2004, Number 5
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Gac Med Mex 2004; 140 (5)
Cholesterol goal Attainment with Lipid Lowering Drugs. The COMETA Mexico Trial.
Meaney E, Vela A, Ramos A, Alemao E, Yin D
Language: Spanish
References: 41
Page: 493-501
PDF size: 74.56 Kb.
ABSTRACT
In a retrospective study to determine rate of patients attaining
therapeutic LDL-C goal values with lipid-lowering drugs,
20 specialists and general practitioners were selected who
enrolled 120 patients whose lipids were measured after at
least 12 weeks of treatment. They were grouped in three
categories: group A (absolute risk of CHD in 10 years
‹10%); group B, with 10–20% risk, and group C, with
›20% risk. Goal LDL-C values were ‹160 mg/dL for group
A, ‹130 for group B, and ‹100 for group C. Mean age was
57 ± 12 years, 59% were males, and 51% were in group C;
83% took statins, 12% fibrates alone, and 5%, combinations.
Atorvastatin and simvastatin were the most used drugs, at
medium doses (mean 12 and 27 mg/day). LDL-C was
reduced 25%; overall, 22% of patient doses were adjusted.
Therapeutic goals were attained in 29% with initial doses
and 42% at the end of study. Goal values were better attained
in groups with lower risk. No differences were noticed among
distinct physician categories. Data show poor compliance
with international guidelines and insufficient attainment of
therapeutic goals.
REFERENCES
Rajavashisth TB, Liao JK, Galis ZS, Tripathi S; Laufs U; Tripathi J; et al. Inflammatory cytokines and oxidized low density lipoproteins increase endothelial cell expression of membrane type 1-matrix metalloproteinase. J Biol Chem. 1999;274:11924–11929
Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witzum JL. Beyond cholesterol. Modifications of low-density lipoproteins that increases its atherogenicity. N Engl J Med 1989;320:915-924.
Gerrity RG, Naito HK, Richardson M, Schwartz CJ. Dietary induced atherogenesis in swine: Morphology of the intima in prelesion stages. Am J Pathol 1979;95:779-786.
Keys A. Coronary heart disease in seven countries. American Heart Association, Monograph No.29. New York 1970.
Kagan A, Harris BR, Winkelstein W Jr., Johnson KG, Kato H, Syme SL, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawai, and California: demographic, physical, dietary and biochemical characteristics J Chronic Dis 1974;27:345-364.
Castelli WP, Garrison KJ, Wilson PW, Abbott RD; Kalousdian S; Kannel WB et al. Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA 1986;256:2835-2838
Stamler J, Wentsworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention trial (MRFIT) JAMA 1986;256:2823-2828
.La Rosa JC, Hunninghake D, Bush D. Criqui MH, Getz GS, Gotto AM Jr., et al. The cholesterol facts. A summary of the evidence relating dietary fats, serum cholesterol, and coronary heart disease: A joint statement by the American heart Association and the National Heart, Lung, and Blood Institute. Circulation 1990;81:1721-1733.
Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, et al. High-density lipoprotein cholesterol and cardiovascular disease: Four prospective American studies. Circulation 1989;79:8-15.
Green MS, Heiss G, Rifkind BM, Cooper GR; Williams OD; Tyroler HA et al. The ratio of plasma high density lipoprotein cholesterol to total and low density lipoprotein cholesterol: age-related changes and race and sex differences in selected North American populations; the Lipid Research Clinics Program Prevalence Study. Circulation 1985;72:93-104.
Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. JAMA 1987;257:2176-2180.
Assman G, Schulte H. Triglycerides and atherosclerosis: Results from the Prospective Cardiovascular Münster Study. Atherosc Rev 1991;22:51-57.
Criqui MH, Heiss G, Cohn R, Cowan LD; Suchindran CM; Bangdiwala S; et al. Plasma triglyceride level and mortality from coronary heart disease. N Engl J Med 1993;328:1220-1225.
Stamler J, Dyer AR, Shekelle RB, Neaton J; Stamler R. Relationship of baseline major risk factors to coronary and all causes mortality, and to longevity: Findings from long-term follow-up of Chicago cohorts. Cardiology 1993;82:191-222.
Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen OP, et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Circulation 1992;85:37-45.
Tall AR. Plasma high density lipoproteins- Metabolism and relationship to atherogenesis. J Clin Invest 1990;86:379-384.
Haberf RL, Dembowski K. Aterotrombosis: common factor in stroke, myocardial infarction and peripheral vascular disease. Eur Heart J Supplements 1999;1 (Suppl A):A41-A44.
Brady AJ. Cardiovascular risk management in clinical practice. Role of lifestyle, hypertension, diabetes and dyslipidaemia. Eur Heart J Supplements, 2(Suppl D), 2000:D4-D6.
Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al. Guide to primary prevention of cardiovascular diseases. A statement for healthcare professionals from the Task Force on Risk Reduction. American heart Association Science Advisory and Coordinating Committee. Circulation 1997;95:2329-2331.
Smith SC Jr., Blair SN, Bonow RO, Brass LM; Cerqueira MD; Dracup K; et al. AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease:2001 update. A statement for healthcare professionals from the American heart Association and the American College of Cardiology. J Am Coll Cardiol 2001;38:1581-1583
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001 May 16;285(19):2486-97.
Wood D, De Backer G, Faegerman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Eur Heart J 1998;19:1434-1503..
Recomendaciones de la Segunda Reunión de Expertos en Dislipidemias organizada por la Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C. Lineamientos sobre la detección, el manejo diagnóstico y el tratamiento dietario y farmacológico de la hipercolesterolemia y la hipertrigliceridemia. Rev Mex Cardiol 1996;7:7-24
Hayward DJ, Guyatt GH, Moore KA, McKibbon KA; Carter AO et al. Canadian physicians´ attitudes about and preferences regarding clinical practice guidelines. CMAJ 1997;156:1715-1723.
Benjamin EJ, Smith SC Jr., Cooper RS, Hill MN; Luepker RV et al. 33rd Bethesda Conference; Preventive cardiology: How Can We Do Better? Task Force # 1-Magnitude of the prevention problem: opportunities and challenges. J Am Coll Cardiol 2002;40:588-603.
Merz NB, Mensah GA, Fuster V, Greenland P; Thompson PD, et al. 33rd Bethesda Conference; Preventive cardiology: How Can We Do Better? Task Force # 5-The role of cardiovascular specialists as leaders in prevention: from training to champion. J Am Coll Cardiol 2002;40:641-649.
Pearson T, Rapaport E, Criqui M, Furberg C; Fuster V; Hiratzka L et al. Optimal risk factor management in the patient after coronary revascularization. A statement for healthcare professionals from an American Heart Association Writing Group. Circulation 1994;90:3125-3133.
ICH Guidelines for Good Clinical Practice. International Conference on Harmonisation for Technical Requirements for the Registration of Pharmaceuticals for Human Use. ICH Harmonised tripartite R Guideline. London. ICH. 1996.
Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultra-centrifuge. Clin Chem 1972;18:499-502.
Maron DJ, Fazio S; Linton MF. Current perspectives on statins. Circulation 2000;101:207-213
Athyros VC, Papageorgiou AA, Mercouris BR, Athyrou VV; Symeonidis AN; Basayannis EO; et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal vs “usual” care in secondary coronary heart disease prevention. Curr Med Res Opin 2002;18:220-228.
.Lipid Research Clinics program. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984; 251:351-364.
Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, et al. Fifteen year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol 1986;8:1245-1255.
Shepherd J, Cobbe SM, Ford I, Isles CG; Lorimer AR; MacFarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995;333:1301-1307.
The Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). Lancet 1994;334:1384-1389.
Downs JR, Clearfield M, Weis S; Whitney E, Shapiro DR; Beere PA et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels. Results of AFCAPS/TexCAPS. JAMA 1998;279:1615-1622.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360:7-22.
Riegger G, Abletshauser C, Ludwig M, Schwandt P; Widimsky J; Weidinger G et al. The effect of fluvastin on cardiac events in patients with symptomatic coronary artery disease during one year of treatment. Atherosclerosis 1999;144:263-270.
Pearson TA; Laurora I; Chu H; Kafonek S. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving lowdensity lipoprotein cholesterol goals. Arch Intern Med 2000;160:459-467.
Cobbe SM. How best to combat the enemies? Lipid lowering Eur Heart J Suppl 2002;4:A48-A52.
Estadísticas de mortalidad. Causas de mortalidad en México 2000., Secretaría de Salud. http//www.ssa.gob.mx.