Challenges of Statins in HIV Hyperlipidemia

2013 ◽  
Vol 09 (02) ◽  
pp. 157 ◽  
Author(s):  
Carlos D Malvestutto ◽  
Judith A Aberg ◽  
◽  
Keyword(s):  
Risk Factors ◽  
Drug Interactions ◽  
Cardiovascular Complications ◽  
Lipid Lowering ◽  
Virologic Suppression ◽  
Lifestyle Modifications ◽  
Negative Effects ◽  
Reductase Inhibitors ◽  
Increased Risk ◽  
Traditional Risk Factors

As a result of access to potent antiretroviral therapy (ART), HIV-infected adults with virologic suppression are living longer, but unfortunately are at increased risk for developing comorbid conditions. It is postulated that this increased risk seen at all ages is partly due to the effects of viral-mediated chronic inflammation in addition to the traditional risk factors. One of the more common traditional risk factors, hyperlipidemia, may be worsened by ART. However, the benefits of ART greatly outweigh the possible negative effects of ART agents on lipid parameters. As the HIV-infected patient population ages, it is critical to control hyperlipidemia in ART-treated patients in order to reduce the risk for long-term cardiovascular complications. If hyperlipidemia cannot be managed through lifestyle modifications, clinical guidelines recommend the use of lipid-lowering medication, particularly HMG Co-A reductase inhibitors (statins), to reduce low-density lipoproteins-cholesterol. However, many ART agents inhibit or induce major metabolic pathways of statins, creating potentially serious drug–drug interactions. In this article, we present a review of the various challenges in managing hyperlipidemia with a focus on drug–drug interactions.

scholarly journals Cardiovascular Complications of HIV-Associated Immune Dysfunction

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Akram M. Zaaqoq ◽  
Faisal A. Khasawneh ◽  
Roger D. Smalligan
Keyword(s):  
Risk Factors ◽  
High Sensitivity ◽  
Immune Dysfunction ◽  
Research Area ◽  
Cardiovascular Complications ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Increased Risk ◽  
Important Research Area ◽  
Traditional Risk Factors

Prolonged survival in HIV infection is accompanied by an increased frequency of non-HIV-related comorbidities. It is suggested that cardiovascular diseases (CVD) occur earlier among HIV-positive patients compared with HIV-negative patients, and at a higher rate. Several factors have been proposed which can be categorized into traditional and nontraditional risk factors. Immune dysfunction is a nontraditional risk factor that contributes significantly to cardiovascular pathology. Markers of inflammation are elevated in HIV-infected patients, and elevations in markers such as high-sensitivity C-reactive protein, D-dimer, and interleukin-6 (IL-6) have been associated with increased risk for cardiovascular disease. However, the data currently suggest the most practical advice is to start antiretroviral therapy early and to manage traditional risk factors for CVD aggressively. A better understanding of the mechanisms of CVD in this population and further efforts to modify chronic inflammation remain an important research area.

scholarly journals Cardiovascular complications in patients with rheumatic diseases.

2018 ◽  
Vol 96 (5) ◽  
pp. 411-418
Author(s):  
A. V. Arshinov ◽  
V. I. Emanuilov ◽  
I. G. Maslova
Keyword(s):  
Risk Factors ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Cardiovascular Complications ◽  
Systemic Lupus ◽  
Increased Risk ◽  
Male Sex ◽  
Traditional Risk Factors ◽  
Vascular Accidents ◽  
Large Vessels

In the recent years, there are more and more reports stating an increased risk of atherosclerosis and cardiovascular complications in patients with rheumatic diseases. It should be noted that the development of atherosclerosis in this category of patients occurs much earlier than in the general population. Indeed, many rheumatic diseases are associated with an increased risk of developing of cardiovascular diseases and death from vascular accidents, including RA, systemic lupus erythematosus, ankylosing spondylitis, gout, psoriatic arthritis, vasculitis of the middle and large vessels. There are reports of an increased risk of cardiovascular disease in patients with systemic scleroderma. It is significant that rheumatic diseases and coronary heart disease combine common pathophysiological mechanisms - systemic and chronic inflammation. At the same time, traditional risk factors such as hypertension, old age, smoking, hypercholesterolemia, obesity and male sex can not fully explain the mechanism of accelerated development of atherosclerosis in patients with rheumatic diseases. The presence of specific risk factors, such as the duration of the course of treatment, glucocorticosteroids administration, the presence of an increased concentration of inflammatory mediators and autoimmune mechanisms create conditions for the acceleration of atherosclerosis in this group of patients. Coordination of efforts of rheumatologists and cardiologists in studying the mechanisms of accelerated development of atherosclerosis in patients with rheumatic diseases will allow to develop adequate methods for timely diagnosis and prevention of cardiovascular complications in patients with this widespread pathology.

Stroke in chronic renal failure

2008 ◽  
Vol 149 (15) ◽  
pp. 691-696
Author(s):  
Dániel Bereczki
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Kidney Diseases ◽  
Cerebrovascular Diseases ◽  
Lipid Lowering ◽  
Increased Risk ◽  
Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

Abstract 14760: Myocardial Scarring by Magnetic Resonance Predicts Sudden Cardiac Death in Pediatric Patients With Hypertrophic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lars Grosse-Wortmann ◽  
Laurine van der Wal ◽  
Aswathy Vaikom House ◽  
Lee Benson ◽  
Raymond Chan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Pediatric Patients ◽  
Risk Markers ◽  
C Statistic ◽  
Increased Risk ◽  
Traditional Risk Factors

Introduction: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has been shown to be an independent predictor of sudden cardiac death (SCD) in adults with hypertrophic cardiomyopathy (HCM). The clinical significance of LGE in pediatric HCM patients is unknown. Hypothesis: LGE improves the SCD risk prediction in children with HCM. Methods: We retrospectively analyzed the CMR images and reviewed the outcomes pediatric HCM patients. Results: Amongst the 720 patients from 30 centers, 73% were male, with a mean age of 14.2±4.8 years. During a mean follow up of 2.6±2.7 years (range 0-14.8 years), 34 experienced an episode of SCD or equivalent. LGE (Figure 1A) was present in 34%, with a mean burden of 14±21g, or 2.5±8.2g/m2 (6.2±7.7% of LV myocardium). The presence of ≥1 adult traditional risk factor (family history of SCD, syncope, LV thickness >30mm, non-sustained ventricular tachycardia on Holter) was associated with an increased risk of SCD (HR=4.6, p<0.0001). The HCM Risk-Kids score predicted SCD (p=0.002). The presence of LGE was strongly associated with an increased risk (HR=3.8, p=0.0003), even after adjusting for traditional risk factors (HR adj =3.2, p=0.003) or the HCM Risk-Kids score (HR adj =3.5, p=0.003). Furthermore, the burden of LGE was associated with increased risk (HR=2.1/10% LGE, p<0.0001). LGE burden remained independently associated with an increased risk for SCD after adjusting for traditional risk factors (HRadj=1.5/10% LGE, p=0.04) or HCM Risk-Kids (HRadj=1.9/10% LGE, p=0.0018, Figure 1B). The addition of LGE burden improved the predictive model using traditional risk markers (C statistic 0.67 vs 0.77, p=0.003) and HCM Risk-Kids (C statistic 0.68 vs 0.74, p=0.045). Conclusions: Quantitative LGE is an independent risk factor for SCD in pediatric patients with HCM and improves the performance of traditional risk markers and the HCM Risk-Kids Score for SCD risk stratification in this population.

Abstract 15796: The Inverse Correlation Between Lifetime Occupational Radiation Exposure Duration and Prevalence of Atrial Arrhythmia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rithika Thirumal ◽  
Catherine Vanchiere ◽  
Ruchi Bhandari ◽  
Sania Jiwani ◽  
Ronald Horswell ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Radiation Exposure ◽  
Large Scale ◽  
Inverse Correlation ◽  
Cardiovascular Complications ◽  
Occupational Radiation Exposure ◽  
Electronic Survey ◽  
Increased Risk ◽  
Traditional Risk Factors ◽  
Occupational Radiation

Introduction: Fluoroscopy assisted procedures have increased occupational radiation exposure among Cardiologists. Radiation has been linked to cardiovascular complications but its effects on cardiac rhythm has not been extensively explored. Hypothesis: We hypothesized that radiation exposure is associated with increased risk of atrial arrhythmias (AA) despite appropriate leaded body coverage. Methods: Demographic, social, occupational, and medical history was collected from board-certified cardiologists via an electronic survey. Bivariate and multivariable logistic regression analyses were performed. Results: We received 1478 responses from cardiologists; 85.4% were males, 79% were White and 66.1% were ≤65 yrs of age. 35.6% of respondents were interventional cardiologists and 16.4% were electrophysiologists, and of those, 92.2% wore lead apparel during all times of radiation exposure. Cardiologists >50 yrs of age, with >10,000 hours of occupational radiation exposure, had a significantly lower prevalence of AA compared to those with ≤10,000 hours of radiation exposure (11.1% vs 16.7%, p =0.019). A multivariate logistic regression was performed and among cardiologists >50 years of age, exposure to >10,000 radiation hours was significantly associated with lower likelihood of AA, after adjusting for age, sex, DM, HTN and OSA (adjusted OR 0.57; 95% CI 0.38 - 0.85, p =0.007). Traditional risk factors such as age, sex, HTN, DM and OSA were more prevalent in those with AA and cataracts, a well-established complication of radiation exposure in cardiologists, was more prevalent in those exposed to >10,000 radiation hours compared to those exposed to ≤10,000 radiation hours, validating the dependent (AA) and independent variables (radiation exposure), respectively. Conclusions: Radiation exposure in Cardiologists with appropriate lead apparel is inversely related to AA. Large scale prospective studies are needed to validate our findings.

scholarly journals Risk Factors for Cholecystectomy After Laparoscopic Roux-En-Y Gastric Bypass

2019 ◽  
Vol 30 (2) ◽  
pp. 507-514 ◽  
Author(s):  
Sylke Haal ◽  
Djoeke Rondagh ◽  
Barbara A. Hutten ◽  
Yair I. Z. Acherman ◽  
Arnold W. J. M. van de Laar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Bypass ◽  
Pain Syndrome ◽  
Female Gender ◽  
Dose Effect ◽  
Preoperative Pain ◽  
Retrospective Case ◽  
Increased Risk ◽  
Risk Patients ◽  
Traditional Risk Factors

Abstract Background Patients who have undergone bariatric surgery are at risk for subsequent cholecystectomy. We aimed to identify risk factors for cholecystectomy after laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods We conducted a retrospective case-control study of patients who underwent LRYGB between 2013 and 2015. Cases underwent cholecystectomy because of biliary symptoms after LRYGB. For each case, two controls were selected without subsequent cholecystectomy. Logistic regression analyses were used to identify risk factors. Results Between 2013 and 2015, 1780 primary LRYGBs were performed. We identified 233 (13.1%) cases who had undergone cholecystectomy after a median (IQR) of 12 (8–17) months, and 466 controls. Female gender (OR (95% CI) 1.83 (1.06–3.17)), Caucasian ethnicity (OR (95% CI) 1.82 (1.10–3.02)), higher percent total weight loss (%TWL) at 12 months (OR (95% CI) 1.06 (1.04–1.09)), and preoperative pain syndrome (OR (95% CI) 2.72 (1.43–5.18)) were significantly associated with an increased risk for cholecystectomy. Older age (OR (95% CI) 0.98 (0.96–0.99)) and preoperative statin use were associated with a reduced risk (OR (95% CI) 0.56 (0.31–1.00)). A dose-effect relationship was found between the intensity of preoperative statin and risk for cholecystectomy. Conclusions In our study, higher %TWL and preoperative pain syndrome were associated with an increased risk for cholecystectomy besides the traditional risk factors female gender and Caucasian ethnicity. These factors can be used to identify high-risk patients, who might benefit from preventive measures. Whether statins can protect bariatric patients from developing gallstones should be investigated prospectively.

scholarly journals Insomnia is associated with an increased risk of type 2 diabetes in the clinical setting

2018 ◽  
Vol 6 (1) ◽  
pp. e000604 ◽  
Author(s):  
Erin S LeBlanc ◽  
Ning X Smith ◽  
Gregory A Nichols ◽  
Michael J Allison ◽  
Gregory N Clarke
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Clinical Setting ◽  
Clinical Importance ◽  
International Classification Of Diseases ◽  
Hospital Inpatient ◽  
Increased Risk ◽  
Traditional Risk Factors

ObjectiveTo determine the possible association between insomnia and risk of type 2 diabetes mellitus (T2DM) in the naturalistic clinical setting.Research design and methodsWe conducted a retrospective cohort study to examine the risk of developing T2DM among patients with pre-diabetes with and without insomnia. Participants with pre-diabetes (identified by a physician or via two laboratory tests) between January 1, 2007 and December 31, 2015 and without sleep apnea were followed until December 31, 2016. Patients were determined to have T2DM when two of the following occurred within a 2-year window: physician-entered outpatient T2DM diagnosis (International Classification of Diseases [ICD]-9 250.00; ICD-10 E11), dispensing of an antihyperglycemia agent, and hemoglobin A1c (A1c) >6.5% (48 mmol/mol) or fasting plasma glucose (FPG) >125 mg/dL. One hospital inpatient stay with an associated T2DM diagnosis was also sufficient for classification of T2DM.ResultsOur cohort consisted of 81 233 persons with pre-diabetes, 24 146 (29.7%) of whom had insomnia at some point during the 4.3-year average observation period. After adjustment for traditional risk factors, those with insomnia were 28% more likely to develop T2DM than those without insomnia (HR 1.28; 95% CI 1.24 to 1.33). The estimate was essentially unchanged after adjusting for baseline A1c level (HR 1.32; 95% CI 1.25 to 1.40) or FPG (HR 1.28; 95% CI 1.23 to 1.33).ConclusionsInsomnia imparts an increased risk of T2DM comparable with that conferred by traditional risk factors (eg, overweight, non-white race, cardiovascular risk factors). This association could have clinical importance because it suggests a new potentially modifiable risk factor that could be targeted to prevent diabetes.

scholarly journals Effects of Bilberry Supplementation on Metabolic and Cardiovascular Disease Risk

Molecules ◽  
2020 ◽  
Vol 25 (7) ◽  
pp. 1653
Author(s):  
Sze Wa Chan ◽  
Brian Tomlinson
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Vision Loss ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cardiovascular Complications ◽  
Increased Risk ◽  
Potential Benefits

Metabolic syndrome is a cluster of interrelated conditions that is associated with an increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Oxidative stress may impair normal physiological functions, leading to various illnesses. T2DM is considered to be associated with increased oxidative stress, inflammation, and dyslipidemia, which may play a significant role in the development of cardiovascular complications, cancer and vision loss through cataracts and retinopathy. While conventional therapies are a cornerstone for the management of the major risk factors of metabolic syndrome, increasing antioxidant defense by increasing intake of antioxidant-rich foods may improve long term prospects in CVD, obesity and T2DM. Bilberry (Vaccinium myrtillus L.) is one of the richest natural sources of anthocyanins which give berries their red/purple/blue coloration. Anthocyanins are powerful antioxidants and are reported to play an important role in the prevention of metabolic disease and CVD as well as cancer and other conditions. This review focuses on the potential effects of bilberry supplementation on metabolic and cardiovascular risk factors. Although there is evidence to support the use of bilberry supplementation as part of a healthy diet, the potential benefits from the use of bilberry supplementation in patients with T2DM or CVD needs to be clarified in large clinical trials.

Sign in / Sign up

Export Citation Format

Share Document