A retrospective review of the use of lipid-lowering agents in combination, specifically, gemfibrozil and lovastatin.

We conducted a retrospective review examining lipid profiles, creatine phosphokinase (CK) levels, and alanine aminotransferase levels (ALT) in patients receiving the combination of gemfibrozil and lovastatin. Serum lipid levels were significantly improved with therapy over those before therapy. Of the 70 patients receiving the combination, 5 experienced mild elevations in CK, 1 a mild elevation in ALT, and 1 mild elevations in both. No patient reported muscle weakness or muscle pain. The combination of these two medications appeared to be at least additive, highly effective, and well tolerated. The mean total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels decreased from 278, 306, and 180 mg% to 200, 151, and 129 mg%, respectively, and the mean high-density lipoprotein cholesterol levels increased from 34 to 40 mg%. This retrospective data analysis suggests that the combination of gemfibrozil and lovastatin may be safe in patients with normal renal function when the dosage of lovastatin is limited and when CK and ALT levels are monitored carefully.     

Combination Therapy with Low-Dose Lovastatin and Niacin Is as Effective as Higher-Dose Lovastatin

Study Objectives . To determine if low-dose lovastatin in combination with niacin causes a greater percentage reduction in low-density lipoprotein (LDL) cholesterol than lovastatin alone, and to determine if the combination increases the risk of serious adverse effects. Design . Prospective, randomized, open-label, clinical trial. Setting . Family medicine clinic of a university-affiliated hospital. Patients . Patients with fasting LDL cholesterol concentrations of at least 150 mg/dl after 4 weeks of dietary stabilization and washout of any cholesterol-lowering drugs. Interventions . Twenty-eight patients received lovastatin 20 mg/day for 4 weeks after dietary stabilization and washout. If LDL cholesterol remained above 130 mg/dl (100 mg/dl in patients with coronary artery disease), they were randomized to receive either lovastatin 40 mg/day or a combination of lovastatin 20 mg/day and niacin 500 mg 3 times/day. Measurements and Main Results . There was no difference in actual or percentage reductions of LDL cholesterol, total cholesterol, and triglycerides between the groups. A greater increase in high-density lipoprotein (HDL) cholesterol occurred with combination therapy (p=0.024). There was no difference in liver function tests, glucose, or uric acid between the therapies. Based on drug-acquisition cost, combination therapy is approximately 40% less expensive than monotherapy. Conclusion . Low-dose niacin plus low-dose lovastatin was as effective as higher-dose lovastatin in lowering total cholesterol, LDL cholesterol, and triglyceride levels. The combination may offer benefit in raising HDL cholesterol levels.     

国产与进口洛伐他汀治疗高脂血症的比较

目的 :比较国产与进口洛伐他汀治疗高脂血症的疗效。方法 :2 0 6例原发性高脂血症病人分为国产组 113例 (男性 68例 ,女性 45例 ,年龄 5 6a±s10a) ,给国产洛伐他汀 2 0mg ,po ,qd× 8wk ;进口组 93例 (男性 5 8例 ,女性 35例 ,年龄 5 7a±10a) ,给进口洛伐他汀 2 0mg ,po ,qd× 8wk。结果 :国产与进口洛伐他汀治疗前后所降低总胆固醇(TC)、三酰甘油 (TG)和低密度脂蛋白胆固醇 (LDL_Ch)差异均有显著意义 (P <0 .0 5 ) ,但 2组间比较差异无显著意义 (P >0 .0 5 )。结论 :国产与进口洛伐他汀有相似的调节血脂效果 ,两者使用均较安全     

Retrospective analysis of hyperlipidemia management in a transplant population

STUDY OBJECTIVES: To determine the prevalence of hyperlipidemia and the effectiveness of hyperlipidemia management in a large population of transplant recipients. A secondary objective was to assess the effect of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III guidelines on hyperlipidemia management compared with the effect from earlier guidelines. DESIGN: Retrospective review of computerized records. SETTING: University-affiliated transplantation center. PATIENTS: Three thousand four hundred fourteen patients with liver, kidney, or pancreas transplants. MEASUREMENTS AND MAIN RESULTS: To determine a diagnosis of hyperlipidemia and the effectiveness of treatment, we assessed the patients's lipid levels. Hyperlipidemia was defined as a total cholesterol level above 200 mg/dl and/or the use of antihyperlipidemic drugs. Of the 3414 patients in the study, 1638 (48%) had hyperlipidemia. Of these, 711 (43%) were receiving antihyperlipidemic drugs; 227 (32%) of the 711 patients had achieved the total cholesterol goal of 200 mg/dl or below. Low-density lipoprotein cholesterol (LDL) levels were available for 1953 (57%) patients. Of these, 537 patients were receiving cholesterol-lowering drugs, and 384 (72%) of the 537 patients achieved the LDL goal of less than 130 mg/dl. CONCLUSION: Although NCEP guidelines recommend monitoring LDL, only slightly more than half of these transplant recipients were monitored. In addition, the patients identified as having hyperlipidemia were not effectively treated to lower their cholesterol levels. Clinicians must be aggressive in diagnosing, monitoring, and treating hyperlipidemia to decrease the rate of cardiovascular disease and to prolong patient survival after transplantation.     

The Effect of Supplemental Dietary Fat on Plasma Cholesterol Levels in Lovastatin-Treated Hypercholesterolemic Patients

Study Objective . A validation study was conducted first to test assumptions about the effect of saturated and unsaturated dietary fat supplements. The second study was conducted to determine the effect on blood cholesterol levels of saturated and unsaturated fat supplements in patients who followed a low-fat diet and were administered lovastatin. Design . Randomized, crossover design, with three periods in the first study and four in the second study, each lasting 6 weeks. Setting . Cholesterol Research Center. Patients . The first study evaluated adults with total cholesterol levels between 200 and 280 mg/dl (5.172 and 7.241 mmol/L). The second study included adults with low-density lipoprotein (LDL) cholesterol levels above 160 mg/dl (4.138 mmol/L). Interventions . Fat supplements with either coconut or canola oil were delivered to patients in oatmeal-raisin cookies. Measurements and Main Results . In the validation study, patients' mean prerandomization total cholesterol level of 222 mg/dl was reduced to 213 mg/dl with canola oil and increased to 233 mg/dl with coconut oil cookies (p=0.0038). In the second study the mean prerandomization total cholesterol level of 214 mg/dl was decreased to 199 mg/dl with canola oil and to 208 mg/dl with coconut oil cookies (p=0.2342). The LDL cholesterol levels changed in a similar fashion in both studies. Conclusions . Changes in total and LDL cholesterol levels in the validation study were expected based on established effects of saturated and unsaturated fatty acids, but changes in these levels in lovastatin-cookie study were not expected. They could have occurred because lovastatin reversed the effect of saturated fats and enhanced the effect of unsaturated fats. Alternatively, they may have been due to enhanced bioavailability of lovastatin when administered with a high-fat diet. These findings must be confirmed.     

多廿醇对高脂血症大鼠血清胆固醇水平的影响

目的观察多廿醇对高脂血症大鼠的降胆固醇作用并探讨其作用机制。方法大鼠分为正常对照组、多廿醇4mg.kg-1预防组、高脂模型组、多廿醇4,6和8mg.kg-1治疗组和洛伐他汀阳性对照组;后5组大鼠在实验前4周给予高脂饲料制备高脂大鼠模型,从第5周开始,除正常对照和高脂模型组外,各给药组ig给予不同浓度的多廿醇或洛伐他汀,每天1次,连续6周。多廿醇预防组喂饲高脂饲料的同时ig多廿醇,每天1次,连续10周。用全自动生化分析仪测定血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平,并测定粪便总胆汁酸(FBA)排出量,紫外分光速率法测定肝脏微粒体3-羟基-3-甲基戊二酸单酰辅酶A(HMG-CoA)还原酶活性,荧光配体标记法测定外周血淋巴细胞低密度脂蛋白受体(LDL-R)活性。结果与高脂模型组比较,多廿醇预防组、多廿醇治疗组和洛伐他汀阳性对照组大鼠血清TC含量明显下降(39.1%～46.4%),LDL-C含量明显下降(66.6%～80.7%),粪便FBA明显升高(9.7%～19.0%),肝脏微粒体HMG-CoA还原酶活性明显下降(13.8%～23.6%),外周血淋巴细胞LDL-R活性升高(27.5%～129.6%);多廿醇预防组、多廿醇8mg.kg-1组和洛伐他汀组HDL-C水平明显升高(12.2%～16.7%);洛伐他汀组TG水平明显下降。结论多廿醇具有明显降低胆固醇的作用,其机制包括增加胆汁酸的排泄、抑制胆固醇合成限速酶HMG-CoA还原酶活性和促进低密度脂蛋白受体活性的表达。     

Management of Protease Inhibitor-Associated Hyperlipidemia

Dyslipidemia, characterized by elevated serum levels of triglycerides and reduced levels of total cholesterol, low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol, has been recognized in patients with human immunodeficiency virus (HIV) infection. It is thought that elevated levels of circulating cytokines, such as tumor necrosis factor-α and interferon-α, may alter lipid metabolism in patients with HIV infection. Protease inhibitors, such as saquinavir, indinavir and ritonavir, have been found to decrease mortality and improve quality of life in patients with HIV infection. However, these drugs have been associated with a syndrome of fat redistribution, insulin resistance, and hyperlipidemia. Elevations in serum total cholesterol and triglyceride levels, along with dyslipidemia that typically occurs in patients with HIV infection, may predispose patients to complications such as premature atherosclerosis and pancreatitis. It has been estimated that hypercholesterolemia and hypertriglyceridemia occur in greater than 50% of protease inhibitor recipients after 2 years of therapy, and that the risk of developing hyperlipidemia increases with the duration of treatment with protease inhibitors. In general, treatment of hyperlipidemia should follow National Cholesterol Education Program guidelines; efforts should be made to modify/control coronary heart disease risk factors (i. e. smoking; hypertension; diabetes mellitus) and maximize lifestyle modifications, primarily dietary intervention and exercise, in these patients. Where indicated, treatment usually consists of either pravastatin or atorvastatin for patients with elevated serum levels of LDL-C and/or total cholesterol. Atorvastatin is more potent in lowering serum total cholesterol and triglycerides compared with other hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, but it is also associated with more drug interactions compared with pravastatin. Simvastatin and lovastatin are significantly metabolized by cytochrome P450 enzymes (CYP3A4) and are therefore not recommended for coadministration with protease inhibitors. Afibric acid derivative (gemfibrozil or fenofibrate) should be used in patients with primary hypertriglyceridemia. However, it must be kept in mind that protease inhibitors, such as nelfinavir and ritonavir, induce enzymes involved in the metabolism of the fibric acid derivatives and may, therefore, reduce the lipid-lowering activity of coadministered gemfibrozil or fenofibrate. In certain patients HMG-CoA reductase inhibitors may be used in combination with fibric acid derivatives but patients should be carefully monitored for liver and skeletal muscle toxicity. Select patients may experience improvements in serum lipid levels when their offending protease inhibitor(s) is/are exchanged for efavirenz, nevirapine, or abacavir; however each patient’s virologic and immunologic status must be taken closely into consideration.     

Short- and long-term effects of lovastatin and pravastatin alone and in combination with cholestyramine on serum lipids,lipoproteins and apolipoproteins in primary hypercholesterolaemia

Summary The effects of the HMG CoA reductase inhibitors lovastatin and pravastatin on serum lipids, lipoproteins and apolipoproteins have been studied in 35 patients with primary hypercholesterolaemia.LDL cholesterol was lowered to the same extent by both agents compared on a mg basis of each drug per day. HDL cholesterol was increased by lovastatin but not by pravastatin. The reduction in serum triglycerides, VLDL triglycerides and VLDL cholesterol was more pronounced after lovastatin than pravastatin. After 1 year the effect of combined treatment with 40 mg pravastatin and 8 g cholestyramine on the reduction in LDL cholesterol (–39%) in 13 patients was comparable to that of 80 mg lovastatin plus 8 g cholestyramine (–40%) in 12 patients with identical baseline values.Differences were also found in the effects of the combination therapy with the two drugs on HDL cholesterol, serum triglycerides, VLDL triglycerides, VLDL cholesterol, and apolipoproteins.     

Long-term administration of the HMG-CoA reductase inhibitor lovastatin in two patients with cholesteryl ester storage disease

OBJECTIVE: In order to suppress de novo cholesterol and VLDL biosynthesis, a long-term therapy trial with lovastatin, a competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, was initiated in two patients with cholesteryl ester storage disease (CESD), and concentrations of plasma lipids were monitored over a period of 9 years. METHODS: We studied two male patients with enzymatically confirmed CESD in whom long-term lovastatin therapy (8 and 9 years) was begun at the age of 7 and 19 years. The diagnosis of CESD was confirmed by the measurement of human lysosomal acid lipase (hLAL) activity in cultured skin fibroblasts and leukocytes. Restriction fragment length polymorphism (RFLP) analysis revealed that both subjects are homozygotes for the common CESD splice site mutation. Levels of serum lipids and lipoproteins were measured yearly. RESULTS: During the first year, total serum cholesterol decreased from 317 to 201 mg/dl in Patient A and from 228 to 120 mg/dl in Patient B, due mainly to the reduction of low-density lipoprotein (LDL) cholesterol from 262 to 151 mg/dt in Patient A and from 166 to 66 mg/dl in Patient B. Accordingly, the LDL cholesterol : high density lipoprotein (HDL) cholesterol ratio was markedly reduced in both patients after one year of therapy. The treatment was continued and, after 9 years of further medication, low total cholesterol and LDL cholesterol levels were still maintained. CONCLUSIONS: The study demonstrates that HMG-CoA reductase inhibitors are well tolerated drugs during long-term treatment of CESD patients and may help to prevent the development of premature atherosclerosis.     

Lovastatin extended release: a review of its use in the management of hypercholesterolaemia

Lovastatin extended release (ER) provides a new form of delivery for lovastatin, an HMG-CoA reductase inhibitor. Lovastatin ER delivers the drug in a more sustained fashion, as shown by a smoother plasma concentration-time profile, a lower maximum plasma concentration and a prolonged half-life compared with that of lovastatin immediate release (IR). At dosages of 10-60 mg/day, lovastatin ER significantly reduced levels of total cholesterol, low density lipoprotein (LDL)-cholesterol and triglycerides, and increased levels of high density lipoprotein-cholesterol, in patients with primary hypercholesterolaemia in a randomised, double-blind study of 12 weeks' duration. These effects were maintained in a 6-month extension study in which patients received lovastatin 40 or 60 mg/day. In a randomised 4-week study in 24 patients with primary hypercholesterolaemia, the reduction in plasma LDL-cholesterol levels was significantly greater with lovastatin ER 40 mg/day than with the IR formulation administered at the same dosage. Lovastatin ER was well tolerated in all studies and adverse events were usually mild to moderate and transient. The tolerability profile of lovastatin ER was similar to that of lovastatin IR. There were no reports of clinically relevant elevations in liver transaminases or creatine phosphokinase attributed to the drug in recipients of lovastatin ER. CONCLUSION: The ER formulation of lovastatin provides smooth and sustained delivery of this established and well-tolerated agent over the dosage interval, significantly reducing LDL-cholesterol in patients with primary hypercholesterolaemia. If, as expected, the beneficial changes in lipid levels are maintained during long-term treatment and further clinical experience confirms the greater efficacy of the lovastatin ER formulation than the IR formulation, then lovastatin ER is likely to supplant lovastatin IR and provide a useful option in the management of patients with dyslipidaemia and prevention of coronary heart disease.     

降脂灵治疗高脂血症疗效和安全性的观察

目的观察中药降脂灵片对高脂血症患者的降脂疗效及安全性。方法对入选的31例高脂血症患者,进行开放性研究,治疗前后自身对照;予降脂灵15片/d,分3次服用。为期4周,于实验前及实验结束后,检测血清总胆固醇、甘油三酯、肝肾功能、血清肌酸激酶等的变化。结果治疗后胆固醇水平与治疗前经较显著下降[(5.8±0.8)mmol/Lvs(6.3±0.7)mmol/L,P<0.05)];甘油三酯、肝肾功能、肌酸激酶变化无统计学意义(P>0.05)。结论中药降脂灵有一定的降低血清胆固醇作用,而对甘油三酯肝肾功能、血清肌酸激酶等无明显影响,是一种安全有效的降脂中药。     

Effects of policosanol and lovastatin on lipid profile and lipid peroxidation in patients with dyslipidemia associated with type 2 diabetes mellitus

In this pilot, randomized, double-blind study, we compared the effects of policosanol and lovastatin on lipid profile and lipid peroxidation in patients with dyslipidemia and type 2 diabetes mellitus. After 4 weeks on a cholesterol-lowering diet, 36 patients were randomized to policosanol (10 mg/day) or lovastatin (20 mg/day) tablets o.i.d. for 8 weeks. Policosanol significantly (p < 0.001) lowered serum low-density lipoprotein-cholesterol (LDL-C) (29.9%), total cholesterol (21.1%), triglycerides (13.6%) and the LDL-C/high-density lipoprotein-cholesterol (HDL-C) (36.7%) and total cholesterol/HDL-C (28.9%) ratios and significantly (p < 0.01) increased HDL-C (12.5%). Lovastatin significantly (p < 0.001) lowered LDL-C (25%), total cholesterol (18%), triglycerides (10.9%) and the LDL-C/HDL-C (30.4%) and total cholesterol/HDL-C ratios (23.9%) and significantly (p < 0.01) raised HDL-C (8.3%). Policosanol was more effective (p < 0.05) than lovastatin in reducing both ratios and in increasing (p < 0.05) HDL-C. Policosanol, but not lovastatin, significantly raised the lag time (20.9%) of Cu+2-induced LDL peroxidation and total plasma antioxidant activity (24.2%) (p < 0.05). Both policosanol and lovastatin significantly decreased the propagation rate (41.9% and 41.6% respectively, p < 0.001), maximal diene production (8.3% and 5.7%) and plasma levels of thiobarbituric acid reactive substances (9.7% and 11.5%, p < 0.001). Both treatments were well tolerated. Only one patient in the lovastatin group withdrew from the trial due to adverse events. In conclusion, policosanol and lovastatin administered short term to patients with dyslipidemia secondary to type 2 diabetes were effective in lowering cholesterol and in inhibiting the extent of lipid peroxidation. Policosanol (10 mg/day) was slightly more effective than lovastatin (20 mg/day) in reducing the LDL-C/HDL-C and total cholesterol/HDL-C ratios, in increasing HDL-C levels and in preventing LDL oxidation. Nevertheless, since this was a pilot study, further clinical studies performed in larger sample sizes of diabetic patients are needed for definitive conclusions.     

Polysorbates as novel lipid-modulating candidates for reducing serum total cholesterol and low-density lipoprotein levels in hyperlipidemic C57BL/6J mice and rats

Polysorbates are amphiphilic, non-ionic surfactants composed of fatty acid esters of polyoxyethylene sorbitan which are widely used in the cosmetic, food and pharmaceutical industries owing to these special characteristics and their low toxicity profiles. In the present study, polysorbates were investigated for their hypolipidemic activity. C57BL/6J mice and Sprague-Dawley rats were fed a high-fat diet for four weeks, then were divided into several groups, normal saline, polysorbates and positive control drugs such as lovastatin and colestyramine were administered orally to the animals for another four weeks. Complete lipid profiles of the experimental animals were determined by assessing the serum levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. The results indicate that polysorbates significantly lowered the lipid components. Polysorbates are potential candidates for preventing intestinal absorption of redundant lipid from daily intake and subsequently for preventing hyperlipidemia as well as atherosclerosis.     

Orlistat use in overweight women with mild hypercholesterolemia

In the present study, we investigated the effects of a 6-month treatment with orlistat on body weight and lipid profile in 27 overweight women (mean body mass index [BMI]: 27.5 kg/m2; median age: 38.4 years) with mild hypercholesterolemia (total cholesterol: 225 mg/dl; low-density lipoprotein cholesterol [LDL-C]: 162 mg/dl). Orlistat was administered three times per day in conjunction with a hypocaloric diet After 6 months of treatment, body weight decreased by 17.71% and BMI decreased by 18.54%, whereas there was a significant (p < 0.01) improvement in serum lipid levels (total cholesterol: -25.33% LDL-C: -30.86%, high-density lipoprotein cholesterol: +9.37%, triglycerides: -35.97%). In conclusion, orlistat in combination with a low-energy diet seems to have a beneficial effect on body weight and lipid profile in overweight women with mild hypercholesterolemia.     

Under treatment with lipid-lowering drugs of high-risk coronary heart disease patients of the GENICA study

OBJECTIVES: To assess the proportion of high-risk coronary artery disease (CAD) patients who received lipid lowering drug treatment (LLDT) and met the LDL-Cholesterol (LDL-C) goal of 100 mg/dl defined by the third report of the U.S. National Cholesterol Education Program (NCEP). METHODS: In 86% (n = 1095) of the 1268 consecutive Italian patients, who were enrolled in the GENICA study after undergoing quantitative coronary angiography for suspected coronary artery disease between 1999 and 2001, the levels of total serum cholesterol, HDL-cholesterol, triglycerides, and LDL-C were measured and accurate information on current LLDT were available. All patients were classified according to the NCEP. RESULTS: Seventy-four percent of the patients (n = 805) had established CAD and cardiovascular events and therefore were candidates for secondary prevention with LLDT; 69% of them had concomitant hyperlipidemia. Only 57% of the patients with CAD and hyperlipidemia were on LLDT. Of the 1052 patients who were at the highest risk class according to NCEP, only 34.2% and 16.7% were on LLDT and reached the LDL-C goal, respectively. CONCLUSIONS: Only 1 patient of 6 in the highest-risk class according to the NCEP accomplished the LDL-C goal. Accordingly, in the field of secondary prevention of coronary artery disease, the implementation of guidelines that emerged from scientific evidence into clinical practice with LLDT still requires major efforts.     

洛伐他汀联御旨必妥治疗高脂血症的临床应用价值

目的探讨洛伐他汀联合脂必妥治疗高脂血症的临床价值。方法将我中心2012年1月～2013年5月收治的高脂血症患者168例按不同治疗方法分为实验组（洛伐他汀＋脂必妥）和对照组（洛伐他汀）,均治疗8周后对两组患者的治疗效果进行综合比较。结果实验组总有效率为90．47％,明显优于对照组的75．00％（P〈0．05）,实验组的总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL—C）、TC—HDL—C／HDL—C均较对照组明显降低（P〈0．05）,高密度脂蛋白胆固醇（HDL—C）较对照组明显升高（P〈0．05）。结论洛伐他汀联合脂必妥治疗高脂血症的临床效果显著,且有较高安全性,值得临床推广应用。     

Treatment of hyperlipidemia in HIV-infected patients.

The treatment of hyperlipidemia in patients infected with HIV is discussed. Hyperlipidemia is common in HIV-infected patients receiving antiretroviral therapy, especially protease inhibitors and stavudine. The recommendations of the National Cholesterol Education Program (NCEP) may not entirely apply to HIV-infected patients. The pathogenesis of hyperlipidemia in these patients may make them refractory to traditional pharmacotherapy, and NCEP's emphasis on diet and exercise may be unrealistic. Other factors that may complicate treatment of hyperlipidemia include metabolism of many antiretroviral drugs by the cytochrome P-450 isoenzyme system, polypharmacy, and drug-food interactions. A patient's cardiac risk should first be assessed. Nonpharmacologic measures, such as a low-fat diet, weight reduction, and exercise, should be considered. Drug therapy is indicated for patients with familial combined hyperlipidemia that is associated with atherogenesis and for patients with triglyceride concentrations exceeding 1000 mg/dL. Drug therapy for hyperlipidemia involves niacin and statins, in addition to fibric acid derivatives and probucol. Switching among antiretroviral agents when one is found to cause hyperlipidemia should be done cautiously because of the risk for viral rebound and disease progression. NCEP guidelines recommend monitoring low-density-lipoprotein cholesterol levels four to six weeks after the start of lipid-lowering therapy and then at three months; more frequent monitoring may be necessary in HIV-infected patients. The treatment of hyperlipidemia in HIV-infected patients is complicated by their need for antiretroviral drugs, which can themselves contribute to lipid disorders.     

Analysis of serum lipids and lipoproteins in Ethiopian diabetic patients

Serum lipids and lipoproteins were determined in 302 randomly selected diabetic patients attending the Tikur Anbessa Hospital diabetic clinic. The main objective of the study was to analyse lipid levels in type 1 and type 2 diabetic patients. Lipid measurement was done by cholesterol pap method. The mean age was 41.4 +/- 14.4 years (range 14-85 years). One hundred sixty (53%) were males and 142 (47%) were females. There were 140 (46.4%) type 1 and 162 (53.6%) type 2 patients. The mean duration of diabetes mellitus, haemoglobin A1c, fasting blood glucose and random blood glucose were 9.4 +/- 5.4 years, 10.4 +/- 2.2%, 195.5 +/- 79.9 mg/dl and 273.1 +/- 114.5 mg/dl respectively. The mean cholesterol, triglycerides, LDL, VLDL and HDL were 166.5 +/- 45.5 mg/dl, 129.9 +/- 92.4 mg/dl, 94.5 +/- 36.4 mg/dl, 24.4 +/- 15.1 mg/dl and 44.3 +/- 11.5 mg/dl respectively. Hypercholesterolemia and Hypertriglyceridemia were seen in 18.5% and 14.2% of the patients. Total cholesterol was significantly higher in females than in males and in type 2 than in type 1 patients (179.3 +/- 48.4 mg/dl versus 154.1 +/- 38.2 mg/dl, P < 0.01 and 183.2 +/- 43.7 mg/dl versus 145.9 +/- 37.6 mg/dl, P < 0.001) respectively. Triglycerides and LDL cholesterol were also significantly higher in type 2 diabetic patients than in type 1 diabetic patients (162.7 +/- 10.5 mg/dl versus 91.5 +/- 53.3 mg/dl, P < 0.001 and 105.6 +/- 36.2 mg/dl versus 81.9 +/- 32.2 mg/dl, P < 0.001), but HDL cholesterol was the same in both types of diabetic patients. Similarly, hyperlipidemia was associated with obesity and hypertension. The study confirms that lipid values are high particularly in type 2 diabetic patients. Hence our patients are at increased risk of developing atherosclerosis therefore periodic check up of lipids in diabetic patients and effective treatment of the dyslipidemia along with a tight metabolic control was recommended.     

Safety and efficacy of simvastatin for the treatment of dyslipidemia in human immunodeficiency virus-infected patients receiving efavirenz-based highly active antiretroviral therapy

STUDY OBJECTIVES: To evaluate the safety and efficacy of simvastatin for treatment of dyslipidemia in patients with the human immunodeficiency virus (HIV) who were receiving efavirenz-based highly active antiretroviral therapy (HAART), and to evaluate the effect of simvastatin when added to efavirenz on CD4(+) count, HIV viral load, and frequency of attainment of patient-specific National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III lipid goals. DESIGN: Retrospective medical record review. SETTING: Veterans Affairs health care system in Dallas, Texas. PATIENTS: Thirteen HIV-infected men who received a stable efavirenz-based HAART regimen concurrently with simvastatin 20 mg/day, and 19 HIV negative men who received simvastatin 20 mg/day (controls). MEASUREMENTS AND MAIN RESULTS: Demographic, clinical, and laboratory data were collected before and after starting simvastatin. Reductions in lipid profile values in the HIV-infected group versus HIV-negative group were as follows: total cholesterol -20% versus -28% (p=0.15), low-density lipoprotein cholesterol (LDL) -36% versus -41% (p=0.06), non-high-density lipoprotein cholesterol (non-HDL) -22% versus -33% (p=0.212), and total cholesterol:HDL ratio -33% versus -30% (p=0.26). These effects were seen without any documented adverse drug reactions or changes in viral and immunologic control. However, 28% fewer HIV-infected patients were able to achieve NCEP ATP III LDL goals compared with HIV-negative subjects. CONCLUSION: These preliminary comparative data suggest that simvastatin can be safely and effectively used to treat dyslipidemia in HIV-infected patients receiving efavirenz-based HAART without compromising viral or immunologic control. However, our results are suggestive of slight lessening of the LDL-lowering effects, which might be explained by the known reduction in simvastatin levels with efavirenz. Furthermore, fewer HIV-infected patients were able to meet their NCEP ATP III goals compared with HIV-negative controls, highlighting the difficulty in treating this population to current standards of care.     

Compliance with national guidelines in patients with diabetes in a family practice clinic

STUDY OBJECTIVE: To assess whether clinicians are treating patients with both type 2 diabetes and hyperlipidemia according to national goals for blood pressure, low-density lipoprotein cholesterol (LDL), and glucose levels. DESIGN: Retrospective chart review. SETTING: University-based family medicine teaching practice. PATIENTS: One hundred twenty-four patients with both type 2 diabetes and hyperlipidemia. MEASUREMENTS AND MAIN RESULTS: Sixty-nine patients (58%) met the National Cholesterol Education Program Adult Treatment Panel II's goals for LDL (< 130 mg/dl for primary prevention and < 100 mg/dl for secondary prevention). Only 47 patients (38%) were in compliance with national standards for both systolic and diastolic blood pressures. The mean hemoglobin A1c (A1C) level was 8.6%; 27 patients (21.8%) had A1C levels below 7%. CONCLUSION: A high percentage of patients in our family practice clinic met their goals for reducing lipid levels, but more aggressive therapy is necessary to attain glucose and blood pressure goals. Data from this study emphasize the need for understanding which factors influence clinicians' treatment decisions.