PubMed Health⌕ Search

Biomedical subjects

Dov Gavish

Publications and source records attributed to Dov Gavish.

13 recordsLinked to original sources
PubMed2006

9-cis beta-carotene-rich powder of the alga Dunaliella bardawil increases plasma HDL-cholesterol in fibrate-treated patients.

The effect of fibrates on high density lipoprotein (HDL)-cholesterol levels is suggested to be mediated by its binding to peroxisome proliferator-activated receptor-alpha (PPARalpha). Upon ligand binding, PPARalpha heterodimerizes with the 9-cis retinoic acid receptor (RXR) and it is this heterodimer which regulates gene expression. We assessed the hypothesis that a combined treatment with fibrate plus 9-cis beta-carotene-rich powder of the alga Dunaliella bardawil, as a source of 9-cis retinoic acid, would improve the drug's effect on HDL-cholesterol levels. In an open-labeled first trial, 20 fibrate-treated men with plasma HDL-cholesterol levels below 40 mg/dl were given Dunaliella capsules, providing 60 mg beta-carotene/day, containing all-trans and 9-cis beta-carotene (1:1 ratio, w/w). Twenty-two fibrate-treated patients participated in a double-blind placebo-controlled second trial. Eleven patients were treated with Dunaliella capsules, and 11 patients were treated with beta-carotene-deficient Dunaliella capsules. Following 6 weeks of the dual treatment plasma HDL-cholesterol increased by 24.5 and 12.7% in the first and second trials, respectively (P=0.002 and 0.012). The dual treatment also increased HDL-cholesterol levels in human apolipoprotein A-I transgenic mice by 87.5% (P=0.021). The results show that a combination treatment of fibrate plus 9-cis beta-carotene-rich Dunaliella powder amplifies the effect of the drug on HDL-cholesterol levels.

Adult↗
PubMed2005

Beyond guidelines: achieving the optimum in LDL cholesterol control.

PURPOSE OF REVIEW: Despite clear treatment guidelines, a major part of the population is not achieving the recommended LDL cholesterol target levels. This fact is more prominent among high-risk populations in which the majority of patients are untreated or undertreated. RECENT FINDINGS: The review will elaborate on the key issues of treating large populations: patient compliance, drug efficacy, cost-benefit, and physician quality of care. SUMMARY: A programme aimed at improving control of hyperlipidemia should address all four issues. The primary care physician should be empowered and given tools for optimizing treatment.

Cholesterol, LDL↗
PubMed2005

Cardiovascular risk assessment and treatment to target low density lipoprotein levels in hospitalized ischemic heart disease patients: results of the HOLEM study.

BACKGROUND: Hypercholesterolemia control status is lacking throughout the western world. OBJECTIVES: To examine whether the treatment recommendations given to ischemic heart disease patients at hospital discharge are compatible with the guidelines of the Israeli medical societies and the U.S. National Cholesterol Education Program for coronary artery disease prevention; and to study the effects of brief educational sessions on the adherence of physicians with the guidelines. METHODS: We included consecutive IHD patients admitted to four central hospitals in Israel between 1998 and 2000. The study was conducted in two phases. In phase 1, we reviewed discharge letters to document treatment recommendations given to each patient. In phase 2 we educated the practitioners by reviewing the Israeli medical societies and the NCEP guidelines and the quality of their recommendations in phase 1, after which we reevaluated the discharge letters. RESULTS: The study included 2,994 patients: 627 in phase 1 and 2,367 in phase 2. Of the patients who needed cholesterol-lowering according to their low density lipoprotein levels, 37.4% were not prescribed such drugs at discharge (under-treatment group). This proportion was reduced by education to 26.6% (P < 0.001) in phase 2. Of the treated patients, 65.6% did not reach the target LDLgoal in phase 1 (under-dosage group) as compared to 60.2% in phase 2 (P = 0.23). In phase 2 there was an increase in the percent of patients reaching LDL levels <130 mg/day (69.3% vs. 63.8% of patients prescribed medication, P = 0.01), but the percent of patients reaching' LDL levels <100 was not different in phase 2 after adjusting for age and gender (the odds ratio for reaching target LDL was 1.16, with 95% confidence interval of 0.95-1.43). CONCLUSIONS: Physician recommendations to IHD patients discharged from hospital were suboptimal. We documented a high proportion of under-treated and under-dosaged patients. Brief educational sessions have a beneficial effect on the usage of statins; however, additional effort in guideline implementations is needed.

Arteriosclerosis↗
PubMed2005

[Lack of treatment continuance: an obstacle for controlling blood pressure].

INTRODUCTION: Blood pressure is one of the most prevalent risk factors for CVD. Despite the large arsenal of medications, the rate of BP control is not optimal. We studied the amount of attention family physicians pay to BP readings and treatment recommendations of hypertensive patients that were discharged from the hospital. METHODS: We included 98 consecutive hypertensive patients (mean age 68.5 +/- 1.1, 44% males) admitted to the hospital. Excluded were patients referred to the hospital from a nursing home. BP measurements were obtained at ER, admission to the ward, 2nd day of admission and day of discharge. Recommended treatment was obtained from the discharge letter. A phone call was made to each patient, 4-8 weeks after discharge, and data was obtained regarding recent BP levels and the current treatment. RESULTS: BP control was achieved in 48% of the patients at hospital discharge and 47% at follow-up. Among patients that received different treatment at follow-up because of the physician's advice or because they were considered to have a high BP (24 patients), BP control was reduced from 63% at discharge to 50% at follow-up. This reduction was attributed to decreased dosage of medications and to the replacement of medications with drugs from the same group, but given at nonequivalent doses. Ten patients that were controlled at discharge but not at follow-up were given fewer medications than recommended (2.7 vs. 3.2). Among the noncontrolled patients with BP > 140/90 at follow-up, treatment was not changed for 48%. CONCLUSION: The blood pressure treatment guidelines are not implemented, and the data regarding BP control that appears in the discharge letter is not adequately used by the family physicians. A better relationship between hospitals and family practice should be obtained to aid in controlling BP.

Aged↗
PubMed2004

Persistent anemia in otherwise asymptomatic severe aortic stenosis: a possible indication for valve replacement?

BACKGROUND: The indication for aortic valve replacement in patients with significant aortic stenosis is symptomatology. Aortic stenosis may be associated with bleeding from colonic angiodysplasia, resulting in anemia. Persistent anemia in such patients, despite lack of an identifiable source of bleeding, is not considered an indication for valve replacement. OBJECTIVES: To report our experience with two elderly female patients who suffered from severe asymptomatic aortic stenosis, low levels of large von Willebrand factor multimer (10% and 5% respectively) and persistent anemia requiring multiple blood transfusions. METHODS: Both patients underwent an intensive work-up, but a source of bleeding could not be identified. Aortic valve replacement was performed in both patients. RESULTS: Aortic valve replacement abolished the need for further blood transfusions during a follow-up period of 20 months with normalization of the vWF multimer level (20% and 30% respectively). CONCLUSION: We suggest that aortic valve replacement be considered in selected patients with severe, otherwise asymptomatic aortic stenosis, who suffer from persistent anemia requiring multiple blood transfusions, lack an identifiable source of bleeding and have low levels of large vWF multimers.

Aged↗
PubMed2004

Atorvastatin reduces fibrinogen levels in patients with severe hypercholesterolemia: additional evidence to support the anti-inflammatory effects of statins.

BACKGROUND: Elevated fibrinogen levels are considered a risk factor for the development of atherosclerosis and might be used as a predictor of risk for the development of atherothrombotic events. Several studies have reached equivocal conclusions regarding the effect of statins on fibrinogen. OBJECTIVES: To evaluate the effect of atorvastatin on plasma fibrinogen levels in patients with severe hypercholesterolemia and no other risk factors. METHODS: Twenty-two patients with low density lipoprotein-cholesterol levels above 170 mg/dl (4.40 mmol/L) and with no other risk factors were included in the study. None of the patients had ever received hypolipidemic medication. Patients were followed for 24 weeks (6 office visits 4 weeks apart). During office visits, lipid profile, complete blood count, fibrinogen and C-reactive protein levels were measured. RESULTS: After 24 weeks of follow-up, total cholesterol decreased by 33% (287 +/- 10 to 192 +/- 8 mg/dl, P < 0.001), LDL-C by 45% (198 +/- 8 to 111 +/- 7 mg/dl, P < 0.001) and triglycerides by 21% (189 +/- 26 to 138 +/- 15 mg/dl, P < 0.001). Fibrinogen levels dropped by 18% (355 +/- 26 to 275 +/- 7 mg/dl, P = 0.01). CRP levels decreased from 0.51 +/- 0.15 to 0.28 +/- 0.10 mg/dl, but the difference was not statistically significant (P = 0.09). High density lipoprotein, hemoglobin, white blood cell and platelet counts did not change. CONCLUSIONS: We found that atorvastatin reduces plasma fibrinogen in patients with hypercholesterolemia.

Adult↗
PubMed2003

Treatment with rosiglitazone reduces hyperinsulinemia and improves arterial elasticity in patients with type 2 diabetes mellitus.

OBJECTIVE: The aim of this study was to determine whether reduction of hyperinsulinemia with rosiglitazone will improve vascular elasticity in patients with non-insulin dependent diabetes mellitus. METHODS: In an open label study 52 patients with non-insulin dependent diabetes mellitus and at least one additional cardiovascular risk factor, were treated for 6 months with 4 mg of rosiglitazone, and uptitrated to 8 mg after 3 months of treatment, if needed. At the beginning of the study and at its end, blood was drawn for insulin, C- peptide, and 24-h urine collected for microalbuminuria/proteinuria. Glucose, chemistry, lipid profile, and hemoglobin A1C were determined at 0, 3, and 6 months. Vascular compliance was measured in monthly intervals. RESULTS: Treatment increased significantly small artery elasticity from 1.45 to 2.43 mL/mm Hg x 100. Large artery elasticity tended to increase toward the end of the study (P = not significant). Systolic blood pressure (BP)decreased from 144 to 124 mm Hg and diastolic BP decreased from 80 to 62.5 mm Hg, despite mild weight gain [corrected]. Heart rate tended to decrease from 76.3 to 74.7 beats/min (P = not significant). Systemic vascular resistance decreased from 1789.8 to 1329.4 dyne sec/cm(5). Plasma insulin, in patients not treated with insulin, decreased from 42.45 +/- 24.90 to 27.86 +/- 14.86 IU/mL (P =.0001). CONCLUSIONS: Treatment with rosiglitazone reduced hyperinsulinemia and improved small artery elasticity with a tendency to improve large artery elasticity, in hypertensive and in normotensive patients. Because rosiglitazone improves insulin receptor sensitivity (IRS), it is logical to assume that the reduction in hyperinsulinemia reflects improvement in IRS. Our data support the hypothesis that hyperinsulinemia and IRS participate in the mechanisms of tissue injury and their improvement induces improvement in arterial elasticity.

Adult↗
PubMed2003

Treatment with amlodipine and atorvastatin have additive effect in improvement of arterial compliance in hypertensive hyperlipidemic patients.

BACKGROUND: This study investigates the effect of amlodipine on arterial compliance (AC), and the effect of atorvastatin on AC when given in combination with amlodipine. METHODS: Twenty-one consecutive hypertensive hyperlipidemic patients were included in this study. Patients were followed every month for 6 months (3 months of amlodipine therapy and 3 months of amlodipine and atorvastatin combination). RESULTS: During the 3 months of amlodipine monotherapy, large and small AC were improved by 26% and 38%, respectively, and the systemic vascular resistance was reduced by 10%. The addition of atorvastatin during the next 3 months improved small AC by an additional 42% and decreased the systemic vascular resistance by another 5%, but large AC and blood pressure did not change. CONCLUSIONS: Amlodipine improves large and small AC, and the beneficial effect of atorvastatin on small AC is additive to the effect achieved by amlodipine.

Aged↗
PubMed2003

Risk factor profile and achievement of treatment goals among hypertensive patients in general practice in Israel: baseline results from the Israeli Blood Pressure Control (IBPC) program.

BACKGROUND: The Israeli Blood Pressure Control program was initiated to enhance the control of modifiable risk factors among high risk hypertensive patients followed by general practitioners in Israel. OBJECTIVE: To report the baseline results of the state of the treatment regarding blood pressure management, lipid and glucose control as well as obesity and smoking cessation among the patients. METHODS: Hypertensive patients were screened in 30 general practice clinics supervised by family medicine specialists seeing 1,000-5,000 patients each. Between 50 and 250 hypertensive patints were diagnosed at each participating clinic. Blood pressure levels, body mass index, lipid and glucose levels, as well as target organ damage and medications were recorded for all patients. RESULTS: Of the 4,948 patients registered, 2,079 were males (42%). Mean age was 64.8 +/- 12. Blood pressure control was achieved in only 33.1% of total hypertensive patients. Low density lipoprotein control was achieved in 31.1% of all patients, and glucose control in only 28.5%% of diabetic patients (glucose < 126 mg/dl); 20.7% of the diabetics had glucose levels above 200 mg/dl. In this group of patients 38.9% were obese (BMI > 30 kg/m2). While there were more obese females than males (48.0% vs. 35.6%), no difference was found in blood pressure, lipid or glucose control between the genders. CONCLUSION: Risk factor management of hypertensive patients attending general practice clinics in Israel is not optimal, especially among those with diabetes or in need of secondary prevention measures. A long-term intervention program for high risk patients in the community is needed to improve the current situation.

Antihypertensive Agents↗
PubMed2002

Prolonged treatment with the AT1 receptor blocker, valsartan, increases small and large artery compliance in uncomplicated essential hypertension.

BACKGROUND: Decreased arterial compliance (AC) is considered an early marker of vascular wall damage. Hypertension gradually decreases arterial compliance. We studied whether treatment with the angiotensin type 1 (AT(1)) antagonist valsartan will affect AC in patients with essential hypertension (EH). METHODS: Twenty-two patients with EH, 6 men and 16 women, mean age 58.7 +/- 4.1 years, without overt target organ damage were included. Antihypertensive medications were withdrawn for 3 weeks, Valsartan was given at 80- and 160-mg doses. The AC, blood pressure (BP), blood, and urine were measured monthly. Large (C1) and small (C2) AC were derived from radial artery waveforms, obtained using a calibrated tonometer (model CR-2000, HDI Inc., Eagan, MN). RESULTS: After 3 months, systolic BP decreased from 172 +/- 17 to 142 +/- 13 mm Hg (P <.0001) and diastolic BP from 95 +/- 9 to 82 +/- 8 mm Hg (P <.0001). The decrease in BP was significant within 1 month and improved further on. The C1 increased by 22%, from 8.0 +/- 3.1 to 9.7 +/- 2.3 mL/mm Hg x 10 (P <.01). The C2 increased by 35%, from 2.9 +/- 1.3 to 3.9 +/- 1.9 mL/mm Hg x 100 (P <.01). Both C1 and C2 reached statistical significance only after 3 months. Systemic vascular resistance (SVR) decreased by 15% from 2,140 +/- 376 to 1,817 +/- 262 dynes/sec/cm(-5) (P <.0001). CONCLUSIONS: Treatment with valsartan in patients with EH improves small and large AC. The improvement in AC was significant only after 3 months of treatment, whereas systolic BP, diastolic BP, and SVR decreased earlier. The AT(1) receptor blockade with valsartan seems to be an effective means of not only lowering BP but of reversal of vascular wall damage, which predisposes to cardiovascular events.

Angiotensin Receptor Antagonists↗
PubMed2002

Efficacy of atorvastatin in treating high risk patients to reach low density lipoprotein-cholesterol goals: the Treat to Target (TTT-Israel) Study.

BACKGROUND: Hyperlipidemia is a major risk factor for coronary heart disease. Reducing low density lipoprotein-cholesterol can significantly reduce the risk of CHD, but many patients fail to reach the target LDL-C goals due to low doses of statins or low compliance. OBJECTIVES: To treat high risk patients with atorvastatin in order to reach LDL-C goals (either primary or secondary prevention) of the Israel Atherosclerosis Society. METHODS: In this open-label study of 3,276 patients (1,698 of whom were males, 52%), atorvastatin 10 mg was given as a first dose, with follow-up and adjustment of the dose every 6 weeks. While 1,670 patients did not receive prior hypolipidemic treatment, 1,606 were treated with other statins, fibrates or the combination of both. RESULTS: After 6 weeks of treatment, 70% of the patients who did not receive prior hypolipidemic medications and who needed primary prevention reached target LDL-C levels. Interestingly, a similar number of patients who received prior hypolipidemic treatment (other statins, fibrates or both) and who did not reach the LDL-C treatment goals reached the LDL-C goals for primary prevention with atorvastatin. Only 34% of all patients who needed secondary prevention reached the ISA LDL-C target of 100 mg/dl. Atorvastatin proved to be completely safe, only two patients had creatine kinase elevation above 500 U/L, and another six had mild CK elevation (< 500 U/L). None of the patients had clinical myopathy, and only one had to be withdrawn from the study. CONCLUSION: Atorvastatin is a safe and effective drug that enables most patients requiring primary prevention to reach LDL-C goal levels, even with a low dose of 10 mg. Patients in need of secondary prevention usually require higher doses of statins.

Adult↗
PubMed2002

Follow-up in a lipid clinic improves the management of risk factors in cardiovascular disease patients.

BACKGROUND: The implementation of treatment guidelines is lacking worldwide. OBJECTIVES: To examine whether follow-up in a specialized lipid clinic improves the achievement rate of the treatment guidelines, as formulated by the National Cholesterol Education Program and the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. METHODS: The study group included patients who were referred to the lipid clinic because of hyperlipidemia. At each of five visits over a 12 month period, lipid levels, liver and creatine kinase levels, body mass index, and adherence to diet and medications were measured, and achievement of the NCEP target level was assessed. RESULTS: A total of 1,133 patients (mean age 61.3 years, 60% males) were studied. Additional risk factors for atherosclerosis included hypertension (41%), type II diabetes mellitus (21%), smoking (17%), and a positive family history of coronary artery disease (32%). All patients had evidence of atherosclerotic vascular disease (coronary, cerebrovascular or peripheral vascular diseases). The low density lipoprotein target of < 100 mg was present in only 22% of patients before enrollment, with improvement of up to 57% after the follow-up period. During follow-up, blood pressure control was improved (from 38% at the time of referral to 88% after 12 months, P < 0.001), as was glycemic control in diabetic patients (HgA1C improved from 8.2% to 7.1% after 12 months, P < 0.001). Improved risk factor control was due to increased compliance to medication treatment (from 66% at enrollment to more than 90% after 12 months), as well as careful attention to risk factor management that translated into a change in the treatment profile during the follow-up. There was an increase in the use of the following medications: aspirin from 68% to 96%, statins from 42% to 88%, beta blockers from 20% to 40%, and angiotensin-converting enzyme inhibitors from 28% to 42%; while calcium channel blocker use decreased from 40% to 30% in patients during follow-up. CONCLUSION: Follow-up of patients in a specialized clinic enhances the achievement of LDL-cholesterol treatment goals as well as other risk factor treatment goals, due to increased patient compliance and increased use of medications.

Adult↗