n=80,812; 78.0%) and lovastatin (n=12,621; 12.2%) were the most frequent. The mean atorvastatin dose was 30.3 mg/day, and 49.9% of its users received presentations of 40 mg or more. A total of 9,258 (8.9%) patients received fibrates, and only 780 (0.8%) were taking ezetimibe. Of this population, 94.9% were treated with lipid-lowering monotherapy, and 97.3% (n=100,813) had co-medication for their comorbidities, with the most frequent being antihypertensive (89.1%), antiplatelet (57.8%), antidiabetic (31.5%) and antiulcerative agents (34.2%). CONCLUSIONS: Atorvastatin is currently the most frequently used lipid-lowering drug in this group of Colombian patients, especially in monotherapy and at doses close to the defined daily dose. Only half received high-intensity doses. New studies are required to verify the efficacy of these therapies.
Introducción. Los fármacos hipolipemiantes, especialmente las estatinas, han demostrado gran relevancia para la prevención y el tratamiento de las enfermedades cardiovasculares. Objetivo. Determinar los patrones de prescripción de los fármacos hipolipemiantes y las variables asociadas con su uso en una población de Colombia. Materiales y métodos. Se trata de un estudio descriptivo y transversal. A partir de una base de datos de dispensación de medicamentos de 4,5 millones de afiliados al sistema de salud de Colombia, se identificaron los pacientes de cualquier edad y sexo en tratamiento con hipolipemiantes (estatinas, fibratos, ezetimibe), entre enero y marzo de 2017. Se incluyeron variables demográficas, farmacológicas y de comedicaciones. Resultados. Se identificaron 103.624 pacientes en tratamiento con hipolipemiantes. La edad promedio fue de 67,5 años y el 49,8 % tenía 65 o más años. El 58,0 % eran mujeres. Las estatinas fueron los más utilizados (n=96.910; 93,5 %), siendo la atorvastatina (n=80.812; 78,0 %) y la lovastatina (n=12.621; 12,2 %) las más frecuentes. La dosis promedio de atorvastatina fue de 30,3 mg/día y el 49,9 % de sus usuarios recibía presentaciones de 40 mg o más. Un total de 9.258 (8,9 %) pacientes recibían fibratos y solo 780 (0,8 %) tomaban ezetimibe. El 94,9 % de casos recibió tratamiento en monoterapia hipolipemiante y el 97,3 % (n=100.813) tenía comedicaciones para comorbilidades, siendo las más frecuentes antihipertensivos (89,1 %), antiagregantes plaquetarios (57,8 %), antidiabéticos (31,5 %) y antiulcerosos (34,2 %). Conclusiones. La atorvastatina es actualmente el medicamento hipolipemiante más utilizado en este grupo de pacientes de Colombia, especialmente en monoterapia y a dosis cercanas a las definidas, aunque solo la mitad recibían dosis recibían dosis de alta intensidad. Se requieren nuevos estudios que verifiquen la efectividad de estos tratamientos.
Assuntos
Hipolipemiantes/uso terapêutico , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Atorvastatina/administração & dosagem , Atorvastatina/uso terapêutico , Cidades/estatística & dados numéricos , Colômbia , Estudos Transversais , Quimioterapia Combinada , Ezetimiba/administração & dosagem , Ezetimiba/uso terapêutico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/administração & dosagem , Lovastatina/administração & dosagem , Lovastatina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto JovemRESUMO
Introduction. Lipid-lowering drugs, especially statins, have shown great relevance in preventing and treating cardiovascular diseases. Objective. To determine the prescription patterns of lipid-lowering drugs and the variables associated with their use in a Colombian population. Materials and methods. This is a cross-sectional descriptive study. From a drugdispensing database of approximately 4.5 million Colombian health system affiliates, patients of all ages and both sexes treated with lipid-lowering agents (statins, fibrates, ezetimibe) were identified between January and March, 2017. Demographic, pharmacological and co-medication variables were included. Results. In total, 103,624 patients were identified as being treated with lipid-lowering agents. The average age was 67.5 years, and 49.8% were 65 years or older. Women comprised 58.0% of the patients. Statins were the most used (n=96,910; 93.5%), and atorvastatin (n=80,812; 78.0%) and lovastatin (n=12,621; 12.2%) were the most frequent. The mean atorvastatin dose was 30.3 mg/day, and 49.9% of its users received presentations of 40 mg or more. A total of 9,258 (8.9%) patients received fibrates, and only 780 (0.8%) were taking ezetimibe. Of this population, 94.9% were treated with lipid-lowering monotherapy, and 97.3% (n=100,813) had co-medication for their comorbidities, with the most frequent being antihypertensive (89.1%), antiplatelet (57.8%), antidiabetic (31.5%) and antiulcerative agents (34.2%). Conclusions. Atorvastatin is currently the most frequently used lipid-lowering drug in this group of Colombian patients, especially in monotherapy and at doses close to the defined daily dose. Only half received high-intensity doses. New studies are required to verify the efficacy of these therapies.
Introducción. Los fármacos hipolipemiantes, especialmente las estatinas, han demostrado gran relevancia para la prevención y el tratamiento de las enfermedades cardiovasculares. Objetivo. Determinar los patrones de prescripción de los fármacos hipolipemiantes y las variables asociadas con su uso en una población de Colombia. Materiales y métodos. Se trata de un estudio descriptivo y transversal. A partir de una base de datos de dispensación de medicamentos de 4,5 millones de afiliados al sistema de salud de Colombia, se identificaron los pacientes de cualquier edad y sexo en tratamiento con hipolipemiantes (estatinas, fibratos, ezetimibe), entre enero y marzo de 2017. Se incluyeron variables demográficas, farmacológicas y de comedicaciones. Resultados. Se identificaron 103.624 pacientes en tratamiento con hipolipemiantes. La edad promedio fue de 67,5 años y el 49,8 % tenía 65 o más años. El 58,0 % eran mujeres. Las estatinas fueron los más utilizados (n=96.910; 93,5 %), siendo la atorvastatina (n=80.812; 78,0 %) y la lovastatina (n=12.621; 12,2 %) las más frecuentes. La dosis promedio de atorvastatina fue de 30,3 mg/día y el 49,9 % de sus usuarios recibía presentaciones de 40 mg o más. Un total de 9.258 (8,9 %) pacientes recibían fibratos y solo 780 (0,8 %) tomaban ezetimibe. El 94,9 % de casos recibió tratamiento en monoterapia hipolipemiante y el 97,3 % (n=100.813) tenía comedicaciones para comorbilidades, siendo las más frecuentes antihipertensivos (89,1 %), antiagregantes plaquetarios (57,8 %), antidiabéticos (31,5 %) y antiulcerosos (34,2 %). Conclusiones. La atorvastatina es actualmente el medicamento hipolipemiante más utilizado en este grupo de pacientes de Colombia, especialmente en monoterapia y a dosis cercanas a las definidas, aunque solo la mitad recibían dosis recibían dosis de alta intensidad. Se requieren nuevos estudios que verifiquen la efectividad de estos tratamientos.
Assuntos
Dislipidemias , Hipolipemiantes , Prescrições de Medicamentos , Farmacoepidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases , EzetimibaRESUMO
Resumen Introducción: Los estudios de utilización de medicamentos sirven para evaluar la efectividad y seguridad de los fármacos en la práctica real, diferente al contexto del estudio clínico controlado. Los hipolipemiantes actúan sobre el perfil lipídico disminuyendo el riesgo de enfermedades cardiovasculares. Objetivo: Describir el desempeño clínico y seguridad de la utilización de medicamentos hipolipemiantes en la práctica médica real en una cohorte de pacientes con diagnóstico de dislipidemia. Metodología: Estudio observacional de cohorte. Se siguió una cohorte de pacientes con indicación de hipolipemiantes durante 6 meses, en 12 ciudades de Colombia pertenecientes a un registro biomédico de seguimiento de pacientes tratados con medicamentos del portafolio de Abbott. Se midieron variables demográficas y clínicas basales, de seguridad y de desempeño clínico de los medicamentos sobre el perfil lipídico a los 3 y 6 meses. Resultados: Se siguieron 501 pacientes en tratamiento con hipolipemiantes. Las estatinas solas disminuyeron el colesterol de baja densidad de 249 mg/ dL (RIQ=226-268) en la medición basal a 190 (177.6-210) y 170 (108-170) en la segunda y tercera medición, respectivamente. Para estatina + ezetimibe, de 167 mg/dL (RIQ=139-184) a 132 (110-150) y 128.5 (101.5-128.5). El fenofibrato disminuyó los triglicéridos de 275 mg/dL (RIQ=21çj-346) a 201 (172-239) y 150.5 (140-150.5). Conclusiones: la administración de estatinas sola o en combinación disminuyó los niveles de LDL y colesterol total, mientras que el fenofibrato demostró su efectividad al disminuir los triglicéridos. No se reportaron efectos adversos. Hubo una adherencia parcial del médico tratante a la guía de práctica clínica para dislipidemias. MÉD.UIS.2019;32(1):13-20.
Abstract Introduction: Drug use studies are important to evaluate the effectiveness and safety of drugs in daily practice, outside the controlled clinical study. Lipid-lowering drugs act on the lipid profile, decreasing the risk of cardiovascular diseases. Objective: To describe the clinical performance and safety of the use of lipid-lowering drugs in real practice in a group of patients diagnosed with dyslipidemia. Methods: An observational, descriptive cohort study. A cohort of patients with hypolipidemic indication for 6 months was followed in 12 cities of Colombia that belong to the biomedical registry of follow-up of patients treated with medicines from the Abbott portfolio. Baseline demographic and clinical variables, safety and efectivity of the drugs were measured on the lipid profile at 3 and 6 months. Results: 501 patients received lipid-lowering agents. Statins alone decreased the low density (LDL) cholesterol of 249 mg / dL (RIQ = 226-268) at baseline to 190 (177.6-210) and 170 (108-170) at the second and third measurements, respectively. For statin + ezetimibe, from 167 mg / dL (RIQ = 139-184) to 132 (110-150) and 128.5 (101.5-128.5). Fenofibrate decreased triglycerides from 275 mg / dL (RIQ = 219-346) to 201 (172-239) and 150.5 (140-150.5). Conclusions: The administration of statins alone or in combination decreased LDL and total cholesterol levels, while fenofibrate demonstrated its effectiveness in lowering triglycerides. No adverse effects were reported. There was partial adherence of the treating physician to GPC for dyslipidemias. There were no adverse events. MÉD.UIS.2019;32(1):13-20.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hipolipemiantes , Prontuários Médicos , Colesterol , Dislipidemias , FarmacovigilânciaRESUMO
LDL-cholesterol (LDL-C) lowering is a primary objective in cardiovascular prevention. Recent studies demonstrated clinical benefit when proprotein convertase subtilisin/kexin-9 inhibitors (PCSK9i) were added to the treatment in patients who had not achieved the LDL-C goal despite being treated with high intensity statins and ezetimibe, however the use of these drugs is limited by their cost. The American College of Cardiology, the Argentine Society of Cardiology and the European Society of Cardiology recommend an LDL-C goal less than 70 mg/dl in secondary prevention, determining thresholds of LDL-C to start treatment with PCSK9i of 70, 100 or 140 mg/dl respectively. In order to evaluate the lipid-lowering regimen prescribed in patients hospitalized for acute coronary syndrome or coronary revascularization and analyze the proportion of eligible to be treated with PCSK9i in a real and simulated scenario, we conducted a study that included 351 patients with coronary disease collected from an electronic database of a university hospital. The 48.4% received high intensity statins, 11.4% ezetimibe and 54.7% did not achieve the LDL-C goal of less than 70 mg/dL. Using a simulation model in which all would be treated with high intensity statins and ezetimibe, the eligibility to prescribe PCSK9i was 31.1%, 12.8% and 9.1% according to the C- LDL thresholds determined by the three scientific societies. Our study demonstrated a gap between the consensus recommendations for LDL-C lowering and the current practice that should be minimized to optimize the cost/effectiveness ratio in secondary prevention.
La reducción del colesterol-LDL (C-LDL) es un objetivo primordial en prevención cardiovascular. Estudios recientes demostraron beneficio clínico al administrar inhibidores de la proprotein convertase subtilisin/kexin-9 (iPCSK9) a pacientes que no habían logrado la meta de C-LDL con estatinas de alta intensidad y ezetimibe, sin embargo el uso de estos fármacos está limitado por su costo. El American College of Cardiology, la Sociedad Argentina de Cardiología y la European Society of Cardiology recomiendan una meta de C-LDL menor a 70 mg/dl en prevención secundaria, determinando umbrales de C-LDL de 70, 100 o 140 mg/dl respectivamente, para iniciar el tratamiento con iPCSK9. Con el objetivo de evaluar el esquema hipolipemiante prescripto en internados por síndrome coronario agudo o revascularización coronaria y analizar la proporción de elegibles para ser tratados con iPCSK9 en un escenario real y simulado, realizamos un estudio que incluyó 351 pacientes con enfermedad coronaria, tomados de una base de datos electrónica de un hospital universitario. El 48.4% recibió estatinas de elevada intensidad, 11.4% ezetimibe y 54.7% no logró la meta de C-LDL menor a 70 mg/dl. Utilizando un modelo de simulación en el que todos serían medicados con estatinas de elevada intensidad y ezetimibe, la elegibilidad para prescribir iPCSK9 fue de 31.1%, 12.8% y 9.1% según los umbrales de C-LDL determinados por las tres sociedades científicas. Nuestro estudio demostró una brecha entre las recomendaciones de los consensos para reducir el colesterol y la práctica habitual que debería ser minimizada para optimizar la relación costo/efectividad en prevención secundaria.
Assuntos
Anticolesterolemiantes/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Inibidores de PCSK9 , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina , Estudos Transversais , Ezetimiba/uso terapêutico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Fatores Sexuais , Sociedades Científicas , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
La reducción del colesterol-LDL (C-LDL) es un objetivo primordial en prevención cardiovascular. Estudios recientes demostraron beneficio clínico al administrar inhibidores de la proprotein convertase subtilisin/kexin-9 (iPCSK9) a pacientes que no habían logrado la meta de C-LDL con estatinas de alta intensidad y ezetimibe, sin embargo el uso de estos fármacos está limitado por su costo. El American College of Cardiology, la Sociedad Argentina de Cardiología y la European Society of Cardiology recomiendan una meta de C-LDL menor a 70 mg/dl en prevención secundaria, determinando umbrales de C-LDL de 70, 100 o 140 mg/dl respectivamente, para iniciar el tratamiento con iPCSK9. Con el objetivo de evaluar el esquema hipolipemiante prescripto en internados por síndrome coronario agudo o revascularización coronaria y analizar la proporción de elegibles para ser tratados con iPCSK9 en un escenario real y simulado, realizamos un estudio que incluyó 351 pacientes con enfermedad coronaria, tomados de una base de datos electrónica de un hospital universitario. El 48.4% recibió estatinas de elevada intensidad, 11.4% ezetimibe y 54.7% no logró la meta de C-LDL menor a 70 mg/dl. Utilizando un modelo de simulación en el que todos serían medicados con estatinas de elevada intensidad y ezetimibe, la elegibilidad para prescribir iPCSK9 fue de 31.1%, 12.8% y 9.1% según los umbrales de C-LDL determinados por las tres sociedades científicas. Nuestro estudio demostró una brecha entre las recomendaciones de los consensos para reducir el colesterol y la práctica habitual que debería ser minimizada para optimizar la relación costo/efectividad en prevención secundaria.
LDL-cholesterol (LDL-C) lowering is a primary objective in cardiovascular prevention. Recent studies demonstrated clinical benefit when proprotein convertase subtilisin/kexin-9 inhibitors (PCSK9i) were added to the treatment in patients who had not achieved the LDL-C goal despite being treated with high intensity statins and ezetimibe, however the use of these drugs is limited by their cost. The American College of Cardiology, the Argentine Society of Cardiology and the European Society of Cardiology recommend an LDL-C goal less than 70 mg/dl in secondary prevention, determining thresholds of LDL-C to start treatment with PCSK9i of 70, 100 or 140 mg/dl respectively. In order to evaluate the lipid-lowering regimen prescribed in patients hospitalized for acute coronary syndrome or coronary revascularization and analyze the proportion of eligible to be treated with PCSK9i in a real and simulated scenario, we conducted a study that included 351 patients with coronary disease collected from an electronic database of a university hospital. The 48.4% received high intensity statins, 11.4% ezetimibe and 54.7% did not achieve the LDL-C goal of less than 70 mg/dL. Using a simulation model in which all would be treated with high intensity statins and ezetimibe, the eligibility to prescribe PCSK9i was 31.1%, 12.8% and 9.1% according to the C- LDL thresholds determined by the three scientific societies. Our study demonstrated a gap between the consensus recommendations for LDL-C lowering and the current practice that should be minimized to optimize the cost/effectiveness ratio in secondary prevention.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pró-Proteína Convertase 9/antagonistas & inibidores , Hipercolesterolemia/tratamento farmacológico , Anticolesterolemiantes/uso terapêutico , Argentina , Sociedades Científicas , Fatores de Tempo , Fatores Sexuais , Estudos Transversais , Fatores Etários , Resultado do Tratamento , Guias de Prática Clínica como Assunto , Estatísticas não Paramétricas , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Ezetimiba/uso terapêuticoRESUMO
BACKGROUND: Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus, and more than 75% of patients who have had diabetes for more than 20 years will have some degree of DR. This disease is highly destructive to self-esteem and puts a high burden on public health and pension systems due to the effects that it has on people of working age. The current mainstay of treatment is laser photocoagulation, which causes impairment of vision and discomfort to patients. Thus, finding a systemic drug that could act on all microcirculation and prevent direct manipulation of the eyes would be highly desirable. OBJECTIVE: To assess the efficacy and safety of the drugs in the statin and/or fibrate groups for the prevention and treatment of DR. METHODS: In this systematic review, we will select randomized controlled trials of fibrates or statins used for the treatment or prevention of DR. Our search strategy will include free text terms and controlled vocabulary (eg, MeSH, Emtree) for, "diabetic retinopathy", "statins", "fibrates", "hypolipidemic agents", and for drugs from both groups. Databases that will be used include Medical Literature Analysis and Retrieval System/PubMed, Embase, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Center on Health Sciences Information, Clinicaltrials.gov, World Health Organization International Clinical Trials Registry Platform, and OpenGrey, and we will not have language or date limits. Two review authors will independently select eligible studies and assess the risk of bias using the Cochrane Collaboration's tool. We will report structured summaries of the included studies and, if possible, conduct meta-analyses. RESULTS: This is a protocol for a systematic review, therefore results are not available. We registered a short version of this protocol before progressing in the review and we are currently in the process of selecting the studies for inclusion. CONCLUSIONS: Intensive glucose control and lowering blood pressure and lipids are mechanisms that protect macrocirculation in diabetic patients. Both macrovascular and microvascular events in diabetic patients appear to have a common pathway, starting with endothelial injury. Thus, prevention and treatment of microvascular events may benefit from the same interventions. In the review for which we have written this protocol, we will assess whether the use of lipid-lowering oral drugs of the statin and/or fibrate groups may prevent and/or retard progression of DR, with the added benefit of preserving visual acuity. TRIAL REGISTRATION: PROSPERO CRD42016029746.
RESUMO
BACKGROUND:Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus, and more than 75% of patients who have had diabetes for more than 20 years will have some degree of DR. This disease is highly destructive to self-esteem and puts a high burden on public health and pension systems due to the effects that it has on people of working age. The current mainstay of treatment is laser photocoagulation, which causes impairment of vision and discomfort to patients. Thus, finding a systemic drug that could act on all microcirculation and prevent direct manipulation of the eyes would be highly desirable.OBJECTIVE:To assess the efficacy and safety of the drugs in the statin and/or fibrate groups for the prevention and treatment of DR.METHODS:In this systematic review, we will select randomized controlled trials of fibrates or statins used for the treatment or prevention of DR. Our search strategy will include free text terms and controlled vocabulary (eg, MeSH, Emtree) for, "diabetic retinopathy", "statins", "fibrates", "hypolipidemic agents", and for drugs from both groups. Databases that will be used include Medical Literature Analysis and Retrieval System/PubMed, Embase, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Center on Health Sciences Information, Clinicaltrials.gov, World Health Organization International Clinical Trials Registry Platform, and OpenGrey, and we will not have language or date limits. Two review authors will independently select eligible studies and assess the risk of bias using the Cochrane Collaboration's tool. We will report structured summaries of the included studies and, if possible, conduct meta-analyses.
Assuntos
Hipolipemiantes , Microcirculação , Retinopatia DiabéticaRESUMO
A movimentação dentária induzida (MDI) envolve processos inflamatórios e de remodelação óssea nos sítios de compressão e tração. Durante o tratamento ortodôntico, fármacos podem modular a taxa de movimentação.Nesse contexto, investigou-se a atorvastatina (ATV), o alendronato (ALD) ou sua combinação (ATV+ALD) na MDI em ratos. Inicialmente, grupos de 6 animais com MDI foram eutanasiados na 6ª h e nos dias 1, 4, 7, 11, 14 e 21, e tiveram suas hemimaxilas analisadas quanto a distância entre molares e incisivos, histomorfometria do ligamento periodontal (LP) das raízes distovestibular, distolingual e intermediária, e atividade de mieloperoxidase (MPO; Ux103/mg de gengiva). Para a abordagem farmacológica, os animais durante 28 d receberam por gavagem água destilada (H2Od; 2 ml/kg/d), ATV (1, 3 e 9 mg/kg/d), ALD (1 e 7 mg/kg/sem) ou combinação de suas menores doses (ATV+ALD), sendo 11 d antes da eutanásia, submetidos à MDI. Foram avaliados além da distância entre molares e incisivos, a histomorfometria e MPO, os níveis de IL-1β(pg/mg de gengiva), imunomarcações para RANKL, OPG e TRAP, e níveis séricos de fosfatase alcalina óssea (FAO; U/l); (Comissão de Ética em Pesquisa Animal-UFC nº 21/14)...
The induced tooth movement (MDI) depends oninflammatoryand bone remodelingprocesses in sites of compression and traction. During orthodontic treatment, drugs canmodulatethe movement ́s rate.In this context, we investigated the influence of atorvastatin (ATV), alendronate (ALD), or combination of these drugs (ATV+ALD) on MDI in rats.First, groups of animals (n=6/group) were euthanized at the 6thhour, and on the 1st, 4st, 7st, 11st, 14stand 21stdays, and they had their hemimaxillas analyzed for the distance between molars and incisors, histomorphometry of periodontal ligament (PL) of distobuccal, intermediate and distolingualroots, and myeloperoxidase activity (MPO; x 103U/mg of tissue). For pharmacological approach, the animals received by gavage during 28 d distilled water (H2Od, 2 ml/kg/d), ATV (1, 3 and 9 mg/kg/d), ALD (1 and 7 mg/kg/wk), or thecombination of lower doses of these drugs (ATV+ALD). Then, the rats weresubmitted to MDI 11 days prior to euthanasia. The distance between molars and incisors, histomorphometry, MPO, IL-1β levels (pg/mg of tissue), immunostaining for RANKL, OPG and TRAP, and serum levels of bone alkaline phosphatase (BALP; U/l)were evaluated. This study was approved by the Ethical aspects: Ethics Committee on Animal Research-UFC No. 21/14...
Assuntos
Humanos , Técnicas de Movimentação Dentária , Hipolipemiantes , Alendronato , Remodelação Óssea , RatosAssuntos
ATPases Transportadoras de Cálcio/efeitos dos fármacos , Hidrazonas/farmacologia , Hipercolesterolemia/tratamento farmacológico , Miocárdio/metabolismo , Tiofenos/farmacologia , Animais , ATPases Transportadoras de Cálcio/metabolismo , Modelos Animais de Doenças , Hipercolesterolemia/metabolismo , Hipercolesterolemia/patologia , Masculino , Miocárdio/patologia , Ratos , Ratos WistarRESUMO
JUSTIFICATIVA E OBJETIVOS: Identificar o perfil lipídico dos pacientes renais crônicos e analisar a prevalência das alterações lipídicas nesses pacientes. MÉTODOS: Realizado um estudo retrospectivo em 136 pacientes portadores de doença renal crônica (DRC) não dialítica atendidos em um único ambulatório. Foram coletados os seguintes dados: sexo, idade, comorbidades, medicações em uso, exame físico e exames laboratoriais. Calculou-se a prevalência das principais dislipidemias e as variáveis foram analisadas por meio das estatísticas descritivas: média aritmética e mediana. Foram utilizados os testes t de Student, Mann-Whitney, qui-quadrado e Exato de Fisher. As variáveis foram comparadas entre os grupos com e sem dislipidemia. RESULTADOS: A prevalência de dislipidemias foi de 75,7%, sendo a média dos valores de colesterol total (CT) de 179,6±41,0mg/dl, HDL-colesterol de 46,1±12,6mg/dl,LDL-colesterol de 101,7±34,5mg/dl e de triglicerídeos de 160,0±87,2mg/dl. O grupo com dislipidemia apresentou níveis superiores de triglicerídeos e inferiores de HDL-colesterol. CONCLUSÕES: Observamos elevada prevalência de dislipidemia neste estudo.
BACKGROUND AND OBJECTIVES: Identify the lipid profile of chronic renal patients and the prevalence of lipid disorders in these patients. METHODS: A retrospective study was performed in 136 patients with chronic kidney diseases (CKD) not dialytic, treated in a unique clinic. The following data were collected: gender, age, comorbidities, medications in use, physical examination and laboratory tests. It has been estimated the prevalence of dyslipidemias and main variables were analyzed through descriptive statistics: arithmetic mean and median. The Student's t-tests, Mann-Whitney, chi-squareand Fisher exact were used. Variables were compared between groups with and without dyslipidemia. RESULTS: The prevalence of dyslipidemias was 75.7%, with an average of the total cholesterol of 179.6±41.0mg/dl, HDL-cholesterol of 46.1±12.6mg/dl, LDL cholesterol of 101.7±34.5mg/dl and triglyceride levels of 160.0±87.2mg/dl. The group with dyslipidemia showed increased levels of triglycerides and lower HDL cholesterol. CONCLUSIONS: We observed a high prevalence of dyslipidemia in this study.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares , Dislipidemias , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Insuficiência Renal CrônicaRESUMO
OBJECTIVE: to evaluate the relation between patient adherence and therapeutic effectiveness of hypolipidemic agents in clinical practice. METHODS: A retrospective cohort study of 417 patients using hypolipidemic drugs (simvastatin, atorvastatin) between 2003 and 2010 was performed. The population studied consists of patients assisted by the Public Health Service in the far-west region of the State of Santa Catarina, Brazil. The Medication Possession Ratio obtained from pharmacy refill data was used to measure patient adherence. Therapeutic effectiveness was evaluated based on the difference obtained in the serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, before and after taking the drug, in an average time of 8.3 months. RESULTS: Following the treatment with hypolipidemic agents, it has been observed a reduction of 14.3% for total cholesterol, 19.6% for LDL-cholesterol, and 14.4% for triglycerides. HDL-cholesterol increased by an 8.0% average. The major changes in lipid profile were promoted by atorvastatin 20 mg daily. The medication adherence rate decreased over the monitoring period. Adherence rates below 60% were associated with therapeutic failure, while rates equal to 80% or higher were associated with the best response to the lipid-lowering drugs. CONCLUSION: Adherence to hypolipidemic agents is higher at the beginning of the treatment, but it decreases over time, affecting the achievement of therapeutic goals.