The prevalance of atherosclerotic vascular disease is unexpectedly high in Turkey despite its young population, with a median age of 29. The mean total cholesterol is lower than in Western European countries; however, smoking is very prevalant, the incidence of metabolic syndrome high and obesity, diabetes and hypertension are becoming a major problem, especially in women. Having these risk factors as well as lower HDL levels leads to high cardiovascular morbidity and mortality at younger ages. This problem is expected to become worse with increasing industrialisation, adaptation to Western diets, a sedentary lifestyle and increasing obesity. A National Heart Health Policy has been developed to overcome this epidemic and combat the risk factors and reduce the burden of atherosclerotic vascular disease.
Aim: The POSITIVE study assessed whether long-term treatment with probucol. a potent anti-oxidant and cholesteryl ester transfer protein (CETP) activator is associated with a lowered risk of cardiovascular events in a very high-risk population: familial hypercholesterolemia (FH). Methods: The study cohort included 410 patients with heterozygous FH, diagnosed between 1984 and 1999 by cardiovascular and metabolic experts at fifteen centers. Traceable patients were screened using predefined eligibility criteria. The primary outcome measure for comparison between probucol exposure and non-exposure was the time to the first cardiovascular event involving hospitalization. Results: Analysis revealed significant differences in baseline characteristics and follow-up treatment between exposure and non-exposure. An observed indication bias was the use of probucol in more severe FH at diagnosis, both for primary and secondary prevention. When the multivariate Cox regression procedure was used after adjustment for possible confounding factors, probucol lowered the risk (hazard ratio [HR], 0.13; 95% confidence interval [CI], 0.050.34) in secondary prevention (n=74) and was statistically significant (p<0.001), although not significant (HR, 1.5; 95% CI, 0.484.67; p=0.49) in primary prevention (n=233). Safety assessment found no specific difference between exposure and non-exposure. Conclusion: Long-term probucol treatment may prevent secondary attack in a higher cardiovascular risk population of heterozygous FH.
Aim: This study was designed to clarify differences in serum phospholipid fatty acid compositions and estimated desaturase activities between Japanese men with and without metabolic syndrome (MetS). Methods: From among 227 males, 40 to 59 years of age, excluding those receiving treatment for lipid disorders, 165 subjects (including 27 with MetS) were selected for this study. Serum phospholipid fatty acid compositions were determined, and desaturase activities were estimated. Results: The C15:0 and C17:0 fatty acids associated with hepatic function were lower, while the C20:3n-6 and C20:4n-3 fatty acids were higher, in subjects with than without MetS (p<0.05). The estimated desaturase activity for D5D(n-6) was lower in subjects with than without MetS (p<0.01). Body fat percentage was an independent negative predictor of C17:0, and a positive predictor of log C20:3n-6 and log C20:4n-3 (p<0.01). HDL-C was an independent negative predictor of log C15:0 and of C17:0 (p<0.01). Conclusion: Decreases in minor saturated fatty acids, accumulation of C20:3n-6 and C20:4n-3 and low estimated D5D activitiy were confirmed to be associated with MetS.
Aim: There have been few comparisons between rosuvastatin and other statins in Japanese patients. This open-label, randomized, parallel-group comparative study was performed to compare the efficacy and safety of rosuvastatin (5 mg) and atorvastatin (10 mg) once daily in Japanese patients with hypercholesterolemia. Methods: Patients with hypercholesterolemia who had received atorvastatin (10 mg/day) for at least 4 weeks and were in category B3, B4, or C according to the Japan Atherosclerosis Society Guidelines for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases 2002 (JAS2002GL) were randomly assigned to rosuvastatin at 5 mg/day (switched treatment) or atorvastatin at 10 mg/day (continued treatment). The primary endpoint was the achievement of JAS2002GL LDL-C goals at 8 weeks. Results: LDL-C goals were reached by 80.3% of the rosuvastatin group and 67.3% of the atorvastatin group at 8 weeks (p<0.01). The percent change of the LDL-C and LDL-C/HDL-C ratio at 8 weeks was significantly greater in the rosuvastatin group than in the atorvastatin group (both p<0.01). Furthermore, rosuvastatin improved fasting plasma glucose (p<0.01). Both drugs were well tolerated. Conclusion: Rosuvastatin (5 mg/day) is a useful treatment option for high-risk patients with hypercholesterolemia.
In a lifestyle modification program for the prevention of cardiovascular disease, quantitative assessment of the diet is essential. We developed a new food frequency and quantity method using portion-sized food models to apply in a lifestyle modification program. We conducted a dietary survey using this method of Japanese middle-aged men and women (n=76) who had undergone four 24hr dietary recalls one year before, and compared the results from the two surveys. Total energy intake and gram intake of macronutrients determined by our method were significantly lower than those determined by 24hr recalls. Correlation coefficients between nutrient intake obtained by the two methods were significant: r=0.532 (p<0.001) for carbohydrate, r=0.327 (p=0.004) for protein, r=0.334 (p=0.003) for total fat, r=0.419 (p<0.001) for saturated fatty acid, and r=0.230 (p=0.046) for polyunsaturated fatty acid. Correlations of nutrient intake were significantly increased with energy adjustment (p<0.05). Correlation coefficients between major food group intake were also significant: r=0.682 (p<0.001) for cereals, r=0.261 (p=0.023) for meat, and r=0.333 (p=0.003) for fish and shellfish. This method was thought to be appropriate for quantitative assessment of the intake of major nutrients and food groups of individuals in Japan.
Aim: Clinical investigations of the effects of garlic preparations in hypercholesterolemia have demonstrated somewhat controversial results. These discrepancies may be due to the differences of the composition of garlic preparations and the biological response they may induce. The study was undertaken to test the hypothesis that garlic powder tablets with a prolonged mode of action promise potent biological effects. Methods: The lipid-lowering effects of time-released garlic powder tablets, Allicor (600 mg daily), were investigated in a double-blinded placebo-controlled randomized study in 42 men aged 3570 with mild hypercholesterolemia. Results: Allicor treatment resulted in a moderate but statistically significant decrease in total cholesterol level that was observed after 8 and 12 weeks of active treatment. By the end of the study, total cholesterol in Allicor-treated patients had fallen by 7.6% (p=0.004) as compared to the level at randomization, and was 11.5% lower than the placebo group (p=0.005). LDL cholesterol in Allicor-treated patients fell by 11.8% (p=0.002) and 13.8% (p=0.009), respectively. HDL cholesterol also increased significantly after 8 and 12 weeks of treatment. By the end of the study, HDL cholesterol in Allicor-treated patients had increased by 11.5% (p=0.013). Conclusion: The obtained results are in good agreement with trials that have demonstrated the cardioprotective action of garlic preparations and may be due to the use of a time-released form of garlic powder tablets that provides a prolonged biological effect.
Background: Cardiovascular diseases constitute major causes of death in patients with chronic kidney diseases. An increase in arterial stiffness predicts the presence of cardiovascular diseases; however, non-invasive arterial stiffness parameters such as pulse wave velocity are confounded by blood pressure. Methods: A new arterial stiffness parameter β for the arterial tree, cardio-ankle vascular index (CAVI), was measured. To examine the usefulness of CAVI to screen for the presence of cardiovascular diseases, cross-sectional studies were performed on 68 patients undergoing chronic hemodialysis. Results: Stepwise regression analysis indicated that CAVI significantly correlated to age (β=0.05, p<0.01) but not blood pressure. In addition, CAVI was higher in diabetics than non-diabetics (8.39±0.37 vs 7.63±0.57, p<0.05). Furthermore, CAVI was markedly elevated in patients with a history of cardiovascular diseases (8.69±0.23 vs 6.66±0.28, p<0.01). Analysis using the ROC curve has demonstrated that CAVI of 7.55 constitutes the cut-off value for the presence of cardiovascular diseases with both sensitivity and specificity of 0.79. Conclusion: The present findings suggest that CAVI can be used as a screening test to detect for the presence of cardiovascular diseases in patients undergoing hemodialysis.
Aim: The effect of pitavastatin on high-sensitivity C-reactive protein (hs-CRP) has not been reported, yet, in humans. We, therefore, investigated the effects of pitavastatin on lipid profiles and hs-CRP in Japanese subjects with hypercholesterolemia. Methods: The subjects were 178 Japanese with hypercholesterolemia, including 103 (58%) with type 2 diabetes. Pitavastatin (12 mg/day) was administered for 12 months. Serum low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), remnant-like particle cholesterol (RLP-C), triglycerides (TG) and hs-CRP levels were measured for 12 months. Results: Serum LDL-C and RLP-C levels were significantly decreased by 30.3% and 22.8%, respectively. Serum TG levels were decreased by 15.9% in subjects with basal TG levels above 150 mg/dl. Serum HDL-C levels were significantly increased. The administration of pitavastatin reduced serum hs-CRP levels by 34.8%. No serious adverse events were observed, including changes in glycosylated hemoglobin levels of diabetic patients. Conclusion: These results suggest that pitavastatin significantly improves lipid profiles and reduces proinflammatory responses, without adverse effects, in Japanese subjects with hypercholesterolemia, including those with diabetes mellitus.