- Email: [email protected]
W16-P-038 Effects of atorvastatin and fenofibrate on postprandial lipemia in type 2 diabetic patients with hyperlipidemia
Workshops W16 Treatment of atherosclerosis risk
110
5.83 yearn) were studied. The first group (I) included 36 patients with raised systolic blood pressure (SBP). The second group (II) included 40 patients with raised systolic and diastolic blood pressure (SDBP). The control group was made up of 10 people (9 man and 1 woman) in good health. Serum cholesterol, HDL, LDL and triglycerides level were assessed automatically using the apparatus Cholestech. We calculated the atherogenicity index (AI) using the formula: AI = (s/cholesterol - s/HDL) + (s/LDL) Results: In group I the mean s/cholesterol level (6.144-0.15 mmol/l) was significantly higher than in group II (5.13+0.31 mmol/1) and than in the control group (5.114-0.34 mmol/l). When analyzing the levels of s/cholesterol, s/triglycerides and AI in elderly patients below 75 years old and above 75 years old we found that their values were significantly higher in those patients above 75 years old. The levels of LDL were similar in all the age groups. We treated all patients with Simvastatin 20 mg ('Vasilip, marketed by KRKA, Slovenia) for 12 weeks. We noticed a significant decrease in s/cholesterol levels in group I (5.014-0.12 mmol/l), in group II (4.984-0.16 mmol/1) and in the control group(5.014-0.13 mmol/1). Conclusion: Elderly patients with arterial hypertension have dyslipidemia which is more pronounced in those with isolated systolic hypertension. These lipid disorders can be corrected using Simvastatin.
Wl
I
6-P-038 I i
E F F E C T S OF ATORVASTATIN AND FENOFIBRATE ON P O S T P R A N D I A L L I P E M I A IN TYPE 2 DIABETIC PATIENTS W I T H H Y P E R L I P I D E M I A
C. Iovine, S. Lilli, A. Gentile, L. Patti, L. Di Marino, P. Cipriano, G. Riccardi, A.A. Rivellese. Department di Clinical and Experimental
Medicine, Federico H University, Naples, Italy Aim: To evaluate the effects of atorvaztatin (20 mg/day) vs fenofibrate (200 mg/day) on postprandial lipids in type 2 diabetic patients with mixed hypedipidemia. Subjects and methods: Eight type 2 diabetic patients (M/F 6/2, age 57.74-5.2 years, BMI 27.94-3.3 kg/m 2) with LDL cholesterol between 115-160 mg/dl and triglycerides between 150-400 mg/dl, participated to a randomized, cross-over study (3 months on atorvastatin and 3 on fenofibrate). At baseline and at the end of the two treatments, patients underwent a standard fat meal whit blood samples taken before and every 2 hours after the meal (for 8 hours) for the assay of cholesterol, triglycerides, apoB48 and apoB100 (SDS-Page method) in plasma lipoproteins and VLDL subfractions (density gradient ultracentrifugation). Results: Concerning the postprandial phase, the incremental areas under the curve (IAUC) chylomicrons and la_,,ge VLDL are reduced after both treatments, but the statistical significance has been reached after fenofibrate for the cholesterol, triglyceride and apoB100 content of chylomicrons (IAUC 5.24-4.6 vs 10.74-9.3 mg/dl/h, p = 0.036; 131.34-95.1 vs 259.1-t-201.5 mg/dl/h, p=0.017; 0.464-1.0 vs 3.0+3.7 mg/dl/h, p= 0.025). Conclusion: During the postprandial state feuofibrate seems to be more effective than atorvastatin in reducing the lipid content of chylomicrons response and the largest intestinally derived lipoprotein particles.
W16-P-0391P E R I P H E R A L A R T E R I A L DISEASE: IS SECONDARY PREVENTION OF CARDIAC DISEASE C O M P A R A B L E TO PATIENTS W I T H CORONARY ARTERY DISEASE? S.E.J. Janes 1, j. West 2 J.T. Walsh 3, B.J. Hopkinson 1.1 Vascular Surgery, Queen's Medical Centre, Nottingham, UK; 2Public Health and Epidemiology, Queen's Medical Centre, Nottingham, UK; 5Cardiology, Queen's Medical Centre, Nottingham, UK Patients with peripheral arterial disease (PAD) are thought to have a high prevalence of modifiable risk factors for atherosclerosis. We aimed to establish whether hospital patients with PAD receive less adequate pharmacological secondary prevention than patients with coronary artery disease (CAD). Methods: Patients were recruited prospectively over 3 months from a vascular surgery ward (PAD) or cardiology ward (CAD) and followed until discharge. All patients were symptomatic and underwent diagnostic peripheral or coronary angiography. Case notes were reviewed on admission to determine prior secondary prevention, and again on discharge to establish which secondary prevention measures were implemented during admission. Results: There were 52 inpatients with peripheral arterial disease (31 male) and 56 patients with CAD (38 male). PAD patients were older and
lived in more deprived areas than CAD patients, p<0.001 and p=0.001 respectively. Multivariate analysis controlling for age, gender, social deprivation, and coexisting CAD showed that PAD was an independent predictor of decreased use of anti-platelet agents (48% vs 71%), statins (33% vs 64%) and ACE inhibitors (23% vs 55%), Odds ratio (OR) 2.9 (95% CI 1.3-6.6) p=0.01, OR 3.6 (1.2-11.0) p=0.02, and OR 7.4 (2.4-23.3) p=0.001, respectively. During admission, secondary prevention was more likely to be initiated in patients with CAD: anti-platelet agents: 2% vs 18%, OR 16.9 (95% CI 2.4-119.9), p<0.0001; statins: 2% vs 18%, OR 18.4 (2.6-133.2), p<0.0001; ACE inhibitors: 2% vs 11%, OR 9.9 (1.3-77.2), p=0.002. Conelusion: Patients with PAD receive significantly less secondary prevention both before and during admission. This treatment inequality suggests guidelines regarding pharmacological treatment of PAD should be developed.
IW16-P-0401
I
STATIN T H E R A P I E S F O R ELEVATED LIPID LEVELS C O M P A R E D ACROSS DOSES TO ROSUVASTATIN (STELLAR): LDL-C G O A L A C H I E V E M E N T W I T H N E W ATP III RECOMMENDATIONS
P.H. Jones 1, C. Watkins 2, J.W. Blasetto 3 . 1Baylor College of Medicine,
Houston, Tex, USA; 2AstraZeneca, Alderley Park, UK; 3AstraZeneca, Wilmington, Del, USA Objective: The National Cholesterol Education Program (NCEP) recently recommended modifying Adult Treatment Panel III (ATP III) goals, including recommending an optional LDL-C target of <70 mg/dL (< 1.8 mmol/L) for very high-risk pts and <100 mg/dL (<2.6 mmol/L) for moderately high-risk pts (2+ risk factors, 10%-20% 10-yr risk). An a posteriori analysis of the STELLAR trial (4522IL/0065) was conducted to determine % of pts reaching LDL-C goals according to the revised criteria. Methods: In this 6-wk, open-label, randomized trial, the efficacy of rosuvastatin (RSV) 10~10 mg was compared with milligram-equivalent or higher doses of atorvastatin (ATV) (10-80 mg), simvastatin (SIM) (10-80 mg), and pravastatin (PRA) (10~10 mg) in 2240 adults with hypercholesterolemia (LDL-C _> 160 and <250 mg/dL, TG <400 mg/dL). Goal achievement was assessed using logistic regression analysis, with significance adjusted to <0.002 for multiple comparisons. Mean (SD) baseline LDL-C was 187 (17)-194 (19) mg/dL; N/group was 156-165. Modified risk categories were low (LDL-C goal, < 160 mg/dL), moderate (<130 mg/dL), moderately high (<100 mg/dL), high (<100 mg/dL) and very high (<70 mg/dL). Distribution of risk categories was similar across all treatments and doses. Results: For each stalin (all doses combined), % moderately high-risk and very high-risk pts who achieved their LDL-C goal were: RSV 69%, 15%; ATV 46%, 6%; SIM 19%, 3%; PRA 4%, 0%, respectively. Table shows % of all pts who achieved the updated ATP III LDL-C goals (all risk categories combined). Proportion of all patients reaching their LDL-C goal (%) Dose 10 mg 20 mg 40 mg
RSV 68 78 78
ATV 50* 61t 72
SIM 45* 56*t 50t*
PRA 26* 40*t 50*tt
80 m g
-
74
69
-
*p<0.002 vs RSV 10 mg; tp<0.002 vs RSV 20 mg; *p<0.002 vs RSV 40 mg. Conclusion: Compared with comparator matins, more patients who received rosuvastatin achieved their optimal LDL-C goal.
Objective:
I W16-P-041
I C O M P A R I S O N OF THE EFFICACY OF ROSUVASTATIN VERSUS O T H E R STATINS IN ACHIEVING 2003 EUROPEAN LDL-C GOALS
D. Kallend 1, O. Faergeman 2, R. Chitra 3. ]AstraZeneca, Macclesfield, UK,
2Dept of Medicine and Cardiology, Aarhus University Hospital, Denmark, ~AstraZeneca, Wilmington, USA Objective: To compare the efficacy of rosuvastatin (RSV) 5 rag, RSV 10 nag, atnrvastatin (ATV) 10 rag, simvastatin (SIM) 20 mg and pravastatin (PRA) 20 nag once daily in enabling patients to achieve 2003 European LDL-C goals. Methods: Data were pooled from five randomised, double-blind, multi-
75th EAS Congress, 23-26 April 2005, Prague, Czech Republic
110
5.83 yearn) were studied. The first group (I) included 36 patients with raised systolic blood pressure (SBP). The second group (II) included 40 patients with raised systolic and diastolic blood pressure (SDBP). The control group was made up of 10 people (9 man and 1 woman) in good health. Serum cholesterol, HDL, LDL and triglycerides level were assessed automatically using the apparatus Cholestech. We calculated the atherogenicity index (AI) using the formula: AI = (s/cholesterol - s/HDL) + (s/LDL) Results: In group I the mean s/cholesterol level (6.144-0.15 mmol/l) was significantly higher than in group II (5.13+0.31 mmol/1) and than in the control group (5.114-0.34 mmol/l). When analyzing the levels of s/cholesterol, s/triglycerides and AI in elderly patients below 75 years old and above 75 years old we found that their values were significantly higher in those patients above 75 years old. The levels of LDL were similar in all the age groups. We treated all patients with Simvastatin 20 mg ('Vasilip, marketed by KRKA, Slovenia) for 12 weeks. We noticed a significant decrease in s/cholesterol levels in group I (5.014-0.12 mmol/l), in group II (4.984-0.16 mmol/1) and in the control group(5.014-0.13 mmol/1). Conclusion: Elderly patients with arterial hypertension have dyslipidemia which is more pronounced in those with isolated systolic hypertension. These lipid disorders can be corrected using Simvastatin.
Wl
I
6-P-038 I i
E F F E C T S OF ATORVASTATIN AND FENOFIBRATE ON P O S T P R A N D I A L L I P E M I A IN TYPE 2 DIABETIC PATIENTS W I T H H Y P E R L I P I D E M I A
C. Iovine, S. Lilli, A. Gentile, L. Patti, L. Di Marino, P. Cipriano, G. Riccardi, A.A. Rivellese. Department di Clinical and Experimental
Medicine, Federico H University, Naples, Italy Aim: To evaluate the effects of atorvaztatin (20 mg/day) vs fenofibrate (200 mg/day) on postprandial lipids in type 2 diabetic patients with mixed hypedipidemia. Subjects and methods: Eight type 2 diabetic patients (M/F 6/2, age 57.74-5.2 years, BMI 27.94-3.3 kg/m 2) with LDL cholesterol between 115-160 mg/dl and triglycerides between 150-400 mg/dl, participated to a randomized, cross-over study (3 months on atorvastatin and 3 on fenofibrate). At baseline and at the end of the two treatments, patients underwent a standard fat meal whit blood samples taken before and every 2 hours after the meal (for 8 hours) for the assay of cholesterol, triglycerides, apoB48 and apoB100 (SDS-Page method) in plasma lipoproteins and VLDL subfractions (density gradient ultracentrifugation). Results: Concerning the postprandial phase, the incremental areas under the curve (IAUC) chylomicrons and la_,,ge VLDL are reduced after both treatments, but the statistical significance has been reached after fenofibrate for the cholesterol, triglyceride and apoB100 content of chylomicrons (IAUC 5.24-4.6 vs 10.74-9.3 mg/dl/h, p = 0.036; 131.34-95.1 vs 259.1-t-201.5 mg/dl/h, p=0.017; 0.464-1.0 vs 3.0+3.7 mg/dl/h, p= 0.025). Conclusion: During the postprandial state feuofibrate seems to be more effective than atorvastatin in reducing the lipid content of chylomicrons response and the largest intestinally derived lipoprotein particles.
W16-P-0391P E R I P H E R A L A R T E R I A L DISEASE: IS SECONDARY PREVENTION OF CARDIAC DISEASE C O M P A R A B L E TO PATIENTS W I T H CORONARY ARTERY DISEASE? S.E.J. Janes 1, j. West 2 J.T. Walsh 3, B.J. Hopkinson 1.1 Vascular Surgery, Queen's Medical Centre, Nottingham, UK; 2Public Health and Epidemiology, Queen's Medical Centre, Nottingham, UK; 5Cardiology, Queen's Medical Centre, Nottingham, UK Patients with peripheral arterial disease (PAD) are thought to have a high prevalence of modifiable risk factors for atherosclerosis. We aimed to establish whether hospital patients with PAD receive less adequate pharmacological secondary prevention than patients with coronary artery disease (CAD). Methods: Patients were recruited prospectively over 3 months from a vascular surgery ward (PAD) or cardiology ward (CAD) and followed until discharge. All patients were symptomatic and underwent diagnostic peripheral or coronary angiography. Case notes were reviewed on admission to determine prior secondary prevention, and again on discharge to establish which secondary prevention measures were implemented during admission. Results: There were 52 inpatients with peripheral arterial disease (31 male) and 56 patients with CAD (38 male). PAD patients were older and
lived in more deprived areas than CAD patients, p<0.001 and p=0.001 respectively. Multivariate analysis controlling for age, gender, social deprivation, and coexisting CAD showed that PAD was an independent predictor of decreased use of anti-platelet agents (48% vs 71%), statins (33% vs 64%) and ACE inhibitors (23% vs 55%), Odds ratio (OR) 2.9 (95% CI 1.3-6.6) p=0.01, OR 3.6 (1.2-11.0) p=0.02, and OR 7.4 (2.4-23.3) p=0.001, respectively. During admission, secondary prevention was more likely to be initiated in patients with CAD: anti-platelet agents: 2% vs 18%, OR 16.9 (95% CI 2.4-119.9), p<0.0001; statins: 2% vs 18%, OR 18.4 (2.6-133.2), p<0.0001; ACE inhibitors: 2% vs 11%, OR 9.9 (1.3-77.2), p=0.002. Conelusion: Patients with PAD receive significantly less secondary prevention both before and during admission. This treatment inequality suggests guidelines regarding pharmacological treatment of PAD should be developed.
IW16-P-0401
I
STATIN T H E R A P I E S F O R ELEVATED LIPID LEVELS C O M P A R E D ACROSS DOSES TO ROSUVASTATIN (STELLAR): LDL-C G O A L A C H I E V E M E N T W I T H N E W ATP III RECOMMENDATIONS
P.H. Jones 1, C. Watkins 2, J.W. Blasetto 3 . 1Baylor College of Medicine,
Houston, Tex, USA; 2AstraZeneca, Alderley Park, UK; 3AstraZeneca, Wilmington, Del, USA Objective: The National Cholesterol Education Program (NCEP) recently recommended modifying Adult Treatment Panel III (ATP III) goals, including recommending an optional LDL-C target of <70 mg/dL (< 1.8 mmol/L) for very high-risk pts and <100 mg/dL (<2.6 mmol/L) for moderately high-risk pts (2+ risk factors, 10%-20% 10-yr risk). An a posteriori analysis of the STELLAR trial (4522IL/0065) was conducted to determine % of pts reaching LDL-C goals according to the revised criteria. Methods: In this 6-wk, open-label, randomized trial, the efficacy of rosuvastatin (RSV) 10~10 mg was compared with milligram-equivalent or higher doses of atorvastatin (ATV) (10-80 mg), simvastatin (SIM) (10-80 mg), and pravastatin (PRA) (10~10 mg) in 2240 adults with hypercholesterolemia (LDL-C _> 160 and <250 mg/dL, TG <400 mg/dL). Goal achievement was assessed using logistic regression analysis, with significance adjusted to <0.002 for multiple comparisons. Mean (SD) baseline LDL-C was 187 (17)-194 (19) mg/dL; N/group was 156-165. Modified risk categories were low (LDL-C goal, < 160 mg/dL), moderate (<130 mg/dL), moderately high (<100 mg/dL), high (<100 mg/dL) and very high (<70 mg/dL). Distribution of risk categories was similar across all treatments and doses. Results: For each stalin (all doses combined), % moderately high-risk and very high-risk pts who achieved their LDL-C goal were: RSV 69%, 15%; ATV 46%, 6%; SIM 19%, 3%; PRA 4%, 0%, respectively. Table shows % of all pts who achieved the updated ATP III LDL-C goals (all risk categories combined). Proportion of all patients reaching their LDL-C goal (%) Dose 10 mg 20 mg 40 mg
RSV 68 78 78
ATV 50* 61t 72
SIM 45* 56*t 50t*
PRA 26* 40*t 50*tt
80 m g
-
74
69
-
*p<0.002 vs RSV 10 mg; tp<0.002 vs RSV 20 mg; *p<0.002 vs RSV 40 mg. Conclusion: Compared with comparator matins, more patients who received rosuvastatin achieved their optimal LDL-C goal.
Objective:
I W16-P-041
I C O M P A R I S O N OF THE EFFICACY OF ROSUVASTATIN VERSUS O T H E R STATINS IN ACHIEVING 2003 EUROPEAN LDL-C GOALS
D. Kallend 1, O. Faergeman 2, R. Chitra 3. ]AstraZeneca, Macclesfield, UK,
2Dept of Medicine and Cardiology, Aarhus University Hospital, Denmark, ~AstraZeneca, Wilmington, USA Objective: To compare the efficacy of rosuvastatin (RSV) 5 rag, RSV 10 nag, atnrvastatin (ATV) 10 rag, simvastatin (SIM) 20 mg and pravastatin (PRA) 20 nag once daily in enabling patients to achieve 2003 European LDL-C goals. Methods: Data were pooled from five randomised, double-blind, multi-
75th EAS Congress, 23-26 April 2005, Prague, Czech Republic