Biomedical subjects

C Cortese

Publications and source records attributed to C Cortese.

78 records · Page 5Linked to original sources

PubMedDate not supplied

[Statins: similarities and differences in the pharmacological, clinical and laboratory aspects].

The inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase (or statins) are the most powerful drugs affecting lipid and lipoprotein levels in plasma. Results obtained from large controlled trials using simvastatin, pravastatin and lovastatin for the primary or secondary prevention of coronary heart disease have demonstrated that treatment with statins is associated with a significant reduction in coronary morbidity and mortality and in total mortality. This is probably due to a more general anti-atherogenic effect of these drugs beyond their lipid-lowering activity. Meta-analysis of data from these large trials indicates that statins have an impact also on the incidence of cerebrovascular events. Currently, six statins have been approved for therapeutic use in different countries. In spite of the similarities in their chemical structure and mechanisms of action, statins may differ in many aspects such as pharmacological properties (hydrophilic vs lipophilic, elimination half-life, cytochrome P450 metabolism, etc.), effects on lipid and other biochemical variables, or pleiotropic effects on different metabolic processes related to atherosclerosis (endothelial function, platelet aggregation, immune function, etc.). In general, the safety and tolerability profile for all statins currently in use is good with a < 2% incidence of undesirable effects.

Atorvastatin↗

PubMedDate not supplied

[Atherosclerosis in light of the evidence from large statin trials].

The results of the large trials with the inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase (or statins) in terms of clinical benefits in patients with coronary artery disease indicate that these drugs act in a complex way on several pathways involved in the atherosclerotic process. Beyond their lipid-lowering activity, statins appear to modify many characteristics of the arterial wall, resulting in protection against the progression of plaque growth and/or the precipitation of acute events. The so called "pleiotropic" effects of statins, such as the restoration of endothelial activity, the antioxidant potential or the antiproliferative effect on smooth muscle cells, have been investigated mainly in in vitro experiments. In the near future, it will be necessary to unravel the biological significance and the clinical relevance of these effects, which also involve other pathological conditions such as cancer and osteoporosis. Furthermore, lessons from the trials with statins have allowed a better understanding of the mechanisms leading to atherosclerosis which is now considered as an inflammatory process affecting the vascular wall. This has opened new perspectives in the search for the development of newer and more targeted anti-atherogenic drugs.

Arteriosclerosis↗

PubMedDate not supplied

Early signs of carotid and iliac atherosclerosis in patients with severe hyperlipoproteinemia.

Hyperlipidemia is a major risk factor for atherosclerosis. Early signs of cardiovascular disease can be detected also in asymptomatic patients with hyperlipidemia. Forty-four patients with serum cholesterol greater than 300 mg/dl (7.8 mmol/l) and/or serum triglycerides greater than 500 mg/dl (5.6 mmol/l) and 35 healthy controls had their carotid and iliac arteries examined by echo-Doppler with spectral analysis. Systolic ankle pressure was also measured. A vascular score was calculated: a 0 score was assigned to normal findings and a 1 score for each artery with abnormality at echo-Doppler or Winsor index less than 0.97. The XbaI Restriction Fragment Length Polymorphism of Apo B gene was investigated in all hyperlipidemic patients. Arterial lesions, especially those of internal carotid and iliac arteries, were more frequent (p less than 0.01) in patients with high serum lipids, compared to controls. Patients with lesions were older and had higher serum triglyceride concentrations compared to those without lesions. When divided according to serum triglycerides, patients with concentrations exceeding 200 mg/dl had higher vascular score (p less than 0.02) compared to those with serum triglycerides less than 200 mg/dl. No difference in restriction fragment length polymorphism (XbaI) of Apo B gene was demonstrated in patients with arterial lesions compared to those without lesions. Non-invasive echo-Doppler examination gives useful information on the arterial involvement of hyperlipidemic patients and its use should therefore be implemented, especially when high triglyceride concentrations are present.

Apolipoproteins B↗

PubMedDate not supplied

[Selective adsorption of homocysteine using HFR-on line technique].

Homocysteine (Hcy) is grossly elevated in hemodialysis (HD) patients. Treatment with folic acid and/or vitamin B12 fails to normalize Hcy levels in the majority of patients. Treatment with various dialyzers with different flux characteristics has produced contrasting results. Hemodiafiltration reinfusion (HFR) on-line (double chamber hemodiafiltration (HDF) with regenerated ultrafiltrate reinfusion) is a novel method combining the processes of diffusion, convection and absorbance. The ultrafiltrate is regenerated through a charcoal-resin device. Our aim was to observe the effect of the HFR on-line technique on removing Hcy. We investigated the effect of this treatment on Hcy levels in 10 patients with a mean Hcy level of 57.6 micromol/L (range 24.1-119.7). We measured Hcy, folate and vitamin B12 pre- and post-dialysis and in the ultrafiltrate pre- and post-cartridge at 10, 120 and 240 min. Mean Hcy levels were 57.6 and 35.3 micromol/L (range 9.9-80.3) (p=0.005) pre- and post-dialysis, respectively, while folate and vitamin B12 were unchanged. Pre- and post-cartridge Hcy levels were 11.6 vs 2.5 (p=0.005), 9.3 vs 3.9 (p=0.005), 7.7 vs 4.6 micromol/L (p=0.012) at three time points considered, while folate and vitamin B12 were essentially undetectable. These preliminary data, which need confirmation in a long-term study, seem to indicate that HFR on-line reduces Hcy levels, not only through a possible reduction in uremic toxins, but also through the actual removal of Hcy by absorbance on the charcoal-resin cartridge.

Adult↗

PubMedDate not supplied

[New trends in the prevention of ischemic heart disease].

In the past years several studies have confirmed the causal role of the three major risk factors, i.e. hypercholesterolemia, hypertension and cigarette smoking in the determination of atherosclerosis and its major complication, coronary heart disease (CHD). In particular the Lipid Research Clinics Primary Prevention Trial and, more recently, the Helsinki Heart Study, have demonstrated beyond doubt the effectiveness of dietary and pharmacological intervention in subjects affected by hypercholesterolemia. The mounting alertness derived from the results of these and other trials has generated the need for "codifying" strategies directed towards the prevention of CHD in the industrialized western world. The population strategy tends to modify cultural and environmental habits such as diet, cigarette smoking, alcohol abuse, physical exercise etc. The individual strategy is directed at identifying, within each population, those individuals who are probably carriers of a particular risk factor, for instance those affected by hyperlipidemia of genetic origin. The two strategies are intended to be two complementary moments in the ceaseless fight against CHD.

Adult↗

PubMedDate not supplied

Lipoprotein abnormalities and extracoronary atherosclerosis in patients with premature ischemic heart disease.

A study of serum lipoprotein (VLDL, LDL, HDL) concentration has been performed on 36 males who had undergone an aorto-coronary bypass operation before age 50. They have been compared to 33 healthy men in the same age range. The presence and severity of coronary, carotid and peripheral atherosclerosis in these patients has been evaluated on the basis of coronary angiograms, continuous wave Doppler and Duplex scanning by echo-Doppler. Lipoprotein abnormalities have been related to the occurrence of extracoronary arterial lesions in association with myocardial ischemia. Total serum cholesterol and triglycerides, LDL cholesterol and triglycerides were higher in IHD patients (p less than 0.05), while HDL cholesterol was lower (p less than 0.01). No statistically significant difference was detected in VLDL lipids or apo B and in LDL apo B. Signs of extracoronary atherosclerosis were more frequent among IHD patients than in controls. Ankle/arm pressure ratio was abnormally low in 12 patients as compared to only one control (p less than 0.01). Echo-Doppler examinations of iliac arteries demonstrated a higher prevalence of lesions among IHD patients as compared to controls (20 versus 2; p less than 0.01). All patients (4 out of 36) with audible carotid bruits had stenoses in the internal carotid artery. In order to evaluate the relationships between lipoprotein concentration and occurrence of extracoronary atherosclerosis, analysis of variance and multiple comparisons were performed on values for lipoprotein concentration in three groups: controls, IHD patients without evidence of extracoronary atherosclerosis, IHD patients with detectable extracoronary lesions. Significant differences among the three groups were demonstrated as regard to LDL cholesterol or triglycerides and HDL cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗