Serum Total Cholesterol Levels Would Predict Nosocomial Infections After Gastrointestinal Surgery

It has been suggested that total cholesterol levels and the use of statin medications are associated with the incidence of complications after gastrointestinal surgery. The aim of this study was to determine if preoperative total cholesterol levels are associated with a higher risk of postoperative infections and mortality. A total of 2211 patients undergoing general surgical procedures between December 2006 and November 2008 at Iizuka Hospital and between January 2010 and March 2012 at Jichi Medical University Hospital were reviewed. Multiple logistic regression models were used to evaluate serum total cholesterol and other variables as predictors of postoperative nosocomial infections. Serum total cholesterol concentrations lower than 160 mg/dl were associated with an increased incidence of superficial and deep incisional surgical site infections. Serum total cholesterol levels showed a reverse J-shaped relationship with the development of organ space surgical site infection and pneumonia. There was no discernible effect of serum cholesterol levels on the postoperative mortality observed in this cohort of patients. Decreased serum albumin was one of the strongest risk factors for the development of nosocomial infection after surgery. Postoperative pneumonia was not observed in patients taking statin medications whose cholesterol levels were <200 mg/dl. Serum total cholesterol may be a valid predictor of surgical outcome. Preoperative statin use may affect the development of postoperative pneumonia in patients with total cholesterol levels below 200 mg/dl.     

Combined intake of glucose-and lipid-lowering medications further elevates plasma levels of PCSK9 in type 2 diabetes patients

Background and aimThis study examined the status of plasma levels of protein convertase subtilisin/kexin 9 (PCSK9) in association with glucose-and lipid-lowering medications in subjects with type 2 diabetes (T2D).MethodsThis study comprised 177 diabetics and 115 non-diabetic subjects recruited from the United Arab Emirates National Diabetes Study (UAEDIAB). Clinical and biomedical data were collected by standard techniques. Plasma levels of PCSK9 were determined using ELISA.ResultsPCSK9 levels were higher in diabetics than non-diabetics (P < 0.001). Diabetics with disease duration >5 years, HbA1c > 7.0%, or male subjects, had significantly higher levels of PCSK9 than their counterparts (P < 0.05). Regression analysis revealed that HbA1c and age are predictors for PCSK9 in T2D subjects. Diabetic subjects with abnormal lipids profile on lipid-lowering medications had a higher level of PCSK9 compared to those with normal lipids profile (85.6 ± 40.5 vs. 63.7 ± 39.5 ng/ml, respectively; P < 0.01). Diabetics on combined intake of insulin and oral glucose-lowering drugs had higher levels of PCSK9 than those not taking any (86.1 ± 41.6 vs 69.7 ± 36.1 ng/ml, respectively; P < 0.05). The highest levels of PCSK9 however, were in diabetics on combined lipid- and glucose-lowering therapy when compared to those, not on any (96.2 ± 34.0 vs 66.0 ± 35.1 ng/ml, respectively; P < 0.01).ConclusionsAge and HbA1c are the most predictors for the elevated levels of PCSK9 in Emirati T2D subjects. Combined therapy of glucose-and lipid-lowering medications further elevates plasma levels of PCSK9 in diabetic subjects.     

阿托伐他汀对冠状动脉微栓塞后心肌炎症的影响

目的 探讨阿托伐他汀干预治疗对冠状动脉微栓塞（CME）后心肌炎症的影响.方法 48只清洁级雄性SD大鼠经左心室内注射自体微血栓,同时短暂夹闭主动脉,建立大鼠CME模型后,随机分为未治疗组及阿托伐他汀（Atrovastatin）干预组,于术后7 d处死.HE染色观察梗死心肌,免疫组织化学染色及Western blot检测肿瘤坏死因子α（TNF-α）、白介素6（IL-6）及细胞间黏附因子1（ICAM-1）等炎症因子在心肌中表达的变化.结果 阿托伐他汀可轻度减少梗死面积,显著抑制CME后心肌中白细胞浸润及TNF-α、IL-6、ICAM-1 蛋白表达（P均〈0.05）.结论 阿托伐他汀能显著抑制CME后心肌炎症反应.     

他汀类药物对颈动脉支架置入预后的影响

目的探讨应用他汀类药物对颈动脉支架置入术(CAS)预后的影响。方法回顾性分析2001年1月—2012年8月,在首都医科大学宣武医院神经外科实施CAS治疗的患者1700例,按是否服用他汀类药物分为他汀组1224例和非他汀组476例。降脂目标为将低密度脂蛋白胆固醇(LDL-C)水平降至2.1 mmol/L或降低基础水平的40%。比较两组患者术后30 d内卒中、心肌梗死和死亡的总发生率,分析他汀类药物与不良事件发生的相关性及并发症的危险因素。结果支架置入技术成功率100%。(1)术后30 d内43例(2.53%)患者出现主要不良事件,其中卒中34例、心肌梗死1例、死亡8例,应用他汀组术后主要不良事件发生率为1.96%(24/1224),而非他汀组术后主要不良事件发生率为3.99%(19/476),两组差异有统计学意义(χ2=5.731,P=0.017)。两组卒中发生率分别为1.56%(19/1224)和3.16%(15/476),差异有统计学意义(P0.05)。(2)围手术期服用他汀类药物是CAS良好预后的保护性因素(OR=0.524,95%CI:0.279~0.983;P=0.044)。结论 CAS的预后他汀治疗组术后主要不良事件发生率低于非他汀治疗组,他汀治疗可降低不良终点事件的发生率。     

冠状动脉支架置入术1年随访LDL-C控制及他汀使用情况:与新指南的距离

目的分析冠状动脉支架置入术后1年随访时低密度脂蛋白胆固醇(LDL-C)控制及他汀使用情况,并与新指南对照。方法入选2010年9月至2012年12月在解放军第三〇六医院心血管内科行冠状动脉支架置入术患者539例,随访1年,收集复查资料,包括LDL-C水平及生化指标以及他汀类药物使用情况。结果治疗1年后,按2004年ACC/AHA血脂指南LDL-C水平,达标373例(69.2%),未达标166例(30.8%)。按2013年ACC/AHA新指南评价,LDL-C水平达标195例(36.1%),未达标344例(63.9%)。两种标准评价是否一致Kappa值为-0.047,P=0.178,两种标准比较存在明显统计学差异。他汀类药物治疗以阿托伐他汀(n=247,10 mg~80 mg)和瑞舒伐他汀(n=147,5 mg~20 mg)为主,其他还包括辛伐他汀(n=139,25.7%,10 mg~40 mg),氟伐他汀(n=2,40 mg),普伐他汀(n=4,40mg)。根据新指南中他汀类药物治疗强度,本研究中低强度降脂治疗21例(4.0%),中等强度512例(94.9%),高强度6例(1.1%),43例联合普罗布考治疗。结论按2013年新指南,冠状动脉支架置入术后他汀治疗1年,随访时多数患者LDL-C不达标,新指南是否适合中国人群需要进一步研究。     

不同ASCVD危险分层患者LDL-C达标及影响因素分析

目的 分析不同动脉粥样硬化性心血管疾病（ASCVD）危险分层患者低密度脂蛋白胆固醇（LDL-C）达标情况及影响因素。方法 本研究纳入2018年6月～2019年3月至大连解放军第967医院就诊的既往给予他汀类药物治疗的患者为研究对象,通过询问并记录的方式收集、整理患者的一般情况和临床资料。根据《中国成人血脂异常防治指南（2016修订版）》将入选患者分为极高危（n=242）、高危（n=207）、低中危（n=139）三组。将极高危患者LDL-C达标定义为坚持或间断服用他汀类药物且LDL-C＜1.8 mmol/L,高危组及低中危组达标分别定义为LDL-C＜2.6 mmol/L和＜3.4 mmol/L,无论是否使用他汀类药物。采用单因素分析影响他汀服药依从性的相关变量,并建立Logistic回归模型进行多因素分析以探讨影响他汀服药依从性的独立影响因素。结果 ①LDL-C达标率在极高危患者为42.1%,高危患者为59.4%,低中危患者为81.3%;不同危险分层患者LDL-C达标率比较,差异有统计学意义（P=0.000）。②极高危和高危患者LDL-C不达标原因包括联合使用降脂药物（他汀类药物联合依折麦布）比例低（10.0%和2.4%）、使用低剂量他汀类药物（37.9%和31.0%）及不按医嘱服药（26.4%和56.0%）;低中危患者LDL-C不达标原因主要为使用低剂量他汀类药物（23.1%）和不按医嘱服药（76.9%）。③单因素分析显示,年龄≤65岁、使用药物种类≤3种和对药物认知良好的患者服药依从性显著增高（均P＜0.05）;独居状态、低收入及易被非医疗机构保健信息影响的患者服药依从性明显偏低（均＜0.05）。④多因素Logistic回归分析显示,使用药物种类少、对药物认知程度良好可以增加他汀类药物服药依从性;低收入、独居状态和非医疗机构保健信息影响可降低他汀类药物服药依从性。结论 改善ASCVD危险患者LDL-C达标率需强化医生对降脂药物的合理使用和提高患者服药依从性。     

The Role of Homocysteine‐Lowering B‐Vitamins in the Primary Prevention of Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of mortality in the Western world. The effort of research should aim at the primary prevention of CVD. Alongside statin therapy, which is maintained to be an effective method of CVD prevention, there are alternative methods such as vitamin B substitution therapy with folic acid (FA), and vitamins B₁₂ and B₆. B‐vitamins may inhibit atherogenesis by decreasing the plasma level of homocysteine (Hcy)—a suspected etiological factor for atherosclerosis—and by other mechanisms, primarily through their antioxidant properties. Although Hcy‐lowering vitamin trials have failed to demonstrate beneficial effects of B‐vitamins in the prevention of CVD, a meta‐analysis and stratification of a number of large vitamin trials have suggested their effectiveness in cardiovascular prevention (CVP) in some aspects. Furthermore, interpretation of the results from these large vitamin trials has been troubled by statin/aspirin therapy, which was applied along with the vitamin substitution, and FA fortification, both of which obscured the separate effects of vitamins in CVP. Recent research results have accentuated a new approach to vitamin therapy for CVP. Studies undertaken with the aim of primary prevention have shown that vitamin B substitution may be effective in the primary prevention of CVD and may also be an option in the secondary prevention of disease if statin therapy is accompanied by serious adverse effects. Further investigations are needed to determine the validity of vitamin substitution therapy before its introduction in the protocol of CVD prevention.     

他汀类药物应用与新发糖尿病风险的关系

<正>心脑血管动脉粥样硬化的发病率呈逐年上升趋势。多种危险因素如脂代谢紊乱、胰岛素抵抗、糖尿病和高血压会诱发和促进动脉粥样硬化的发生。这些危险因素常常共存于同一个患者,并加剧动脉粥样硬化的发展速度[1]。而他汀类药物在动脉粥样硬化性心血管疾病的一级和二级预防中     

JCL roundtable: Managing lipid disorders in young women

The roundtable discussion in this issue will focus on the problems faced by young women with lipid disorders. This is often the source of confusion for the patient and physician because the myth continues that young women do not have complications of atherosclerosis as a result of elevated blood cholesterol. The essential role of women in bearing children during the early years of adulthood also produces difficult decisions because the mother and fetus are usually experiencing similar exposure to therapeutic regimens. We are joined in this discussion by Drs. Pamela Morris of the Medical University of South Carolina and Robert Wild of the University of Oklahoma Health Sciences Center. Dr Morris is an Internist, and Dr Wild is an Obstetrician and Gynecologist. Both are board certified in clinical lipidology and are actively publishing in this field. We have recorded this roundtable discussion during the National Lipid Association Scientific Sessions held in New Orleans during May 2016.