P52 Brisighella Heart Study: evaluation of compliance to therapy

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s24 P52

P54

Brisighella Heart Study: evaluation of compliance to therapy Nascetti S. M.D., D’Addato S. M.D. PbD, Dormi A Math. D, Gaddi A M.D. PbD. Dip. Medicina Clinica e Biotecnologia Applicata, Centro Atcrosclerosi, Universiti degli Stodi di Bologna. Via Massarenti9,40138 Bologna -Introduction- An important problem in the prescription of chronic therapies (T) is compliance. The percentage of subjects that interrupt or irregularly follow pharmacologicalT varies 6om 4% to 15% in the first year of treatment, and may reach 30% if the T last five years or more. - Aims- Evaluation of tbe compliance to lipid-lowering drug T in tbe populatiozintervention study Brisigbella Heart Study (BHS). -Method- The Brisigbella Study is a longitudinal and observational, study which began in 1972 and is still in progress. Of tbe 3636 citizens tbat attended the 1988 control, 1521 were selectedon tbe basis of their cholesterolemia levels to take part in the BHS, and 688 of these were followed every 6 months, l?om 1988 to 1994. The follow-up included 10 check-ups,over an average of 5 years (range 4-7) of observation, with a total of 3449.5 person years. Tbe analysis was based on 352 (51.2%) subjectswho attendedall the controls. -Results- The 352 subjects were divided into 3 compliance groups: I) those who took T regularly - 54 (15.3%), II) those who never took T - 90 (25.6%), III) those who took T irregularly - 208 (59.1%), 176 (67.2%) of whom began T at the first control. The meanduration of T in this last group was 28.8 months(range 6-54). The 3 groups differed significantly (p
BODY

COMPOSITION PATIENTS

AND

BALANCED

HYPOCALOIUC

DIET

IN

WITR REART TRANSPLANTATION. PRELIMINARY DATA. GuzzoG., SaniG”, Monto@&&, MuliaariM., hiaccheriniMO.,Scopetani N.,MontagmniM Instituteof InternalMedicineandMedicalPathology,’ HeartSurgery Institute.Universityof Siena.Italy. It is known that patients subjected to heart transplantation, indipendentlyfrom the individual clinical motivations,need prolonged immunosuppressant therapy (corticostemids, cyclosporine) with inevitable repercussionson tbe body composition and on the blood parameters,both for interferencewitb ti principal mechanismsof the intermediarymetabolismandfor kidney suffering. Therefore, in tbe present study in collaboration witb the Heart Surgery Institute of tbe University of Siena, we have investigatedthe possibleinfluence of balancedhypocsloric diet on body compositionof the aforesaid patients. In order we have emploied the body bioelectricsl impedanceanalysis (STA/BIA Akem-Italy) for nutritional assessment In particular the technique allows to evaluate the total body water (TBW), fat mass(FM), fat fTeemass(FFM) and theoretical basal metabolic rate. Till now we have evaluated 6 male patients and the sntbropomedc study was completed by body composition analysis by bioelectricsl impedance(age range 5 li13,2 years, BMI 30.&7,27% fat mass 24,2+4,25% TBW 54&5,8 FM/FFM 3,2+0,82).At the momentonly one patient hasbeen checked atI.%2 months f?om the beginning of the diet, in this case we have observed a hearteningimprovement of tbe metabolic blood values as well ss of the body composition , which showed reduction of tbe FM with conservationof the FFM. Therefore it is our intention to increasetbe actoal casestudy in the convinction that checkedandbalancedfeedingcould sarve,togetbaran opportunemotor rehabilitation in the long term managementof the patient subjectedto hearttransplantation.

P53 P55 Hypercholuterolemia in children: muln of an alitnmt~ referencestudyIn a Re& EmiIiaprimary ,chcol w

educational

ManicatdiV., MichclliniD.*, MontomiM.

Dept.of InternalMedicine,Hospitalof Guastalla.AUSLReggioEmilia * Dept.of Pediatrics,AUSLR&o Emilia lncrcasedle;ek of plasmacbolatercl and ewn athetosdemsis lesionshavebeen demiied in children.From 1990to 1994an educationalalimentaryproject (named‘Amicodbo’l - cartiedout in the ‘Collodi’ PrimarySchmlin R&o El&a. MElHODS: 193childtenaacd611 y., 106M and 87 F, participatedin the study. The family history of CVD, obesity and hypercholenemlemia was tecotded.Plasmalevel of total ch&teml (CTI Rctlotton, Boehtinget).height andwdghtweremeasuted. Alimentaryhabitswetcinvestigatedwith a cmnplete onedayrecall.All parpmnaswac collectedat the beginningand after 4 years of the interdbdplinatyeducationalalimmtarypmject. RESULTS:TC levelsdateued ftom 162* 2Eto l%f 27 mg/dl (p-0.07).The prevalmceof children with a TC>170 mg/dl dareawd from 31 to 22%, p200 mg deaeasedfimn 9.4 to 6.9%. H~holestetolania was mxe frequentlyfound in children with a family history of the fame (SOVI 2896,p-0.04), but not in thosewith a CVD and obesityhistory. 17.9%of the chiklten wete overv&ht or obeseand 61%of themhadat least onenatentin the #amecondition.Hvuercholatcrolemia ~0s more frequentin the &se atoup (34 va 26%Yad a”TC level>170m$/dl, u=NSI. The nutritional data showed an exce&e intake of liuida (35%) and _ ~~I ~~ cholatnol (272mg/lOXIKcal/day),P poor &take of fibpa (i3 &day) and catbohydrata(49,5%).Theselevelswereunrelatedto sex,bodyweightandTC. In the 8roupaaa whole,the cholestetolintakedexaxd at the endof the study (from 272 to 204 tng/looO Kcal/day, pZOO mg/dl,ftom212to 178ms/dl @
EFFECTS OF EQUAL DOSES OF PRAVASTATIN, SIMVASTATIN AND ATORVASTATIN IN HETEROZYGOUS PATIENTS WITH FAMILIAL HYPERCEOLESTEROLEMIA De Mattei S, Masturzo P, Fascetti V, Elicio N and Bertolini S. Dpt. of Internal Medicine, Univ. of Genoa - Italy. Forty-two patients with severe heterozygous Familial Hypercholesterolemia ( 16M and 26F, 58.6f12.3 years of age) were treated for separate periods with 40 mgiday of Pravastatin (P), Simvastatin (S) and Atorvastatin (A). Each period of this open study lasted from 3 to 6 months. Plasma lipid concentrations (mmol/L) and safety parameters were determined monthly and the comparisons among treatments were performed using the mean value obtained in each patient during each treatment period.

Baseline P

S A

Total chol. LDL chol. HDL chol. Triglyc. 11.00*1.48 8.99k1.38 1.25f0.34 1.87kO.72 8.25kO.89 6.46f0.85 1.37kO.34 1.43f0.54 j 7.82flo.87 1 5.86ti.89 ) 1.37+0.31 1 1.45M.57 j 6.53kO.83 1 4.67+0.75 1 1.32f0.30 1 1.23f0.55

During the P, S and A periods the % variations observed were: - 25.0, - 28.0 and - 40.6 for total chol. (P < S < A, P A, P 0.003); - 23.5, -22.4 and - 34.2 for triglycerides (P = S < A, PcO.001). The percentage of patients with clinical or biochemical side effects (about 3%) was similar for each dw.