Hyperlipidemias: Latin America

Santos RD, Anonymous00317. · Departamento de Aterosclerose, Sociedade Brasileira de Cardiologia, Brasil. · Arq Bras Cardiol. · Pubmed #11781591 links to  free full text

This publication has no abstract.

Alves Cde A, Lima DS. · Universidade Federal da Bahia, Salvador, BA, Brasil. · J Bras Pneumol. · Pubmed #19009217 links to  free full text

Abstract: This article aims to review the physiopathology, diagnosis and treatment of cystic fibrosis-related dyslipidemia (CFD). Bibliographic searches of the Medline and Latin American and Caribbean Health Sciences Literature databases were made (year range, 1987-2007), and the most representative papers on the theme were selected. The characteristic symptoms of CFD are hypertriglyceridemia-with or without hypocholesterolemia-and essential fatty acid deficiency. The principal CFD risk factors are pancreatic insufficiency, high-carbohydrate diet, liver diseases, inflammatory state and corticosteroid therapy. There are no specific recommendations regarding screening, which is typically performed based on the diagnosis, and at regular intervals, and more frequently in individuals belonging to high-risk groups. Treatment includes a balanced diet, micronutrient supplementation, and regular physical exercise according to individual tolerance. In the great majority of the cases, CFD-related hypertriglyceridemia does not reach values for which the use of hypolipidemic drugs is indicated. We conclude that there are few articles in the literature regarding the frequency, etiology and management of CFD. Preventive and therapeutic recommendations for hypertriglyceridemia are extrapolated from studies in individuals without cystic fibrosis. Further research is necessary to investigate the association of essential fatty acid deficiency and the physiopathology of cystic fibrosis . Since hypertriglyceridemia is an important risk factor for coronary artery disease, prospective studies will contribute for a better understanding of the natural history of this condition and define how to prevent and treat it.

Mennickent C S, Bravo D M, Calvo M C, Avello L M. · Departamento de Farmacia, Facultad de Farmacia, Universidad de Concepción, Casilla 237, Concepción, Chile. · Rev Med Chil. · Pubmed #18769836 links to  free full text

Abstract: Results of numerous epidemiologic studies indicate that elevated serum cholesterol, especially the LDL fraction, is a major cause of coronary heart disease (CHD). Epidemiologic and angiographic evidence from primary and secondary prevention studies involving several HMG-CoA reductase inhibitors (statins) indicate that decreasing elevated serum cholesterol concentration (specifically LDL-cholesterol) can reduce the incidence of CHD and/or progression of atherosclerosis and results in a decrease in associated morbidity and mortality. It has been estimated that each 1% reduction in LDL-cholesterol concentration may result in a 1% decrease in the incidence of CHD. Furthermore, an analysis of pooled data from primary and secondary prevention studies found that treatment with a statin for a median duration of 5.4 years was associated with a 31% and 21% reduction in the risk of major coronary events and total mortality, respectively. This paper deals with the pharmacology of statins, specially with the pleiotropic effects of these drugs.

Omoruyi FO. · Department of Basic Medical Sciences, University of the West Indies, Kingston, Jamaica. · Plant Foods Hum Nutr. · Pubmed #18594988 No free full text.

Abstract: Sapogenin has been proposed to be the active component responsible for the beneficial effects of Jamaican bitter yam (Dioscorea polygonoides) in the management of diabetes. Most of the research activities on bitter yam have focused on the role sapogenin play in the management of diabetes. Changes in weight, activities of carbohydrate digestive and transport enzymes, alterations in the intestinal morphology, changes in blood lipids, reduction in lipid peroxidation and the prevention of liver damage associated with diabetes have all been attributed to bitter yam sapogenin supplementation. Also, the possible exploitation of bitter yam for nutraceutical/pharmaceutical purposes is based on the high saponin content. There are however, concerns about the beneficial claims of the findings especially with regard to the possible adverse effects that may accrue in the clinical applications. This review therefore provides an overview of the findings in this research area with a view to proposing the potential mechanisms whereby the supplement of bitter yam sapogenin extract exert its hypoglycemic and hypolipidemic properties and the probable adverse effects in diabetes mellitus.

Oliveira Sousa M, Alía P, Pintó X. · Departamento de Análises Clínicas e Toxicológicas, Facultade de Farmacia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. · Med Clin (Barc). · Pubmed #18579034 No free full text.

Abstract: Hypertriglyceridemia constitutes an independent risk factor for coronary disease. The gene apolipoprotein A5 (ApoA5) is a newly discovered member in the ApoA1/C3/A4/A5 cluster, and its product, apolipoprotein A5, influences on triglycerides through an unknown mechanism. Recently, there have been described the clinical consequences and the functional effects over more than 10 variants of the ApoA5 gene, associated with atherosclerosis. In different studies carried out in different ethnic groups, it has been observed a great variation in the distribution of the ApoA5 genotypes for the respective polymorphisms. Different authors have described associations among the ApoA5 gene, high triglyceride concentrations and an increase in the cardiovascular risk. In this context, the ApoA5 gene is considered as a probable biochemical and genetic marker of increased triglyceride concentrations and also a risk factor of coronary disease in some populations.

Hutz MH, Fiegenbaum M. · Genetics Department, Biosciences Institute, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. · Am J Cardiovasc Drugs. · Pubmed #18533737 No free full text.

Abstract: Although pharmacologic treatment for cholesterol reduction represents an advance in cardiovascular and atherosclerosis treatment, the benefits of such therapy are still limited because of interindividual variability in the response to these drugs. Disease severity, treatment adherence, physiologic conditions, biologic conditions, and the patient's genetic profile could be cited as important factors in the evaluation of interindividual variability. In regard to the latter consideration, three large groups of genes could be investigated: (i) genes that code for proteins involved in metabolism and/or drug transport, thereby influencing the pharmacokinetics of these compounds; (ii) genes that code for proteins involved in the mechanism of action and/or in the metabolic pathway of drug action, and which therefore influence pharmacodynamics; and (iii) genes that code for proteins involved in direct development of the disease or in intermediate phenotypes. In this review we discuss pharmacogenetic studies of the HMG-CoA reductase inhibitors (statins) and the implications of pharmacogenetic considerations for predicting treatment efficacy and reducing the adverse effects of these drugs. Once new studies have been performed and most of the genetic variability associated with drug action has been revealed, the great challenge will be to apply this knowledge in clinical medicine.

Rodrigues AC, Hirata MH, Hirata RD. · University of Sao Paulo, Department of Clinical and Toxicological Analysis, Av Prof Lineu Prestes, 580, Sao Paulo, SP 05508-900, Brazil. · Curr Opin Mol Ther. · Pubmed #18041665 No free full text.

Abstract: The statins or HMG-CoA reductase inhibitors are considered one of the most effective classes of drugs for reducing LDL and total cholesterol. Although, statin treatment has beneficial effects in the prevention of cardiovascular disease, considerable inter-individual variation exists in response to statin therapy, as well as in the incidence of adverse effects. Genetic factors contribute to patients' inter-variability in the lipid-lowering response to statins,drug-interactions and the occurrence of muscle damage havebeen reported. However, studies investigating aspects of pharmacokinetics, pharmacodynamics and disease-related genes have found no association that could impact on the decisions to treat with statins. Improved strategies that assess the simultaneous influence of multiple relevant susceptibility factors on disease risk (eg, diet, lifestyle and gene effects) are required. Data from pharmacogenetics studies investigating the association between gene variation and drug response and/or susceptibility to adverse effects are promising and are expected to impact on the clinical treatment of hypercholesterolemia.

Forti N, Diament J. · Instituto do Coração, HCFM, USP, CEP 05427-000, São Paulo, SP, Brazil. · Rev Assoc Med Bras. · Pubmed #17665079 links to  free full text

Abstract: Apolipoprotein (apo) B is present in atherogenic lipoproteins (remnant Qm and VLDL, LDL and Lp (a)) and apo A is present in non-atherogenic lipoprotein (HDL). Measurement of the apos is automated, standardized, with a small variation of coefficient and does not require fasting blood samples. The authors reviewed clinical, epidemiological and therapeutic trials on hyperlipidemia with apo B and A-I evaluation. These works showed the importance of apo B and A-I as cardiovascular risk factors. Experts recommended apo B / apo A-I ratio as an alternative to TC / HDL-c ratio for risk estimate. Future positioning from the Guidelines is expected to include apos in individual risk prediction and as a therapeutic target. The authors suggest that, in clinical practice, measurement of apo B is necessary for coronary heart disease patients with desirable LDLc levels or when this assessment is not possible and the measurement of apo A-I if HDL-c values are very low.

Matos MA, Alencar RW, Matos SS. · Medical School of Medicine and Public Health, Salvador, BA, Brazil. · Braz J Infect Dis. · Pubmed #17625723 links to  free full text

Abstract: Avascular necrosis (AVN) of the femoral head is an emerging complication in HIV infected patients. It has been suggested that the increased incidence of AVN in this population may be caused by an increased prevalence of predisposing factors for osteonecrosis, including protease inhibitors, hyperlipidemia, corticosteroid use, alcohol and intravenous drug abuse. The aim of this study was to assess the risk factors for avascular necrosis developing in the femoral head of HIV infected individuals. This study consisted of meta-analysis of the secondary data extracted from current literature. The selected articles allowed two study groups to be drawn up for comparison. Group 1 comprised 324 individuals infected by the HIV virus, who did not present femoral head AVN. Group 2 comprised 32 HIV positive patients, who presented femoral head AVN. The parameters used for analysis were as follows: age, gender, sexual preference, use of intravenous drugs, time of diagnosis, CD4+ cell count, use of antiretroviral agents and duration, serum cholesterol and serum triglycerides. The present study found a statistically significant association between hypertriglyceridemia, hypercholesterolemia, sexual preference and intravenous drug abuse. The authors concluded that femoral head osteonecrosis is associated with hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) and intravenous drug abuse. This study supports the hypothesis that protease inhibitors play a role in the development of osteonecrosis through a tendency to cause hyperlipidemia.

Vercesi AE, Castilho RF, Kowaltowski AJ, Oliveira HC. · Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil. · IUBMB Life. · Pubmed #17505963 No free full text.

Abstract: Changes in mitochondrial function are intimately associated with metabolic diseases. Here, we review recent evidence relating alterations in mitochondrial energy metabolism, ion transport and redox state in hypercholesterolemia and hypertriglyceridemia. We focus mainly on changes in mitochondrial respiration, K(+) and Ca(2+) transport, reactive oxygen species generation and susceptibility to mitochondrial permeability transition.

Morales Villegas E. · Investigación Cardiometabólica S.C. Hospital Central Médico-Quirúrgica de Aguascalientes, Mexico. · Arch Cardiol Mex. · Pubmed #17469345 No free full text.

Abstract: Himsworth in 1939 postulated that Diabetes Mellitus type 2 (DM2) was not only an insulin deficiency state but also a cellular insulin insensitivity disease. Thirty years later, DeFronzo and Reaven demonstrated that insulin resistance (IR) preceded and predisposed for DM2 and atherosclerotic-cardiovascular-disease (ACVD). Reaven was the first to point out the relationship between IR and with hyperglycemia, dyslipidosis, and hypertension as mediators for ACVD, creating the concept of Syndrome X (SX) in 1988. WHO and, thereafter, other medical societies and medical groups, mainly ATP-III, in 2002, based on the difficulty of diagnosing IR in a simple, reliable, and inexpensive way, proposed and published the Metabolic Syndrome (MS) concept, as a group of five variables, i.e., obesity, hyperglycemia, hypertriglyceridemia, low HDL, and hypertension, as an easy clinical approximation to suspect and treat an increased cardiometabolic risk. Nowadays, there are deep and extensive controversies on this issue; however, these controversies do not really exist since all discordant points of view are rather quantitative and not qualitative in nature. This article is aimed at differentiating and harmonizing the complementary concepts of SX and MS, at analyzing why MS is a good "clinical window" to look for IR and its underlying manifestations, and finally to accept that the MS concept complements, but does not substitute or antagonize, traditional scales used to asses cardiovascular risk, such as the Framingham scale.

Gurfinkel EP, Lernoud VS, Laguens RP, Favaloro RR. · Institute of Cardiology and Cardiovascular Surgery, Favaloro Foundation, Buenos Aires, Argentina. · Circulation. · Pubmed #17339572 links to  free full text

Abstract: BACKGROUND: The beginnings of coronary artery bypass graft in Latin America could be set in the year 1971. Since then, improvements in technique and greater experience have resulted in a rapid increase in the rate of interventions performed in the region. METHODS AND RESULTS: Searches through PubMed and Literatura Latinoamericana y del Caribe en Ciencias de la Salud, as well as personal communications from specialists from Latin America, have been the source of information. Articles were selected by their content related to the theme, and the authors' nationality and information is mainly from Latin America. Demographic information of the population of Latin America denotes higher age averages, and this implies an increase in the severity of comorbidities in patients who undergo surgery. Longer life expectancy and improvements in medical therapy have implied that patients survive a first intervention beyond the expected time a bypass persists patent. Wall vessel properties of arterial conduits, plus a better anastomotic technique, seem to be the current solution to worsening in the coronary health of patients who undergo revascularization surgery in Latin America. CONCLUSIONS: Despite scarce economic investment in medical sciences, many academic groups contribute to the exploration of therapeutic pharmacological combinations and inclusively apply genetic strategies.

Borba EF, Carvalho JF, Bonfá E. · Rheumatology Division, São Paulo University Medical School Hospital, São Paulo, SP, Brazil. · Clin Dev Immunol. · Pubmed #17162363 links to  free full text

Abstract: Autoimmunity and inflammation are associated with marked changes in lipid and lipoprotein metabolism in SLE. Autoantibodies and cytokines are able to modulate lipoprotein lipase (LPL) activity, a key enzyme in lipid metabolism, with a consequent "lupus pattern" of dyslipoproteinemia characterized by elevated levels of very low-density lipoprotein cholesterol (VLDL) and triglycerides (TG) and lower high-density lipoprotein cholesterol (HDL) levels. This pattern favors an enhanced LDL oxidation with a subsequent deleterious foam cell formation. Autoantibodies and immunocomplexes may aggravate this oxidative injury by inducing accumulation and deposition of oxLDL in endothelial cells. Drugs and associated diseases usually magnify the close interaction of these factors and further promote the proatherogenic environment of this disease.

Gurfinkel EP, Lernoud VS. · Institute of Cardiology and Cardiovascular Surgery, Fundacion Favaloro, Buenos Aires, Argentina. · Curr Opin Cardiol. · Pubmed #16900015 No free full text.

Abstract: PURPOSE OF REVIEW: There is an enormous literature on the prevention of myocardial infarction. However, most articles are focused categorically on evidence-based medicine and give no room for conceptual analyses. In this article, we attempt to review the main aspects of this theme from a different point of view. RECENT FINDINGS: In the last decade, scientists have encouraged the understanding and gradual application of genetics in the study of common diseases. This is one of the main angles from which we try to review the prevention of myocardial infarction. Another important factor is the consideration of cost-effectiveness. Consequently, we remark on the value of interventions that can have an impact on cost. SUMMARY: In preventing myocardial infarction modern physicians should emphasize the importance of behavioral and cultural changes and learn from genetic advances in restoring the delicate balance that is altered in atherosclerotic disease.

Rigotti R A, Arteaga Ll A, Maiz G A. · Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. · Rev Med Chil. · Pubmed #16802058 links to  free full text

Abstract: Primary and secondary prevention trials have clearly demonstrated that lowering serum cholesterol levels with statins reduces the incidence of cardiovascular events. Recent studies plus post hoc analysis of previous clinical trials show that risk reduction is proportional to the magnitude of LDL cholesterol lowering. Therefore, new recommendations of the National Cholesterol Education Program (USA) have defined a category of patients with very high cardiovascular risk, who should achieve serum LDL cholesterol levels below 70 mg/dl. This proposal will require new and more efficient pharmacologic strategies to attain the increasingly strict therapeutic goals for LDL cholesterol. This article reviews the clinical studies that support the use of intensive lipid lowering therapy to reduce cardiovascular risk. An effective reduction of serum cholesterol can be obtained using statins in high doses or a combination of hypolipidemic drugs with different mechanisms of action.

Torres N, Torre-Villalvazo I, Tovar AR. · Departamento de Fisiología de la Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, DF 14000, Mexico. · J Nutr Biochem. · Pubmed #16481155 No free full text.

Abstract: Soybeans have a high-quality protein that has been consumed for approximately 5000 years in Oriental countries. The awareness that soy products are healthy has increased their consumption in Western countries. Substantial data from epidemiological surveys and nutritional interventions in humans and animals indicate that soy protein reduces serum total and low-density lipoprotein (LDL) cholesterol and triglycerides as well as hepatic cholesterol and triglycerides. This review examines the evidence on the possible mechanisms for which soy protein has beneficial effects in diabetes, obesity and some forms of chronic renal disease. Consumption of soy protein due to low methionine content reduces serum homocysteine concentration, decreasing the risk of acquiring a cardiovascular disease. On the other hand, soy protein reduces the insulin/glucagon ratio, which in turn down-regulates the expression of the hepatic transcription factor sterol regulatory element binding protein (SREBP)-1. The reduction of this factor decreases the expression of several lipogenic enzymes, decreasing in this way serum and hepatic triglycerides as well as LDL cholesterol and very LDL triglycerides in diabetes and obesity, reducing lipotoxicity in the liver. Soy protein intake also reduces hepatic lipotoxicity by maintaining the number of functional adipocytes, preventing the transfer of fatty acids to extra adipose tissues. Furthermore, soy protein isoflavones stimulate the transcription factor SREBP-2, increasing serum cholesterol clearance. The reduction of serum cholesterol and triglyceride concentrations by soy protein intake produces beneficial effects in the kidney preventing the inflammatory response, increasing the renal flow by releasing endothelial nitric oxide (NO) synthase from the caveolae, facilitating the synthesis of NO. Thus, soy protein consumption may reduce the clinical and biochemical abnormalities in diseases mediated by lipid disorders.

Leighton F, Miranda-Rottmann S, Urquiaga I. · Laboratorio de Nutrición Molecular, Facultad de Ciencias Biológicas, Universidad Católica de Chile, Chile. · Cell Biochem Funct. · Pubmed #16170835 No free full text.

Abstract: The positive health effects derived from moderate wine consumption are pleiotropic. They appear as improvements in cardiovascular risk factors such as plasma lipids, haemostatic mechanisms, endothelial function and antioxidant defences. The active principles would be ethanol and mainly polyphenols. Results from our and other laboratories support the unifying hypothesis that the improvements in risk factors after red wine consumption are mediated by endothelial nitric oxide synthase (eNOS). Many genes are involved, but the participation of eNOS would be a constant feature.The metabolic syndrome is a cluster of metabolic risk factors associated with high risk of cardiovascular disease (CVD). The National Cholesterol Education Programmmes Adult Treatment Panel III (NCEPATP III) clinical definition of the metabolic syndrome requires the presence of at least three risk factors, from among abdominal obesity, high plasma triacylglycerols, low plasma HDL, high blood pressure and high fasting plasma glucose. The molecular mechanisms responsible for the metabolic syndrome are not known. Since metabolic syndrome apparently affects 10-30% of the population in the world, research on its pathogenesis and control is needed.The recent finding that eNOS knockout mice present a cluster of cardiovascular risk factors comparable to those of the metabolic syndrome suggests that defects in eNOS function may cause human metabolic syndrome. These mice are hypertensive, insulin resistant and dyslipidemic. Further support for a pathogenic role of eNOS comes from the finding in humans that eNOS polymorphisms associate with insulin resistance and diabetes, with hypertension, with inflammatory and oxidative stress markers and with albuminuria. So, the data sustain the hypothesis that eNOS enhancement should reduce metabolic syndrome incidence and its consequences. Therefore red wine, since it enhances eNOS function, should be considered as a potential tool for the control of metabolic syndrome. This hypothesis is supported by epidemiological observations and needs experimental validation in human intervention studies.

Rebolledo OR, Actis Dato SM. · CENEXA--Center of Experimental and Applied Endocrinology, National University of La Plata--National Research Council, PAHO/WHO Collaborating Center, School of Medical Sciences, La Plata, Argentina. · Eur Rev Med Pharmacol Sci. · Pubmed #16128039 No free full text.

Abstract: Postprandial glucose and triglyceride increments after a mixed meal are more prolonged in people with type 1 and 2 diabetes or with impaired glucose tolerance than in normal individuals. Evidence in the literature suggests that these transient increases represent an additional and independent risk for chronic hyperglycemia to induce endothelial dysfunction, an important fact for the development of diabetic vascular complications. This article presents the more relevant mechanisms by which acute postprandial hyperglycemia and hyperlipidemia have been proved to determine the risk of reactive oxygen species overproduction, an increased synthesis of non enzymatic early-glycated and nitrated proteins, and a more atherogenic lipoprotein profile. Recent recommendations suggest that care for this transient glycoxidative stress should be associated with fasting glucose or HbA1c care, to reduce the risk of macro- and microvascular complications in people with diabetes.

Martins SL, Silva HF, Novaes MR, Ito MK. · Departamento de Nutrição, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília-DF, Brasil. · Arch Latinoam Nutr. · Pubmed #15807199 No free full text.

Abstract: Plant sterol and stanol esters are called "functional" compounds due to their hypocholesterolemic properties. The objective of this review is to update recent findings concerning the effect of phytosterols in the blood cholesterol, emphasizing the results from experimental and human studies. The hypocholesterolemic effect is observed with the intake of 2.5g/day of phytosterols or phytostanols. Daily intake, usually of stanols, for 4 weeks has shown to to be effective in lowering blood total- as well as LDL-cholesterol by about 10%. The mechanism of action in lowering blood cholesterol comes from their structural similarity to cholesterol, hence they act by competing with cholesterol at the luminal absorption site. The adverse effects of a high intake of phytosterols and phytostanols are the lower absorption of some liposoluble vitamins and antioxidants.

Jufe GS. · Facultad de Medicina, Universidad de Buenos Aires. · Vertex. · Pubmed #15785785 No free full text.

Abstract: Psychiatric drugs bring indeniable benefits for the treatment of psychiatric disorders. But their use can come along with a varying degree of side effects, some of them known for a long time, and some that are at present starting to focus attention. In this group we can find metabolic side effects, because of their possible relationship with the mortality of patients with severe psychiatric disorders. In this article, effects of psychiatric drugs on glucose and lipids metabolism are revised.

Lasses y Ojeda LA, Gutiérrez JL, Salazar E. · Servicio de Cardiología Geriátrica, Instituto Nacional de Cardiologia Ignacio Chávez, México. · Arch Cardiol Mex. · Pubmed #15709510 No free full text.

Abstract: Age is an independent and unmodifiable risk factor for coronary atherosclerosis. In Mexico, coronary heart disease is responsible for 50 % of the deaths for those older than 65 years of age. Aging produces major differences in the presentation, diagnosis, prognosis, and response to therapy in coronary heart disease. The goal of treatment is the prolongation of survival and the improvement of the quality of life. However, in the elderly, the aim of therapy should focus on attaining a meaningful quality of life thus allowing them to be functionally independent. Clinical trials demonstrate conclusively that lowering serum cholesterol levels will reduce the incidence of coronary heart disease irrespective of age. Dietary advise and life-style modifications are the first-line approach in the elderly. When these measures are insufficient to achieve target lipid reductions, statins are the drug of choice. Fibrates may be indicated if triglycerides are high and C-HDL is low. Given the grater coronary risk of older population, the absolute benefit will be greater in the elderly.

Cahn PE, Gatell JM, Squires K, Percival LD, Piliero PJ, Sanne IA, Shelton S, Lazzarin A, Odeshoo L, Kelleher TD, Thiry A, Giordano MD, Schnittman SM. · Fundación Huésped, Buenos Aires, Argentina. · J Int Assoc Physicians AIDS Care (Chic Ill). · Pubmed #15573713 No free full text.

Abstract: Protease inhibitor (PI) treatment can result in dyslipidemia in a significant proportion of patients. Atazanavir (ATV) is a once-daily PI that has not been associated with clinically relevant increases in total cholesterol (TC), fasting low-density lipoprotein cholesterol (LDL-C), or fasting triglyceride (TG) concentrations. The objectives of this paper were to evaluate lipid profiles in untreated patients, and investigate the frequency and severity of dyslipidemia in the same individuals after treatment with ATV or nelfinavir (NFV) for 48 weeks. Two multinational, randomized, active-controlled, blinded trials compared the safety and efficacy of ATV and NFV in combination with two nucleoside reverse transcriptase inhibitors (NRTIs) in antiretroviral (ARV)-naive patients. Serum lipid concentrations were analyzed in patients who had available measurements both at baseline and at week 48. Patients who had missing data at either time point were not included. Lipid levels remained within baseline ranges at week 48 with ATV treatment, whereas clinically relevant elevations in TC, fasting LDL-C, and fasting TG concentrations occurred with NFV treatment. Mean changes from pre-treatment baseline in fasting LDL-C ranged from -6 percent to +6 percent in the ATV-treatment groups, and from +27 percent to +31 percent in the NFV-treatment groups. After 48 weeks, there was a substantive increase in the proportion of NFV-treated patients who would be recommended for lipid-lowering treatment by National Cholesterol Education Program (NCEP) guidelines, whereas a lesser proportion of ATV-treated patients would be recommended for lipid-lowering treatment. Atazanavir does not lead to dyslipidemia in ARV-naive patients, and may limit the need for lipid-lowering strategies to reduce the risk of cardiovascular disease.

Aguilar Salinas CA, Zamora M, Gómez-Díaz RA, Mehta R, Gómez Pérez FJ, Rull JA. · Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico. · Semin Vasc Med. · Pubmed #15478042 No free full text.

Abstract: Familial combined hyperlipidemia is the most frequent cause of primary dyslipidemia in Mexico. Its manifestations include hypercholesterolemia, hypertriglyceridemia, or a combination of both. Despite its high frequency, a proper diagnosis is rarely made. Assessment of the lipid profiles of at least three first-degree relatives is necessary. The diagnosis of familial combined hyperlipidemia in a family not only leads to the identification of other affected family members but, more important, allows cardiovascular risk stratification of those affected. Prospective studies have confirmed the atherogenicity of the disease. A critical review of the current literature in this field is presented in this article. Although three screenings of the genome have been completed, the genes responsible for this disorder have not been identified. Limitations with respect to the characterization of affected subjects and the heterogeneity of the disease are among possible explanations. However, familial combined hyperlipidemia, because of its high prevalence, must be given greater priority. It represents a great challenge for physicians involved in the treatment of dyslipidemic patients.

Forti N, Diament J. · Faculdade de Medicina, USP, InCor, Hospital das Clínicas, FMUSP, São Paulo, SP. · Arq Bras Cardiol. · Pubmed #15375477 links to  free full text

This publication has no abstract.

Soltero-Pérez IF. · Escuela de Medicina UCV, San José, Caracas, Venezuela. · Am J Ther. · Pubmed #14624281 No free full text.

Abstract: Atherosclerosis is a very complex disease. Although it is thought that hyperlipidemia, dyslipidemia, and other conditions such as high blood pressure are mainly responsible for the development of atherosclerosis, many other factors such as endothelial dysfunction and inflammation play a significant role in its pathology. The clinicians should be aware of all the contributing factors to optimize the therapy for atherosclerosis. A combination of lifestyle modification, nutritional measures, and pharmacological intervention with statins or fibrates would achieve good results if the treatment of atherosclerosis were pursued vigorously. In the presence of hypertension, the use of angiotensin-converting enzyme inhibitors and calcium channel blockers would be more appropriate.