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Estrogen replacement therapy (ERT) and LDL-cholesterol targets
Thursday June 29, 2000: Read by Title Abstracts T:W31 Prevention of CVD
IThT19:W31 ] Five years experience with preventive activities in hypercholesterolemic children J. HyAnek1, V. Martin~ov~0, L. Vadurova I , J. Dvo~Akovd I , L. T~iborsk~ l .
/Dept. Clin. Biochem., Metab. Unit, Hospital, "Na Homolce", Prague, Czech Republic
Objective: To present our live years experience with preventive activities of "Parents's Club for Children Suffering from Familiar Hypercholesterolemia". Methods and Results: 100 children (4-18 yrs) suffering from familiar hypercholesterolemia (FH), born from parents with high cardiovascular risk (at least one parent or grandparent after operation of aortoconary or peripheral artery bypasses) attend the metabolic surgery for dietetic or medical treatment of FI-I. Parents of these children are organized in the "Club" in order to support the preventive activities in risk families and to increase the production and quality control of lowcholesterol products on the market. The prominent activities and efforts are as follows: • Education: lectures and courses of invited specialists dealing with genetic, metabolic and enviromenta[ risks for these children; dietetic rules for preparation and cooking of lowcholesterul foods and dishes; warning against not recommended "pseudolowcholesterul" products (burners, supervitamins etc). • Organization: rehabilitation of children in swimingpool, summer holiday camps in mountains for whole families; weekends-trips. • Quality control: controlling of recommended low-cholesterol products labelled in Delvita supermarkets with the logo "Program For Health". These lowcholesterol products are selected and recommended only after laboratory confirmation of low cholesterol content in the State Veterinary Institute. Conclusions: We have good experience with the managing of this Club. It can help us to recognize the nutritional and psychosocial behaviour of the family and to increase the compliance for dietetic treatment of FH. We can detect the anxious families where children could be damaged by strong lowcholesterol diet.
I ThT20:W31 t Estrogen replacement therapy (ERT) and LDL-cholesterol targets A.A. Faludi 1, M.C. Bertolami 1, A.T. Paes I , J.M. Aldrighi 2./lnstituto Dante
Pazzanese de Cardiologia; 2Faculdade de Sadde Pdblica da Universidade de S~o Paulo, Sdo Paulo, Brazil
Objective: To evaluate, in postmenopausal women, the importance of ERT in the modification of LDL-c targets from <130 mg/dL to <160 mg/dL, considering that ERT dismisses menopause as a risk factor (RF) for coronary heart disease. Methods: We analyzed postmenopausal women, followed in a Cardiology Ambulatory for primary prevention of coronary heart disease. The association of RF (hypertension, obesity, smoking status and familiar antecedents) was investigated Results: Among 227 included women, ages varying from 50 to 92 years old (average 64.5), 64 (28.2%) were ERT users. Considering that ERT nullifies menopause as a RF, the table shows the percentages of women with and without ERT, and after annulment of menopause as a RF, that already were in the target LDL-c zones < 130 and 160 mg/dL before any therapy. Thirty six women from a total of 45 (80%) who were on ERT and presented at least two RF and accordingly had LDL-c target < 130 mg/dL, changed the therapeutic target to < 160 mg/dL. LDL-c
No ERT
With ERT
With ERT*
<130 < 160
3.8% 41 (125) 65.8% 25 (38)
40% 18 (45) 52.6% 10 (19)
22.2% 2 (9) 70.9% 39 (55)**
% and numbers of women who presented LDL-c target with and without ERT. Total numbers of each target group appear between brackets. *after annulment of menopause as a RF due to ERT. **p = 0.04.
Conclusion: In this population, the percentage of ERT users that had their LDL-c therapeutic target increased from 130 to 160 was significant, justifying the discussion of the importance of ERT in this context. l ThT21 :W31 ] Prevalence of blood hypertension in dyslipidemic patients S. Bottazzo, G.C. Griffo, P. Zanchi. Medical Dep., Umberto 1 Hospital,
Venice-Mestre, Italy The value of blood pressure in un important parameter in order to evaluate the risk of coronary heart disease in dyslipidemic patients. The aim of this study was to measure blood pressure (BP) in a group of hyperlipidemic subjects
317
using office conventional (OBP) and ambulatory monitoring blood pression (AMBP) methods. In 50 (30 E 20 M, aged 57 d: 7 ys) dyslipidemic patients clinical BP was taken at two separate sitting by manual device and the average was recordered. All patients were submitted to 24-hour BP monotoring by pressurometric device (Del Mar Avionics P6). The 24-h, daytime and nigthftme measures were cosidered. The BP values (mean + SD) are shown in the Table:
PAS PAD
OBP
24-h
148 ~ 14 92 4- 10
120 :t: 12 69 ± 9
Daytime
Nigthtime
125 4- 12 72 4- 9
113 :t: 14 65 :t= 9
With OBP values, 53% of patients have to be considered hypertensive (BP > 140/90 m m Hg) while with ABPM (Daytime > 135/85 m m Hg) only 29%. Conclusions: EAS guidelines recommend to evaluate BP in all dyslipidemic patients. In our study hypertension was overestimated by OBP respect to ABPM. In patients with hyperlipidemia we suggest to perform a ABPM before to assess the global risk for CHD.
ThT22:W31
1
I Effect of policosanoi in older patients with type II hypereholesterolemia and high coronary risk
G. Castafio 1, g. M ~ 2, J.C. Ferufindez2 , J. Illnait 2, L. Ferudndez 2, E. Alvarez2./Medical Surgical Research Center; 2Center of Natural
Products, National Center for Scientific Research, Havana, Cuba The present study was undertaken to investigate the effects of policosanol in older patients with type II hypercholesterulemia and >1 concomitant atherosclerotic risk factors. After 6 weeks on lipid-lowering diet, 179 patients randomly received placebo or policosanol at 5 and 10 mg/d for successive periods of 12 weeks each one. Policosanol (5 and 10 mg/d) significantly (p < 0.001) reduced LDL-C (16.9% and 24.4%) and (TC) (12.8% and 16.2%); significantly (p < 0.01) raised (p < 0.001) HDL-C by 14.6% and 29.1%, and consequently, significantly decreased (p < 0.01) ratios of LDL-C/HDL-C (29.1%) and TC/HDL-C (28%). Triglycerides remained unchanged after therapy. Policosanol, but not placebo, significantly improved (p < 0.01) cardiovascular capacity as assessed using the Specific Activity Scale. No serious adverse experiences (AE) occurred in policosanol patients compared with 7 AE (7.9%) reported by placebo patients (p < 0.01). This study shows that policosanol is effective, safe and well tolerated in older hypercholesterolemic patients. I
ThT23:W31 Ii The cardiologist and the cholesterol-lowering therapy: A
different approach for a better prevention of the coronary heart disease
R. Volpe, A. Rossetti I , V.N. Di Lecce 2, G.L. Softs, R. Di Giovambattista I .
Prevention and Protection Department of the Italian National Research Council, Cardiology Unit of the Castel di Sangro Hospital; 2Medical Clinic I of the University of Rome "La Sapienza", Rome, Italy Many important pharmacological studies have put in evidence that both the patients already suffering from coronary heart disease (CHD) (4 S, CARE, LIPID) and those who are at high coronary risk (WOSCOPS) receive benefit from the pharmachological therapy with statines. Yet, other studies (EUROSPIRE Study, Italian Project of Coronary Units) stress the fact that less than 1/3 of the CHD patients are treated with statines. Moreover, in many cases, the statines are not prescribed with continuity but in therapeutic cycles (The "Di.S.Co." Project of the Italian National Research Council). Some hypotheses may explain a similar approach by cardiologists: a greater importance attributed to the coagulation mechanisms and to the haemodynamic factors of the atherosclerosis rather than to the metabolic factors; the considerable amount of drugs tha the patients suffering from CHD already take regularly; the conviction that the revascularization procedures will solve the problem; the underassessment of cholesterol levels when measured short time after a coronary event; the conviction that cholesterol lowering drugs have a high hepatic and muscular toxicity; the concern that the reduction of the cholesterol levels may involve an excess of mortality for turnouts, accidents suicides. However, if we consider how well tolerated and safe the statines are, even if used for long periods, the remarkable reduction in cardiovascular risk obtained with these drugs in patients already well treated for the CHD ("the added benefit" of the statines), the clinical evidence that the benefits of the cholesterul-lowering therapy (not only reduction of incidence of coronary events
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000
IThT19:W31 ] Five years experience with preventive activities in hypercholesterolemic children J. HyAnek1, V. Martin~ov~0, L. Vadurova I , J. Dvo~Akovd I , L. T~iborsk~ l .
/Dept. Clin. Biochem., Metab. Unit, Hospital, "Na Homolce", Prague, Czech Republic
Objective: To present our live years experience with preventive activities of "Parents's Club for Children Suffering from Familiar Hypercholesterolemia". Methods and Results: 100 children (4-18 yrs) suffering from familiar hypercholesterolemia (FH), born from parents with high cardiovascular risk (at least one parent or grandparent after operation of aortoconary or peripheral artery bypasses) attend the metabolic surgery for dietetic or medical treatment of FI-I. Parents of these children are organized in the "Club" in order to support the preventive activities in risk families and to increase the production and quality control of lowcholesterol products on the market. The prominent activities and efforts are as follows: • Education: lectures and courses of invited specialists dealing with genetic, metabolic and enviromenta[ risks for these children; dietetic rules for preparation and cooking of lowcholesterul foods and dishes; warning against not recommended "pseudolowcholesterul" products (burners, supervitamins etc). • Organization: rehabilitation of children in swimingpool, summer holiday camps in mountains for whole families; weekends-trips. • Quality control: controlling of recommended low-cholesterol products labelled in Delvita supermarkets with the logo "Program For Health". These lowcholesterol products are selected and recommended only after laboratory confirmation of low cholesterol content in the State Veterinary Institute. Conclusions: We have good experience with the managing of this Club. It can help us to recognize the nutritional and psychosocial behaviour of the family and to increase the compliance for dietetic treatment of FH. We can detect the anxious families where children could be damaged by strong lowcholesterol diet.
I ThT20:W31 t Estrogen replacement therapy (ERT) and LDL-cholesterol targets A.A. Faludi 1, M.C. Bertolami 1, A.T. Paes I , J.M. Aldrighi 2./lnstituto Dante
Pazzanese de Cardiologia; 2Faculdade de Sadde Pdblica da Universidade de S~o Paulo, Sdo Paulo, Brazil
Objective: To evaluate, in postmenopausal women, the importance of ERT in the modification of LDL-c targets from <130 mg/dL to <160 mg/dL, considering that ERT dismisses menopause as a risk factor (RF) for coronary heart disease. Methods: We analyzed postmenopausal women, followed in a Cardiology Ambulatory for primary prevention of coronary heart disease. The association of RF (hypertension, obesity, smoking status and familiar antecedents) was investigated Results: Among 227 included women, ages varying from 50 to 92 years old (average 64.5), 64 (28.2%) were ERT users. Considering that ERT nullifies menopause as a RF, the table shows the percentages of women with and without ERT, and after annulment of menopause as a RF, that already were in the target LDL-c zones < 130 and 160 mg/dL before any therapy. Thirty six women from a total of 45 (80%) who were on ERT and presented at least two RF and accordingly had LDL-c target < 130 mg/dL, changed the therapeutic target to < 160 mg/dL. LDL-c
No ERT
With ERT
With ERT*
<130 < 160
3.8% 41 (125) 65.8% 25 (38)
40% 18 (45) 52.6% 10 (19)
22.2% 2 (9) 70.9% 39 (55)**
% and numbers of women who presented LDL-c target with and without ERT. Total numbers of each target group appear between brackets. *after annulment of menopause as a RF due to ERT. **p = 0.04.
Conclusion: In this population, the percentage of ERT users that had their LDL-c therapeutic target increased from 130 to 160 was significant, justifying the discussion of the importance of ERT in this context. l ThT21 :W31 ] Prevalence of blood hypertension in dyslipidemic patients S. Bottazzo, G.C. Griffo, P. Zanchi. Medical Dep., Umberto 1 Hospital,
Venice-Mestre, Italy The value of blood pressure in un important parameter in order to evaluate the risk of coronary heart disease in dyslipidemic patients. The aim of this study was to measure blood pressure (BP) in a group of hyperlipidemic subjects
317
using office conventional (OBP) and ambulatory monitoring blood pression (AMBP) methods. In 50 (30 E 20 M, aged 57 d: 7 ys) dyslipidemic patients clinical BP was taken at two separate sitting by manual device and the average was recordered. All patients were submitted to 24-hour BP monotoring by pressurometric device (Del Mar Avionics P6). The 24-h, daytime and nigthftme measures were cosidered. The BP values (mean + SD) are shown in the Table:
PAS PAD
OBP
24-h
148 ~ 14 92 4- 10
120 :t: 12 69 ± 9
Daytime
Nigthtime
125 4- 12 72 4- 9
113 :t: 14 65 :t= 9
With OBP values, 53% of patients have to be considered hypertensive (BP > 140/90 m m Hg) while with ABPM (Daytime > 135/85 m m Hg) only 29%. Conclusions: EAS guidelines recommend to evaluate BP in all dyslipidemic patients. In our study hypertension was overestimated by OBP respect to ABPM. In patients with hyperlipidemia we suggest to perform a ABPM before to assess the global risk for CHD.
ThT22:W31
1
I Effect of policosanoi in older patients with type II hypereholesterolemia and high coronary risk
G. Castafio 1, g. M ~ 2, J.C. Ferufindez2 , J. Illnait 2, L. Ferudndez 2, E. Alvarez2./Medical Surgical Research Center; 2Center of Natural
Products, National Center for Scientific Research, Havana, Cuba The present study was undertaken to investigate the effects of policosanol in older patients with type II hypercholesterulemia and >1 concomitant atherosclerotic risk factors. After 6 weeks on lipid-lowering diet, 179 patients randomly received placebo or policosanol at 5 and 10 mg/d for successive periods of 12 weeks each one. Policosanol (5 and 10 mg/d) significantly (p < 0.001) reduced LDL-C (16.9% and 24.4%) and (TC) (12.8% and 16.2%); significantly (p < 0.01) raised (p < 0.001) HDL-C by 14.6% and 29.1%, and consequently, significantly decreased (p < 0.01) ratios of LDL-C/HDL-C (29.1%) and TC/HDL-C (28%). Triglycerides remained unchanged after therapy. Policosanol, but not placebo, significantly improved (p < 0.01) cardiovascular capacity as assessed using the Specific Activity Scale. No serious adverse experiences (AE) occurred in policosanol patients compared with 7 AE (7.9%) reported by placebo patients (p < 0.01). This study shows that policosanol is effective, safe and well tolerated in older hypercholesterolemic patients. I
ThT23:W31 Ii The cardiologist and the cholesterol-lowering therapy: A
different approach for a better prevention of the coronary heart disease
R. Volpe, A. Rossetti I , V.N. Di Lecce 2, G.L. Softs, R. Di Giovambattista I .
Prevention and Protection Department of the Italian National Research Council, Cardiology Unit of the Castel di Sangro Hospital; 2Medical Clinic I of the University of Rome "La Sapienza", Rome, Italy Many important pharmacological studies have put in evidence that both the patients already suffering from coronary heart disease (CHD) (4 S, CARE, LIPID) and those who are at high coronary risk (WOSCOPS) receive benefit from the pharmachological therapy with statines. Yet, other studies (EUROSPIRE Study, Italian Project of Coronary Units) stress the fact that less than 1/3 of the CHD patients are treated with statines. Moreover, in many cases, the statines are not prescribed with continuity but in therapeutic cycles (The "Di.S.Co." Project of the Italian National Research Council). Some hypotheses may explain a similar approach by cardiologists: a greater importance attributed to the coagulation mechanisms and to the haemodynamic factors of the atherosclerosis rather than to the metabolic factors; the considerable amount of drugs tha the patients suffering from CHD already take regularly; the conviction that the revascularization procedures will solve the problem; the underassessment of cholesterol levels when measured short time after a coronary event; the conviction that cholesterol lowering drugs have a high hepatic and muscular toxicity; the concern that the reduction of the cholesterol levels may involve an excess of mortality for turnouts, accidents suicides. However, if we consider how well tolerated and safe the statines are, even if used for long periods, the remarkable reduction in cardiovascular risk obtained with these drugs in patients already well treated for the CHD ("the added benefit" of the statines), the clinical evidence that the benefits of the cholesterul-lowering therapy (not only reduction of incidence of coronary events
Xllth International Symposium on Atherosclerosis, Stockholm, Sweden, June 25-29, 2000