Hyperlipidemias: Finland

Viikari J. · Turun yliopiston kliininen laitos, TYKS:n sisätautiklinikka Kiinamyllynkatu 4-8 20520 Turku. · Duodecim. · Pubmed #12833785 No free full text.

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Taskinen MR. · Department of Medicine, Division of Cardiology, University of Helsinki, Helsinki, Finland. · Diabetologia. · Pubmed #12774165 No free full text.

Abstract: The recognition that the increase of plasma triglyceride rich lipoproteins (TRLs) is associated with multiple alterations of other lipoproteins species that are potentially atherogenic has expanded the picture of diabetic dyslipidaemia. The discovery of heterogeneity within major lipoprotein classes VLDL, LDL and HDL opened new avenues to reveal the specific pertubations of diabetic dyslipidaemia. The increase of large VLDL 1 particles in Type 2 diabetes initiates a sequence of events that generates atherogenic remnants, small dense LDL and small dense HDL particles. Together these components comprise the atherogenic lipid triad. Notably the malignant nature of diabetic dyslipidaemia is not completely shown by the lipid measures used in clinical practice. The key question is what are the mechanisms behind the increase of VLDL 1 particles in diabetic dyslipidaemia? Despite the advances of recent years, our understanding of VLDL assembly and secretion is still surprisingly incomplete. To date it is still unclear how the liver is able to regulate the amount of triglycerides incorporated into VLDL particles to produce either VLDL 1 or VLDL 2 particles. The current evidence suggests that the machinery driving VLDL assembly in the liver includes (i) low insulin signalling via PI-3 kinase pathway that enhances lipid accumulation into "nascent " VLDL particles (ii) up-regulation of SREBP-1C that stimulates de novo lipogenesis and (iii) excess availability of "polar molecules" in hepatocytes that stabilizes apo B 100. Recent data suggest that all these steps could be fundamentally altered in Type 2 diabetes explaining the overproduction of VLDL apo B as well as the ability of insulin to suppress VLDL 1 apo B production in Type 2 diabetes.Recent discoveries have established the transcription factors including PPARs, SREBP-1 and LXRs as the key regulators of lipid assembly in the liver. These observations suggest these factors as a new target to tailor more efficient drugs to treat diabetic dyslipidaemia.

Koponen H, Saari K, Savolainen M, Isohanni M. · Department of Psychiatry, University of Oulu, Oulu, Finland. · Eur Arch Psychiatry Clin Neurosci. · Pubmed #12563538 No free full text.

Abstract: Antipsychotic medication is the mainstay of treatment for functional psychotic illnesses. However, for some patients weight gain and the disturbances in blood-lipid levels and glucose balance associated with their use are significant disadvantages, and pose health risks that may affect prognosis. A substantial body of evidence suggests that weight gain is at least partly related to the blocking effects of antipsychotic medication on serotonin- and histamine-mediated neurotransmission. The disadvantages associated with weight gain can be reduced by an appropriate choice of antipsychotic and avoidance of polypharmacy, by regular monitoring of the patient's weight, and, if necessary, by the patient's participation in a dieting programme.

Gylling H, Miettinen TA. · Department of Clinical Nutrition, University of Kuopio, Kuopio University Hospital, PL 1627, 70211 Kuopio, Finland. · Curr Opin Investig Drugs. · Pubmed #12498007 No free full text.

Abstract: Statins effectively inhibit cholesterol synthesis and are currently the most commonly used drugs for the treatment of hypercholesterolemia. However, patients with familial hypercholesterolemia and those unwilling to take, or who cannot tolerate statins, and patients with combined hyperlipidemia require a combination treatment. Statins combined with cholesterol malabsorption, caused, e.g., by plant stanol esters or ezetimibe (Schering-Plough Corp/Merck & Co Inc), or with bile acid malabsorption, caused by bile acid binding resins or guar gum, inhibit compensatory increases in cholesterol synthesis and effectively lower LDL cholesterol levels. Combination therapy of statins with fibrates should be controlled by lipidology experts. Recent information on indications and advantages of combining statins with n-3 fatty acids, hormone replacement therapy, or niacin, will also be discussed.

Taskinen MR. · University of Helsinki, Department of Medicine, Finland. · Acta Diabetol. · Pubmed #12222625 No free full text.

Abstract: Coronary heart disease (CHD) is associated with a 2- to 4-times greater risk of morbidity and mortality in patients with type 2 diabetes than in non-diabetic individuals. Dyslipidaemia is an important CHD risk factor in diabetic patients. The key atherogenic features of diabetic dyslipidaemia are elevated levels of serum triglycerides, low levels of high density lipoprotein (HDL) cholesterol, and the preponderance of small, dense low density lipoprotein (LDL). As a result, treatment guidelines for diabetic dyslipidaemia recommend elevated LDL cholesterol and triglyceride levels and low HDL cholesterol levels as targets of therapy. Unfortunately, however, these lipid abnormalities often persist despite best efforts to control hyperglycaemia, improve diet, and increase physical exercise, and therefore demand specific therapeutic intervention. Statins are the first choice for LDL cholesterol lowering as they are effective and well tolerated, and do not have adverse effects on glycaemic control. Furthermore, recent evidence suggests that statins may also be employed to treat moderately elevated levels of triglycerides. An increasing number of primary and secondary prevention trials have shown that lipid-lowering therapy with statins can significantly reduce the risk of CHD events in patients with diabetic dyslipidaemia.

Viikari J, Rönnemaa T, Jokinen E. · Turun yliopiston kliininen laitos ja TYKS:n sisätautiklinikka 20520 Turku. · Duodecim. · Pubmed #12184132 No free full text.

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Uusitupa M. · · Duodecim. · Pubmed #12116497 No free full text.

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Savolainen M. · Oulun yliopisto, sisätautien klinikka Kajaanintie 50 90220 Oulu. · Duodecim. · Pubmed #12077889 No free full text.

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Kivipelto M, Laakso MP, Tuomilehto J, Nissinen A, Soininen H. · Department of Neuroscience and Neurology, University of Kuopio, Kuopio, Finland. · CNS Drugs. · Pubmed #12056919 No free full text.

Abstract: This paper focuses on hypertension and hypercholesterolaemia as risk factors for Alzheimer's disease and, as such, subjects for prevention. The long-term, prospective, population-based studies regarding the relationship between hypertension or hypercholesterolaemia and Alzheimer's disease, and the clinical studies regarding the association between antihypertensive or lipid-lowering medications and the risk of Alzheimer's disease, are reviewed. These studies provide evidence to suggest that elevated blood pressure and cholesterol levels earlier in life may have an important role in the development and expression of late-life Alzheimer's disease. Based on these data, we propose that proper, early interventions aimed at reducing these cardiovascular risk factors may have an impact on the future incidence and prevalence of Alzheimer's disease.

Taskinen MR. · University of Helsinki, Meilahti Hospital, Helsinki, Finland. · Atheroscler Suppl. · Pubmed #12044586 No free full text.

Abstract: By the year 2025, there will be more than 300 million type 2 diabetes sufferers worldwide. This epidemic will be followed by a wave of cardiovascular disease. Diabetes is in fact a serious vascular disease with poor prognosis, and not only a disease characterized by elevated blood glucose. If adequate attention were paid to this, it would be much easier to relieve the burden of cardiovascular disease in type 2 diabetes patients. One important cardiovascular risk factor in type 2 diabetic people is dyslipidemia. This is characterized by low HDL-cholesterol, high serum VLDL-triglycerides, and a preponderance of small, dense LDL. Even slight elevations of LDL-cholesterol in type 2 diabetic patients are associated with a substantial increase in cardiovascular risk. The composition of lipid particles in diabetic dyslipidemia is more atherogenic than in dyslipidemia in general. This means in turn that normal lipid concentrations are more atherogenic in diabetic than in non-diabetic patients. Retrospective analyses show that, in terms of protection from cardiovascular endpoints, the benefit of lipid lowering in type 2 diabetic patients is at least as great as in the non-diabetic population. Lowering of LDL-cholesterol is a very attractive target for the reduction of coronary heart disease in type 2 diabetic people.

Syvänne M. · HYKS:n sisätautien klinikka, kardiologian toimiala PL 340, 00029 HYKS. · Duodecim. · Pubmed #11877856 No free full text.

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Niskanen L, Uusitupa M, Laakso M. · KYS:n sisätautien klinikka ja Kuopion yliopiston kliinisen ravitsemustieteen laitos PL 1777, 70211 Kuopio. · Duodecim. · Pubmed #11877851 No free full text.

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Miettinen HE, Kontula K. · HYKS:n sisätautien klinikka, 00290 Helsinki. · Duodecim. · Pubmed #11859519 No free full text.

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Ylitalo R, Lehtinen S, Wuolijoki E, Ylitalo P, Lehtimäki T. · Department of Pharmacological Sciences, University of Tampere, Tampere, Finland. · Arzneimittelforschung. · Pubmed #11838268 No free full text.

Abstract: Chitosan (CAS 9012-76-4) is derived by alkaline deacetylation from chitin, an abundant polymeric product of natural biosynthesis especially in crustaceans. It is available in a primary, unorganised structure, but also in a microcrystalline form. As a dietary supplement, chitosan has been claimed to control obesity and to lower serum cholesterol. A variety of chitosan products have been freely available worldwide in health stores and pharmacies. This review summarises the current knowledge about cholesterol-lowering and safety properties of chitosan and focuses its possible application for the treatment of hypercholesterolaemia. Chitosan behaves as a polycationic(+) cellulose-like fibrillar biopolymer that forms films with negatively charged surfaces. It is not specifically hydrolysed by digestive enzymes in man, but limited digestion of chitosan due to bacterial flora and to the unspecific enzymes might occur. Negatively charged molecules in stomach attach strongly to the positive charged tertiary amino group (-NH3+) of chitosan. Therefore, chitosan reduces fat absorption from gastrointestinal tract by binding with anionic carboxyl groups of fatty and bile acids, and it interferes with emulsification of neutral lipids (i.e., cholesterol, other sterols) by binding them with hydrophobic bonds. In short-term animal studies the safety of chitosan has been good. There are only few studies with chitosan in humans. In man, dietary chitosan has been reported to reduce serum total cholesterol levels by 5.8-42.6% and low-density lipoprotein levels by 15.1-35.1%. In short-term trials up to 12 weeks, no clinically significant symptoms have been observed with chitosan compared to placebo. Mild and transitory nausea and constipation have been reported in 2.6-5.4% of subjects. Although chitosan has been clinically well tolerated, it cannot be recommended to people allergic to crustaceans.

Miettinen TA. · Department of Medicine, University of Helsinki Central Hospital, Finland. · Int J Clin Pract. · Pubmed #11777299 No free full text.

Abstract: A clear relationship has been documented between plasma levels of low-density lipoprotein cholesterol (LDL-C) and the risk of coronary heart disease. LDL-C is believed to be key in the pathogenesis of coronary atherosclerosis, although increasing evidence suggests that low levels of high-density lipoprotein cholesterol and elevated triglyceride levels are contributory factors. Chylomicron remnants formed via the exogenous (dietary and biliary) pathway of cholesterol metabolism may also have atherogenic potential. Dietary modification, especially with plant stanol (sterol) ester margarine, which inhibits cholesterol absorption and improves the fatty acid pattern, lowers LDL-C sufficiently in many hypercholesterolaemic patients, and is also a useful adjunct to pharmacological therapy. Cholesterol absorption inhibitors typically lower LDL-C by 10-20%. Ezetimibe, the first selective cholesterol absorption inhibitor, has been shown to lower LDL-C by approximately 18% following a once-daily 10 mg dose, either as monotherapy or as combination therapy. Combination therapy with selective cholesterol absorption inhibitors such as ezetimibe along with statins or fibrates may allow more patients with hypercholesterolaemia to achieve target LDL-C levels compared with treatment with monotherapy. Ezetimibe may be useful in the management of patients who respond poorly to or are unable to tolerate statins, or in patients with hereditary or drug-induced phytosterolaemia.

Laakso M. · Department of Medicine, University of Kuopio, Finland. · Int J Clin Pract Suppl. · Pubmed #11594246 No free full text.

Abstract: Insulin resistance is a core defect in Type 2 diabetes, occurring in peripheral organs (skeletal muscle and adipose tissue) leading to decreased glucose uptake and utilisation and in liver leading to increased hepatic glucose production. As long as the beta-cell can compensate for this by producing more insulin, glucose tolerance remains normal. However, as insulin resistance worsens, the beta-cell starts to fail to compensate leading to impaired glucose tolerance and then frank diabetes. The exact pathophysiology of insulin resistance is not clear but it probably involves a combination of genetic and environmental factors. These factors may result in changes in the number of insulin receptors, their affinity for insulin or a defect in post-receptor signalling or a combination of these. Insulin resistance also affects lipid metabolism such that there is increased production of triglycerides from the liver, which in turn both amplifies insulin resistance and exacerbates atherogenesis. The promotion of atherosclerosis by insulin resistance means that patients with Type 2 diabetes are at particularly high risk of cardiovascular disease. Therefore, treatment of insulin resistance with thiazolidinediones has the potential to offer improvements both in glycaemic control and in cardiovascular events.

Vapaatalo H, Mervaala E. · Institute of Biomedicine, Pharmacology University of Helsinki, Finland. · Med Sci Monit. · Pubmed #11535960 No free full text.

Abstract: The endothelium, a continuous cellular monolayer lining the blood vessels, has an enormous range of important homeostatic roles. It serves and participates in highly active metabolic and regulatory functions including control of primary hemostasis, blood coagulation and fibrinolysis, platelet and leukocyte interactions with the vessel wall, interaction with lipoprotein metabolism, presentation of histocompatibility antigens, regulation of vascular tone and growth and further of blood pressure. Many crucial vasoactive endogenous compounds like prostacyclin, thromboxane, nitric oxide, endothelin, angiotensin, endothelium derived hyperpolarizing factor, free radicals and bradykinin are formed in the endothelial cells to control the functions of vascular smooth muscle cells and of circulating blood cells. These versatile and complex systems and cellular interactions are extremely vulnerable. The balances may be disturbed by numerous endogenous and exogenous factors including psychological and physical stress, disease states characterized by vasospasm, inflammation, leukocyte and platelet adhesion and aggregation, thrombosis, abnormal vascular proliferation, atherosclerosis and hypertension. The endothelial cells are also the site of action of many drugs and exogenous toxic substances (e.g. smoking, alcohol). As markers and assays for endothelial dysfunction, direct measurement of nitric oxide, its metabolites from plasma and urine, functional measurement of vascular nitric oxide dependent responses and assay of different circulating markers have been used. In numerous pathological conditions (e.g. atherosclerosis, hypertension, congestive heart failure, hyperhomocysteinemia, diabetes, renal failure, transplantation, liver cirrhosis) endothelial dysfunction has been described to exist. Some of them, as well as hormonal and nutritional factors and drug treatment will be discussed in this short review.

Taskinen MR. · Department of Medicine, University of Helsinki, Helsinki, Finland. · Exp Clin Endocrinol Diabetes. · Pubmed #11460569 No free full text.

Abstract: The recognition that hypertriglyceridemia is associated with multiple alterations of other lipoproteins that are potentially atherogenic has expanded the picture of diabetic dyslipidemia. Elevation of large VLDL1 particles initiate a sequence of events that results in generation of atherogenic lipoproteins including remnants and small dense LDL. This abnormality is also associated with the lowering of HDL cholesterol. The clinical implication is that the concentration of plasma triglycerides should be maintained as low as possible to avoid these deleterious consequences of hypertriglyceridemia.

Huuskonen J, Olkkonen VM, Jauhiainen M, Ehnholm C. · Department of Biochemistry, National Public Health Institute, Mannerheimintie 166, 00300, Helsinki, Finland. · Atherosclerosis. · Pubmed #11254896 No free full text.

Abstract: High-density lipoproteins (HDL) play a major protective role against the development of coronary artery disease. Phospholipid transfer protein (PLTP) is a main factor regulating the size and composition of HDL in the circulation and plays an important role in controlling plasma HDL levels. This is achieved via both the phospholipid transfer activity of PLTP and its capability to cause HDL conversion. The present review focuses on the impact of PLTP on HDL metabolism. The basic characteristics and structure of the PLTP protein are described. The two main functions of PLTP, PLTP-mediated phospholipid transfer and HDL conversion are reviewed, and the mechanisms and control, as well as the physiological significance of these processes are discussed. The relationship between PLTP and the related cholesteryl ester transfer protein (CETP) is reviewed. Thereafter other functions of PLTP are recapitulated: the ability of PLTP to transfer cholesterol, alpha-tocopherol and lipopolysaccharide (LPS), and the suggested involvement of PLTP in cellular cholesterol traffic. The discussion on PLTP activity and mass in (patho)physiological settings includes new data on the presence of two forms of PLTP in the circulation, one catalytically active and the other inactive. Finally, future directions for PLTP research are outlined.

Yki-Järvinen H. · Department of Medicine, University of Helsinki, Finland. · Drugs. · Pubmed #11129129 No free full text.

Abstract: Although the diagnosis of type 2 (noninsulin-dependent) diabetes mellitus is made when blood glucose levels exceed values which increase the risk of microvascular complications, macrovascular disease is the major complication of type 2 diabetes mellitus. Both epidemiological and prospective data have demonstrated that treatment of hyperglycaemia is markedly effective in reducing the risk of microvascular disease but is less potent in reducing that of myocardial infarction, stroke and peripheral vascular disease. Treatment of other cardiovascular risk factors, although by definition less prevalent than hyperglycaemia, appears to be more effective in preventing macrovascular disease than treatment of hyperglycaemia. In recent years, data from intervention trials have suggested that greater benefits with respect to the prevention of macrovascular disease can be achieved by effective treatment of hypertension and hypercholesterolaemia, and by the use of small doses of aspirin (acetylsalicylic acid) than by treating hyperglycaemia alone. On the other hand, the UK Prospective Diabetes Study (UKPDS), which examined the impact of intensive glucose and blood pressure (BP) control on micro- and macrovascular complications, is the only intervention trial to include only patients with type 2 diabetes mellitus. The UKPDS data, the epidemic increase in the number of patients with type 2 diabetes mellitus and their high cardiovascular risk have, however, initiated several new trials addressing, in particular, the possible benefits of treatment of the most common form of dyslipidaemia (high serum triglyceride and low high density lipoprotein cholesterol levels) in these patients. Type 2 diabetes mellitus is thus a disease associated with a high vascular risk, where the majority of patients need, and are likely to benefit from, pharmacological treatment of several cardiovascular risk factors provided treatment targets have not been achieved by life-style modification.

Raitakari OT, Celermajer DS. · Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. · Ann Med. · Pubmed #10949060 No free full text.

Abstract: Endothelial health is a key factor in normal cardiovascular homeostasis, and recent studies have revealed several important functions of the vascular endothelium that protect against atherothrombosis. These include control over arterial tone, coagulation, fibrinolysis, and vascular growth. Consequently, endothelial dysfunction has been implicated as an important event in the pathogenesis of atherosclerosis, coronary vasoconstriction, hypertension, and myocardial ischaemia. Therefore, there has been considerable research interest in diagnostic assays for the assessment of endothelium. This review outlines the current status of markers of endothelial dysfunction, particularly those related to vasomotor control, as well as circulating markers of vascular health.

Sarti C, Kaarisalo M, Tuomilehto J. · Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland. · Drugs Aging. · Pubmed #10933514 No free full text.

Abstract: Various studies on the relationship between serum cholesterol level and the risk of stroke have been published recently. Subsequent reviews have extrapolated information on stroke from the clinical trials originally aimed at lowering cholesterol for the primary and secondary prevention of myocardial infarction (MI) in middle-aged patients. We have reviewed the epidemiological knowledge on the relationship between serum cholesterol levels and stroke, and also focused on possible reduction of the risk of stroke with hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor treatment. Possible benefits from such therapy are particularly relevant for the elderly population which is at particularly high risk for stroke. The effects of serum cholesterol levels on the risk for haemorrhagic and ischaemic stroke have been evaluated. Indirect epidemiological evidence indicates that serum levels of total cholesterol and its subfractions are determinants of stroke, but their associations are relatively weak. When exploring the possible association of serum cholesterol levels with the increased risk of stroke with aging, we concluded that, as in younger adults, elevated total cholesterol and decreased high density lipoprotein-cholesterol levels predispose to ischaemic stroke in the elderly. The mechanism through which serum cholesterol levels increase stroke risk is based on its actions on the artery walls. Indirect evidence suggests that the reduction in the stroke risk with HMG-CoA reductase inhibitors is larger than would be expected with reduction of elevated serum cholesterol level alone. Therefore, antioxidant and endothelium-stabilising properties of HMG-CoA reductase inhibitors may contribute in reducing the risk of stroke in recipients. Lowering high serum cholesterol with HMG-CoA reductase inhibitors has been beneficial in the primary and secondary prevention of MI. No trials have specifically tested the effect of cholesterol lowering with HMG-CoA reductase inhibitors on stroke occurrence. High serum cholesterol levels are a risk factor for ischaemic stroke, although the risk imparted is lower than that for MI. Although the relative risk of stroke associated with elevated serum cholesterol levels is only moderate, its population attributable risk is high given the increase in the elderly population worldwide. The effect of cholesterol reduction with HMG-CoA reductase inhibitors on prevention of ischaemic stroke should be evaluated in prospective, randomised, placebo-controlled trials in the elderly. The tolerability of lipid-lowering drugs in the elderly and the cost effectiveness of primary prevention of stroke using lipid-lowering drugs also needs to be assessed in the elderly.

Taskinen MR. · Department of Medicine, University of Helsinki, Finland. · Drugs. · Pubmed #10576525 No free full text.

Abstract: Atherosclerosis, the complication most prominently associated with type 2 diabetes and cardiovascular disease, represents a major burden for both individuals and society. Mortality rates associated with cardiovascular disease among patients with type 2 diabetes are at least 3 times those in the general population, and although 'traditional' cardiovascular risk factors affect patients with this disorder as they do other individuals, they do not account for the excess risk attached to type 2 diabetes. There is a growing body of evidence to show that hyperglycaemia and dyslipidaemia are connected with this excess cardiovascular risk: hypertriglyceridaemia has been implicated in several prospective clinical studies, and available data suggest that low density lipoprotein (LDL)-cholesterol is more atherogenic in patients with type 2 diabetes than in other individuals. It is possible that this increased atherogenicity is associated with a preponderance of small, dense LDL particles that are more prone to oxidation and glycation than larger fractions and that may be involved in endothelial dysfunction. These findings lead to the recommendation of mandatory global risk assessment, accompanied by good glycaemic control, aggressive lowering of serum levels of LDL-cholesterol and maintenance of serum levels of triglyceride at the lowest possible level in patients with type 2 diabetes.

Miettinen TA, Gylling H. · Department of Medicine, University of Helsinki, Finland. · Curr Opin Lipidol. · Pubmed #10095984 No free full text.

Abstract: Renewal has occurred in the use of plant sterols for the treatment of hypercholesterolemias. A novel development was to convert plant sterols to corresponding stanols and esterify them to fat soluble form. In contrast to the crystalline plant sterols or stanols, plant stanol esters can be easily consumed during normal food intake in soluble form in different fat-containing food constituents when they have a potent cholesterol-lowering effect, shown in normo- and hypercholesterolemic men and women without or with coronary heart disease, children and diabetes. Cholesterol lowering is approximately 10% for total and 15% for LDL cholesterol, with the respective values for stanol ester margarine (2-3 g/day stanols) being 15% and 20%. Stanol esters reduce cholesterol absorption efficiency by up to 65%, increase cholesterol elimination in feces as cholesterol itself, usually not as bile acids, and stimulate cholesterol synthesis. Serum beta-carotene level is lowered, but no fat malabsorption or lowering of serum fat soluble vitamins have been observed. In contrast to plant sterols, stanols and their esters are minimally absorbed and they reduce serum plant sterol concentrations, also preventing statin-induced increase of plant sterols. Stanol ester margarine has been included in dietary treatment of hypercholesterolemia followed by the addition of drug treatment in resistant cases.

Michou SM, Kähönen M, Lehtimäki T, Nikus K, Viik J, Niemelä K, Kallio J, Lehtinen R, Kööbi T, Turjanmaa V, Nieminen T. · Department of Pharmacological Sciences, Medical School, University of Tampere, Tampere, Finland. · Clin Drug Investig. · Pubmed #17803342 No free full text.

Abstract: BACKGROUND AND OBJECTIVES: Several studies have shown that treatment of coronary heart disease (CHD) does not meet the goals set in recommendations. The aim of this study was to investigate the adequacy of CHD drug treatment and secondary prevention measures, particularly with respect to age and gender biases, in a Finnish university hospital setting. METHODS: The participant pool consisted of patients in FINCAVAS (Finnish Cardiovascular Study), which is a cohort study recruiting consecutive patients performing a clinical exercise test at Tampere University Hospital, Tampere, Finland. 802 patients (581 men, 221 women) with a prior diagnosis of CHD recruited between October 2001 and December 2004 were included in the analysis. RESULTS: Only roughly 12% of both men and women had an optimal risk factor profile. High blood pressure and hypercholesterolaemia were more common in women than in men, whereas smoking was more frequent among men. Men used ACE inhibitors (32.9% vs 20.4%, respectively), beta-adrenoceptor antagonists (80.8% vs 68.3%, respectively) and aspirin (acetylsalicylic acid) [69.7% vs 58.8%, respectively] more frequently than women, but the frequency of use of these medications was also not at the recommended levels in men. Risk factor control is poorer in older than younger age groups. CONCLUSIONS: CHD patients, particularly women, who performed an exercise stress test in a university hospital are suboptimally treated.