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P60 Lowering blood cholesterol in survivors of Myocardial infarction (MI): still a challenge
Abstracts
S26
P62
P60 Lowering blood cholesterol in survivors of Infarction (MI): still a challenge
Myocardial
M. Ferraro, F.Florio, E. Stellitano, F. Naccarato. V.Tucci, D. Galasso, A.Pujia on behalf of of CAL.1.M. group Department of experimental medicine - University of Catanzaro Very strong evidence exists to support lowering blood cholesterol in secondary prevention. In fact a reduction of 40% in mortality is achievable with a reduction of LDL levels. Nevertheless many physicians show reluctance to treat hypercolesterolemia in survivors of MI. We evaluated the management of cardiovascular risk factors focusing on the treatment of hypercholesterolemia in 902 patients who were survivors of MI. The data were collected from medical records of patients admitted to the Hospital’s Internal Medicine Units from January 1 to December 3 1 1997. The patients should have had a diagnosis of MI (by ECG and enzymes elevation) and a total cholesterol above 220 mg/dl or under treatment with hypolipidemic agents. The mean age was 68 (41-93 y). 244 (26.6%) patients were eligible. Among these only 44 (I 8%) were treated. The therapeutic goal (TCQZO mg/dl) was reached only in I8 patients (41%). Very few females and elderly people were treated (Fig. I). Therefore the treatment of hypercholesterolemia in secondary prevention remain a challenge.
ANTIPLATELET THERAPY IN PATIENTS WITH LOWER LIMBS ARTERIOPATHY: A IO-YEAR PROSPECTIVE STUDY. Carlo Giansante, Nicola Fiotti, Salvatore Calabrese, Claudia Del Be/lo, Frank0 Krbavcic, Gianfranco Guarnieri. OBJECTIVES. The aim of this study was to determine whether antiplatelet therapy was effective in prOteChg patients with lower limbs arteriopathy (LLA) against vascular death and non-fatal vascular events. METHODS. A cohort of 223 patients with LLA, second Stage according Fontaine, was randomly assigndtake ASA or ticlopidine, and followed for 10 years. Patients underwent regular visits for monitoring the evolution of the LLA and for determining some coagulation markers, every six months. The primary and point was a composite of vascular death and major vascular events, furthermore death for any causes was monitored. The controls consisted in 446 subjects, matched for sex and age, randomly selected from the Regional Health Database. RESULTS. Total, vascular and neoplastic mortality was higher in patients with LLA than in COntrOk; total mOrkditY Was similar in patients treated with ASA or with ticlopidine. Cardiac vascular events were significantly lower in patients treated with ticlopidine than in those treated with ASA. CONCLUSIONS. Despite antiplatelet therapy, the Overall mortality in patients with LLA is higher than in the general population; ticlopidine is more effective than ASA in protecting against cardiac vascular events.
P61 SEVERE INTERMITTENT CLAUDICATION TREAThiENT WITH PGE, a - CICLODESTRINA IV.: COSTS / EFFECTIVNESS ANALYSIS OF A NEW “SHORT TERM” PROTOCOL.
M. Bucci, *MR Cesamne,*MT. De Sanctis,D. Di Clemente,P. Iacobitti, *L. Ineandela, *G. Laurora, F. Mauna, A Nepa, F. Spitaleri, P. Undo, M Zimarino, $kN. Nicolaides, *G. Bekam, G. Martines. of Chieti Univ.; *Angiology Centre of ‘Pierangeli” Clinic, Medical The Pescara;Italy,T St Mary’s Hospital, London Univ., U.K. PGE, a-ciclc&trina is mofe and more used in the medical treatmentof severe intermittent clauctication,but their therapeuticpmtocols are generally too long for patients@ts) and too expensive for the community. Methods: To confirm PGE,‘s efficacy and safety and to analyze the costs of the different treatment protocols, we suggesteda new “short term protocol” (ST?) eomparedwith the classic “long term protocol” (LTP) in a randomized 20-week study including 109pts., divided into 2 groupsclinically [averagetotal walking distance (TWD) of 65fs ml, age (62f8 yrs) and sex (M= 60.4%) matched.LTP (PGE, 60 @die, 5 clayseach week, for 4 weeks and then twice a week for other 4 weeks) was performed in 55 pts. The remaining 54 pts. were treatedwith STP (60 pg BID, only for two days every 4 weeks, for 12 weeks). Treadmill testswemprformed at the inclusioq at the beginning of each phase and at the end of 20 week. In bath groups similar training plan was used and all pts. were advisedto reducetheir risk factors. Results: Intention-to-treat analysis indicated au increase in TWD at the 4m week(101.5%inSTpvs78.3%inLTp,~.05),atthe8~(260.9%vs107.3% p~O.05)and at 20mweek (351% vs 242%, p
P63 Glococortioidstherapy reduceslipoproteia (a) serumlevelsin patientswith ob6troctiverespiratorydiseasm A. Montagnani, l A. Fossi, l V. Beltmmi, M. Mom. Institute of Internal Medicine and * Institute of Respiratory Diseases, University of Siena The Lipoprotein (a) [Lp(a)] is consideredan atherosclerotic risk faaor sif&bntly associatedwith coronary artery diseaseaad less influenced by drugs.Howcar, some data on @ocorticoids (GCS) treatment to suggesta lowering innueace on Lp(a) levels by therapy with GCS. In order to investigate further this issue,we have studied 21 patients (age range: 69i6 years) affected by obstructive broncopulmonary dig and treated with GCS ml I2 healthy subjectsage and sex matched.Total cholesterol, LDL-cholesterol, HDLcholesterol and Triglycaides (TG) serumlevels have been assessedin fasting blood samplesdrawn at basehe, 3”, 7”, 14* day; in &II period methylpreduisoloae was tapaed over from 20 mg twice day to I6 mg once day. Moreover, au additional lipid assessmenthas been performed at IS* day a&r GcS withdrawal. Two-sample analysis and analysis of variance have been pafomred with parametric and non-parametric test, as appmpriate. Q(a) circulating mediau levels showed a progressive decreasein obstructive respiratory patients during GCS treatmentreaching a significant wO.05) difference with respectto basal values at 7’ and 14’ by, dmdkr Lp(a) trends towards the basal values. Moreover, we found a signifcaat (pdO.05)difference (6.Oti.8 mg/dl vs 10.2f1.9 rngdl) ofLp(a) values between treated patients aad healthy subjectsat 7 day. Throughout the study period any significant changehas been found both ia patients and in control group. Our data Seemto point out a GCS infhmace on L&a) serumlevels. In addition to the well known effects GCS therapy might be able to re&w Lp(a) semm levels in patients with obshuctive bmnchop~~aun~p&y. However, further investigaticmsare neededto better clarify whether GCS could have any protecting effect on athemscle.roticcornnary diseaseby reducing Lp(a).
S26
P62
P60 Lowering blood cholesterol in survivors of Infarction (MI): still a challenge
Myocardial
M. Ferraro, F.Florio, E. Stellitano, F. Naccarato. V.Tucci, D. Galasso, A.Pujia on behalf of of CAL.1.M. group Department of experimental medicine - University of Catanzaro Very strong evidence exists to support lowering blood cholesterol in secondary prevention. In fact a reduction of 40% in mortality is achievable with a reduction of LDL levels. Nevertheless many physicians show reluctance to treat hypercolesterolemia in survivors of MI. We evaluated the management of cardiovascular risk factors focusing on the treatment of hypercholesterolemia in 902 patients who were survivors of MI. The data were collected from medical records of patients admitted to the Hospital’s Internal Medicine Units from January 1 to December 3 1 1997. The patients should have had a diagnosis of MI (by ECG and enzymes elevation) and a total cholesterol above 220 mg/dl or under treatment with hypolipidemic agents. The mean age was 68 (41-93 y). 244 (26.6%) patients were eligible. Among these only 44 (I 8%) were treated. The therapeutic goal (TCQZO mg/dl) was reached only in I8 patients (41%). Very few females and elderly people were treated (Fig. I). Therefore the treatment of hypercholesterolemia in secondary prevention remain a challenge.
ANTIPLATELET THERAPY IN PATIENTS WITH LOWER LIMBS ARTERIOPATHY: A IO-YEAR PROSPECTIVE STUDY. Carlo Giansante, Nicola Fiotti, Salvatore Calabrese, Claudia Del Be/lo, Frank0 Krbavcic, Gianfranco Guarnieri. OBJECTIVES. The aim of this study was to determine whether antiplatelet therapy was effective in prOteChg patients with lower limbs arteriopathy (LLA) against vascular death and non-fatal vascular events. METHODS. A cohort of 223 patients with LLA, second Stage according Fontaine, was randomly assigndtake ASA or ticlopidine, and followed for 10 years. Patients underwent regular visits for monitoring the evolution of the LLA and for determining some coagulation markers, every six months. The primary and point was a composite of vascular death and major vascular events, furthermore death for any causes was monitored. The controls consisted in 446 subjects, matched for sex and age, randomly selected from the Regional Health Database. RESULTS. Total, vascular and neoplastic mortality was higher in patients with LLA than in COntrOk; total mOrkditY Was similar in patients treated with ASA or with ticlopidine. Cardiac vascular events were significantly lower in patients treated with ticlopidine than in those treated with ASA. CONCLUSIONS. Despite antiplatelet therapy, the Overall mortality in patients with LLA is higher than in the general population; ticlopidine is more effective than ASA in protecting against cardiac vascular events.
P61 SEVERE INTERMITTENT CLAUDICATION TREAThiENT WITH PGE, a - CICLODESTRINA IV.: COSTS / EFFECTIVNESS ANALYSIS OF A NEW “SHORT TERM” PROTOCOL.
M. Bucci, *MR Cesamne,*MT. De Sanctis,D. Di Clemente,P. Iacobitti, *L. Ineandela, *G. Laurora, F. Mauna, A Nepa, F. Spitaleri, P. Undo, M Zimarino, $kN. Nicolaides, *G. Bekam, G. Martines. of Chieti Univ.; *Angiology Centre of ‘Pierangeli” Clinic, Medical The Pescara;Italy,T St Mary’s Hospital, London Univ., U.K. PGE, a-ciclc&trina is mofe and more used in the medical treatmentof severe intermittent clauctication,but their therapeuticpmtocols are generally too long for patients@ts) and too expensive for the community. Methods: To confirm PGE,‘s efficacy and safety and to analyze the costs of the different treatment protocols, we suggesteda new “short term protocol” (ST?) eomparedwith the classic “long term protocol” (LTP) in a randomized 20-week study including 109pts., divided into 2 groupsclinically [averagetotal walking distance (TWD) of 65fs ml, age (62f8 yrs) and sex (M= 60.4%) matched.LTP (PGE, 60 @die, 5 clayseach week, for 4 weeks and then twice a week for other 4 weeks) was performed in 55 pts. The remaining 54 pts. were treatedwith STP (60 pg BID, only for two days every 4 weeks, for 12 weeks). Treadmill testswemprformed at the inclusioq at the beginning of each phase and at the end of 20 week. In bath groups similar training plan was used and all pts. were advisedto reducetheir risk factors. Results: Intention-to-treat analysis indicated au increase in TWD at the 4m week(101.5%inSTpvs78.3%inLTp,~.05),atthe8~(260.9%vs107.3% p~O.05)and at 20mweek (351% vs 242%, p
P63 Glococortioidstherapy reduceslipoproteia (a) serumlevelsin patientswith ob6troctiverespiratorydiseasm A. Montagnani, l A. Fossi, l V. Beltmmi, M. Mom. Institute of Internal Medicine and * Institute of Respiratory Diseases, University of Siena The Lipoprotein (a) [Lp(a)] is consideredan atherosclerotic risk faaor sif&bntly associatedwith coronary artery diseaseaad less influenced by drugs.Howcar, some data on @ocorticoids (GCS) treatment to suggesta lowering innueace on Lp(a) levels by therapy with GCS. In order to investigate further this issue,we have studied 21 patients (age range: 69i6 years) affected by obstructive broncopulmonary dig and treated with GCS ml I2 healthy subjectsage and sex matched.Total cholesterol, LDL-cholesterol, HDLcholesterol and Triglycaides (TG) serumlevels have been assessedin fasting blood samplesdrawn at basehe, 3”, 7”, 14* day; in &II period methylpreduisoloae was tapaed over from 20 mg twice day to I6 mg once day. Moreover, au additional lipid assessmenthas been performed at IS* day a&r GcS withdrawal. Two-sample analysis and analysis of variance have been pafomred with parametric and non-parametric test, as appmpriate. Q(a) circulating mediau levels showed a progressive decreasein obstructive respiratory patients during GCS treatmentreaching a significant wO.05) difference with respectto basal values at 7’ and 14’ by, dmdkr Lp(a) trends towards the basal values. Moreover, we found a signifcaat (pdO.05)difference (6.Oti.8 mg/dl vs 10.2f1.9 rngdl) ofLp(a) values between treated patients aad healthy subjectsat 7 day. Throughout the study period any significant changehas been found both ia patients and in control group. Our data Seemto point out a GCS infhmace on L&a) serumlevels. In addition to the well known effects GCS therapy might be able to re&w Lp(a) semm levels in patients with obshuctive bmnchop~~aun~p&y. However, further investigaticmsare neededto better clarify whether GCS could have any protecting effect on athemscle.roticcornnary diseaseby reducing Lp(a).