Diagnosis and Management of Statin Intolerance Alonso, Rodrigo; Cuevas, Ada; Cafferata, Alberto
Journal of Atherosclerosis and Thrombosis,
03/2019, Letnik:
26, Številka:
3
Journal Article
Odprti dostop
Statins are the main treatment for hypercholesterolemia and the cornerstone of atherosclerotic cardiovascular disease prevention. Many patients taking statins report muscle-related symptoms, one of ...the most important causes of statin treatment discontinuation, which is associated with an increased risk of cardiovascular events. Therefore, it is important to identify patients who are truly statin intolerant to avoid unnecessary discontinuation of this beneficial treatment. Some studies indicate that not all muscle complaints are caused by statins, and most patients can tolerate a statin upon re-challenge, down-titration of dose, or switching to another statin. In this paper, we review the definitions of statin intolerance and approaches to reducing cardiovascular risk among individuals reporting statin-associated muscle symptoms.
Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not ...routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.
Findings from epidemiological studies over the past 30 years have shown that visceral adipose tissue, accurately measured by CT or MRI, is an independent risk marker of cardiovascular and metabolic ...morbidity and mortality. Emerging evidence also suggests that ectopic fat deposition, including hepatic and epicardial fat, might contribute to increased atherosclerosis and cardiometabolic risk. This joint position statement from the International Atherosclerosis Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity summarises the evidence for visceral adiposity and ectopic fat as emerging risk factors for type 2 diabetes, atherosclerosis, and cardiovascular disease, with a focus on practical recommendations for health professionals and future directions for research and clinical practice. We discuss the measurement of visceral and ectopic fat, pathophysiology and contribution to adverse health outcomes, response to treatment, and lessons from a public health programme targeting visceral and ectopic fat. We identify knowledge gaps and note the need to develop simple, clinically applicable tools to be able to monitor changes in visceral and ectopic fat over time. Finally, we recognise the need for public health messaging to focus on visceral and ectopic fat in addition to excess bodyweight to better combat the growing epidemic of obesity worldwide.
COVID-19 is a pandemic disease caused by a coronavirus, designed as SARS CoV-2, whose clinical presentation is widely variable, with most patients having mild or no symptoms, but others developing a ...malign disease with multi-organ failure and even death. Accumulating data from different populations have shown that obesity is a risk factor for a severe evolution of the disease, however, the mechanisms that explain this association are not clearly understood. An ominous evolution of COVID-19 has been attributed to an exacerbated inflammatory response, designed as "cytokine storm" with augmented production of cytokines/chemokines through the activation of toll-like receptors (TLR) by pathogen-associated molecular patterns, that triggers an inflammatory downstream response, mediated in part by the adaptor molecule, myeloid differentiation factor 88 (MyD88). Previous studies have reported an increased expression of MyD88 and TLRs in people with obesity, mainly in those with metabolic complications. Therefore, we hypothesize, that an underlying increased Myd88/TLR signaling may predispose to patients with obesity to develop an exaggerated and dangerous inflammatory reaction against SARS CoV-2 infection, explaining at least in part, the higher severity of COVID-19. In addition, MyD88/TLR signaling in people with obesity could have a role in the development of several chronic diseases.
Aims
Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to ...effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs).
Materials and methods
An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs who were primarily concerned with direct patient care.
Results
A total of 14 502 PwO and 2785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of three (mean, six) years between the time PwO began struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest in or motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; however, more referrals and follow‐up appointments are required.
Conclusions
Our international dataset reveals a need to increase understanding of obesity and improve education concerning its physiological basis and clinical management. Realization that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations.
Abstract An international panel of the International Atherosclerosis Society has developed a new set of recommendations for the management of dyslipidemia. The panel identifies non-high-density ...lipoprotein cholesterol as the major atherogenic lipoprotein. Primary and secondary prevention are considered separately. Optimal levels for atherogenic lipoproteins are derived for the two forms of prevention. For primary prevention, the recommendations emphasize lifestyle therapies to reduce atherogenic lipoproteins; drug therapy is reserved for subjects at greater risk. Risk assessment is based on estimation of lifetime risk according to differences in baseline population risk in different nations or regions. Secondary prevention emphasizes use of cholesterol-lowering drugs to attain optimal levels of atherogenic lipoproteins.
Abstract Objectives Weight regain after bariatric surgery may be associated with behavioral, metabolic, or mechanical factors alone or in combination. The aim of this study was to investigate which ...factors are related to weight regain in the long-term after sleeve gastrectomy (SG). Methods A retrospective case–control study with 40 patients undergoing SG (32 women, 8 men; age 42.9 ± 10.7 y; preoperative body mass index 35 ± 2.8 kg/m2 ), was performed. Patients were grouped according percentile—>50% (cases) or <50% (controls)—of weight regain (%WR cutoff: 25% of weight loss). Weight history, anthropometry, glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), thyroid-stimulating hormone, resting energy expenditure, body composition, dietary survey, psychological test, and physical activity were recorded. Residual gastric capacity was estimated using a radiologic method. Results (median p25–p75) The evaluation was conducted 38.5 mo (34–41 mo) after SG. Percent weight regain ranged from 2.7% to 129.2% (25.4% 13–37.1). Patients in the higher %WR group had a greater residual gastric volume (252.7 ± 108.4 versus 148.5 ± 25.3; P < 0.05) and the estimated volume was significantly correlated with %WR ( r = 0.673; P = 0.023). Significantly higher body mass index ( P = 0.001), resting energy expenditure ( P = 0.04), fasting insulin ( P = 0.01), and HOMA-IR ( P = 0.02) were observed in the higher %WR group. A higher fat intake and a trend toward higher total energy intake were observed in the group with greater %WR. Clinical or borderline levels of anxiety were more frequently observed in the higher %WR group (70% versus 30%; P = 0.01). Conclusions Results from the present study demonstrated that the most important factor associated with long-term weight regain after SG was residual gastric volume. Additional prospective studies with larger numbers of patients are necessary to confirm our results.
In March of 2020, the World Health Organization declared the SARS‐Cov2 2019 (COVID‐19) outbreak a global pandemic after documenting community scale transmission in every region, including Latin ...America. The risk factors associated with severity of disease include older age, diabetes, hypertension, cardiovascular and lung diseases, and immune suppression. Additional evidence strongly suggests that obesity is also a risk factor for severe forms of COVID‐19 disease, while other types of malnutrition increase the risk of hospitalization from influenza‐like diseases, regardless of the causative agent of the illness (1). Although detailed data are not yet available on the impact of under nutrition in the evolution of COVID‐19, given the known inflammatory response caused by this condition, it is reasonable to expect a suboptimal immune response and higher risk of severity, as found with obesity (2).
Indicaciones para el uso de los inhibidores de la PCSK9 Alonso, Rodrigo; Cuevas, Ada
Revista colombiana de cardiología (Bogotá, Colombia : 1989),
November 2017, 2017-11-00, 2017-11-01, Letnik:
24, Številka:
S2
Journal Article
Recenzirano
Odprti dostop
Los anticuerpos monoclonales anti PCSK9, evolocumab y alirocumab, representan un nuevo grupo de hipolipemiantes no-estatinas, destinados a conseguir reducciones significativas en el cLDL, ...específicamente en pacientes de alto riesgo cardiovascular que no logran las metas en el cLDL propuestas en la actualidad a pesar de cambios en el estilo de vida, tratamiento máximo tolerado de estatinas en monoterapia o combinadas con ezetimibe, así como en aquellos que son intolerantes o tienen contraindicación para el uso de estatinas pero que igualmente tienen alto riesgo de eventos cardiovasculares. La evidencia clínica demuestra que los i. PCSK9 son fármacos eficaces y seguros, que reducen los eventos cardiovasculares.
The anti-PCSK9 monoclonal antibodies evolocumab and alirocumab represent a new group of non-statin hypolipidemic medications targeted at achieving significant reductions in LDLc, specifically in patients with high cardiovascular risk who do not attain the currently recommended LDLc goals, despite lifestyle changes and a maximum tolerated dose of statins in monotherapy or combined with ezetimibe. They are also directed to patients with intolerance, or a contraindication, to the use of statins, but who also have a high risk of cardiovascular events. The clinical evidence shows that the PCSK9 inhibitors are effective and safe medications, and that they reduce cardiovascular events.
Set-point theory and obesity Farias, Maria Magdalena; Cuevas, Ada M; Rodriguez, Fatima
Metabolic syndrome and related disorders
9, Številka:
2
Journal Article
Recenzirano
Obesity is a consequence of the complex interplay between genetics and environment. Several studies have shown that body weight is maintained at a stable range, known as the "set-point," despite the ...variability in energy intake and expenditure. Additionally, it has been shown that the body is more efficient protecting against weight loss during caloric deprivation compared to conditions of weight gain with overfeeding, suggesting an adaptive role of protection during periods of low food intake. Emerging evidence on bariatric surgery outcomes, particularly gastric bypass, suggests a novel role of these surgical procedures in establishing a new set-point by alterations in body weight regulatory physiology, therefore resulting in sustainable weight loss results. Continuing research is necessary to elucidate the biological mechanisms responsible for this change, which may offer new options for the global burden of obesity.
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