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Article
Role of Ezetimibe in Combination with Statins(Simvastatin and Atorvastatin) in Controlling Dyslipidemia

Authors: Gamal A.Abdulbari --- Shatha H. Ali شذى حسين علي --- Falah H.Al-Malki
Journal: Iraqi Journal of Pharmaceutical Sciences المجلة العراقية للعلوم الصيدلانية ISSN: 16833597 Year: 2009 Volume: 18 Issue: 1 Pages: 1-12
Publisher: Baghdad University جامعة بغداد

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Abstract

Cardiovascular risk is independently increased by plasma lipids abnormalities (low- density and high density lipoprotein -cholesterol and triglycerides). Most patients have more than one lipid abnormality. Combination therapy with lipid-modifying agents could offer an important therapeutic option for improving the overall lipid profile. Combinations have demonstrated to provide additive efficacy and significant reductions in coronary events . This study was designed to evaluate the effect of ezetimibe, when used in combination with other hypolipidaemic agents ( statins) on lipid profile as well as on liver function ,renal function, oxidative stress, and platelets function when given to dyslipidaemic patients . Forty four patients (24 males and 20 females) with age ranged between 40-70 years (54 ±14.6) with dyslipidaemia on statins therapy for at least 6 month were involved in this clinical trials. They were randomized into two groups treated with either a combination of 20 mg/day simvastatin or a combination of 20mg/day atorvastatin and 10mg/day of ezetimibe.The study also included 22 apparently healthy subjects with age ranged (40-70years) and sex(11males and 11 females) matching that of the patients group. Serum lipid profile (total cholesterol -TC, triglycerides -TG, low density lipoprotein-cholesterol –LDL-C, very low density lipoprotein-cholesterol-VLDL-C, and high density lipoprotein-cholesterol –HDL-C), oxidative stress marker (Malondialdehyde-MDA), liver functions indices (Alanin aminotransferase -ALT,Aspartate aminotransferase- AST, total bilirubin), renal function parameters (urea, creatinine, and microalbuminuria) and platelets function test (bleeding time)were evaluated before and after 4 and 6 weeks of starting ezetimibe treatment . Treatment with ezetimibe plus simvastatin or atrovostatin resulted in significant lowering in TC, TG, LDL-C levels with elevation in HDL-C also the LDL/HDL ratio lowered significantly ( by 38.16%). This effect was associated with significant changes in liver function , and oxidative stress without changes in platelets function nor in renal function. The results presented in this study indicated that ezetimibe can be used in clinical practice for the treatment of dyslipidaemia, when combined with other hypolipidaemic agents like simvastatin and atorvastatin to improve the therapeutic profile with ameliorating some of their adverse effects.

ان خطر أمراض الأوعية القلبية يمكن إن يزداد بصورة غير معتمدة عند الاختلال في الدهون الثلاثية والدهون البروتينية عالية الكثافة وواطئة الكثافة. وجد ان معظم المرضى لهم أكثر من خلل واحد في الدهون. ان العلاج المركب من المواد المعدلة للدهون يوفر فائدة علاجية مهمة لتحسين كل مستويات الشحوم في الدم . و العلاج المركب يمكن ان يكون له فعالية إضافية مسبباً هبوطاً معنوياً في التأثيرات على الشرايين التاجية. أجريت هذه الدراسة وصممت لتقييم فعالية الايزتايمب مع مواد خافضة للدهون مثل الستاتينات على معايير الكيمياء الحياتية والمتمثلة بمستويات ايض الدهون و فرط الأكسدة ووظائف الكبد والكلى ، إضافة إلى تأثيره على وظائف الصفيحات الدموية (زمن النزف) ومقارنة هذه التأثيرات مع أدوية تقليدية خافضة للدهون (سمفاستاتين و اتورفستاتين) كنظام مختلط مع الازيتياميب عند مرضى الشحام .اشتملت هذه الدراسة على (44) مريضا (24 ذكور، 20 اناث) بعمر يتراوح بين (40-70) سنة وبمعدل 54± 14.6 مريضاً بداء الشحام مستمرين على العلاج بادوية الستاتين. تم تقسيم المرضى عشوائياً الى مجموعتين كالأتي:المجموعة الأولى: هي مجموعة المرضى الذين استخدموا نظام مختلط بين السمفاستاتين والايزيتايميب 20+10 ملغم يومياً والمجموعة الثانية على نظام مختلط بين الاتورفاستاتين والايزيتايميب 20+10 ملغم يومياً. استمرت فترة المتابعة ستة أسابيع متتالية. كذلك ضمن الدراسة مجموعة مقارنة من الأصحاء بأعمار مقاربة وبنفس توزيع الجنس لمجاميع المرضى بالشحام وبعدد (22). تم قياس مستويات الشحوم في الدم (TC,TG,HDL,LDL) ومعايير فرط الاكسدة المالوندالديهايد ووظائف الكبد (AST,ALT T.Bil.) ووظائف الكلى (S.Urea,creatinine,MAU) ووظائف الصفيحات الدموية (Bleeding Time) قبل اعطاء العلاج وبعد مرور 4 اسابيع من اعطاء الازيتاميب. اظهرت تحاليل البيانات فروقا معنوية واضحة للازيتاميب مع السمفاستاتين او الاتروفاستاتين على مستوى شحوم الدم حيث لوحظ حصول انخفاض معنوي في تراكيز (TC,TG&LDL) وارتفاع مستوى HDL وانخفاض ملحوظ في نسبةترافق مع تغير معنوي في وظائف الكبد ALT,AST,T.Bil. . كذلك ظهر تحسن معنوي في معايير فرط الاكسدة متمثلة بانخفاض مستوى MD A و لم يتم ملاحظة أي تأثيرات ظاهرة او سلبية ذات دليل معنوي لوظائف الكلى والكبد والصفيحات الدموية.في ضوء النتائج التي افرزتها هذه الدراسة يمكن استنتاج مايلي :ان الازيتاميب يمكن ان يستخدم كعلاج اضافي بكفاءة لعلاج مرض الشحام وعندما يؤخذ مع ادوية خافضة للكوليسترول كالسمفاستاتين والاتروفاستاتين يمكن ان يحسن الفائدة العلاجية ومنع التأثيرات الجانبية المتوقعة.


Article
Evaluation of periodontal status in type 2diabetic patients on statin therapy
تقييم حالة دواعم السن عند مرضى السكري من النوع الثاني الذين يعالجون بأدوية السـتاتينات

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Abstract

Background: Dyslipidemia is prevalent in type 2 diabetes mellitus (DM). Statin drugs were first used to treat hypercholesterolemia and later to treat dyslipidemia particularly in DM. However, it was found that they also have an anti-inflammatory pleiotropic effect. Chronic periodontitis is a continuous inflammatory process whose progression is modulated by the presence of DM.Aim of study: To assess the association between the use of statin drugs and any improvement in periodontal status.Materials & methods: Eighty (40 males and 40 females) type 2 diabetic patients were enrolled in this study. Patients were selected consecutively but with consideration of sex and exclusion criteria to compose two groups: - Forty (20 males and 20 females) patients who were on a statin drug for at least six months and were assigned as the ( Statin group ).-Forty (20 males and 20 females) patients who received no statin drug at any time and were assigned as ( Non statin group ).Periodontal status was evaluated by periodontal disease index (PDI) which includes plaque, calculus, and periodontal components of this index.Assessment of glycemic control included serum glucose assay and HbA1c assay.Lipid profile assay included estimation of serum total cholesterol (TC), serum triglycerides (TG), high density lipoprotein cholesterol (HDL-C), and calculation of low density lipoprotein (LDL-C). Results: The difference between the mean levels of HbA1c in statin group and non statin group was statistically non significant (8.61±1.82% vs. 9.10±1.26% respectively). There were no significant differences between statin group and non statin group in regard to the mean levels of TC, HDL-C, and LDL-C. The mean level of TG was higher in statin group and the difference was statistically of high significance (151.10±55.02 vs. 122.43±34.39 mg/dl, P<0.01). The mean values of plaque, calculus, and periodontal disease index were lower in statin group than in non statin group. The difference in plaque index was statistically highly significant (1.31±.0.57 vs. 1.70±0.50, P<0.01), while the differences in calculus index and periodontal disease index were statistically significant (0.61±0.47 vs. 0.87±0.65, and 2.75±0.89 vs. 3.16±.0.78 respectively, P< 0.05).Conclusion: Diabetic patients on statin therapy exhibited fewer clinical signs of periodontal disease than those without statin therapy. Key words: Diabetes mellitus, Dyslipidemia, Statins, Periodontitis

الخلفية: أن شذوذ شحميات الدم هو حالة منتشرة في مرضى السكّري من النوعِ الثاني . أن ادوية الستاتينات ( Statins ) قد اَستعملت في البدايةًً لمعالجة فَرْطُ كوليستيرولِ الدَّم ولاحقاً لمُعَالَجَة شذوذ شحميات الدم خصوصاً في السكّري. لقد وُجِدَ بأنّ لهذه الادوية تأثيرات متعددة المظاهر و منها تأثيرها المُضادُّ للالْتِهاب ً. أن الْتِهابُ دَوَاعِمِ السِّنّ المُزمن هو عملية ألتهابية مستمرة يتأثر تقدمها بوجود السكري هدف الدراسةِ: تَقييم العلاقة بين إستعمالِ ادوية الستاتينات وأيّ تحسن في الْتِهابُ دَوَاعِمِ السِّنّ.المواد والطرق: ثمانون من مرضى السكري (40 ذكر و40 أنثى)قد سُجّلوا في هذه الدراسةِ. المرضى إختيروا لإعْداْد مجموعتين:- أربعون (20 ذكر و20 أنثى) من المرضى كَانوا يعالجون بادوية الستاتينات لستّة شهورِ على الأقل. - أربعون (20 ذكر و20 أنثى) من المرضى لم يعالجوا بأدوية الستاتينات. تم تقييم حالة دواعم السن باستخدام دالة مرض دواعم السن والتي تشتمل على دالة اللوحة السنية، دالة القلح أو التكلس السني، ودالة دواعم السن.أن تقدير تضبيط سكر الدم قد تضمن قياس الكلوكوز في مصل الدم والهيموغلوبينِ الغليكوزيلاتي في الدم. أن تقدير مرتسم الشحوم قد تضمن قياس الكوليسترول الكلي وثُلاَثِيُّ الغليسريد وكوليسترول البروتين ٌالشَحْمِيٌّ رَفيعُ الكَثافَة في مصل الدم وحساب كوليسترول البروتين ٌالشَحْمِيٌّ خفيض الكَثافَة. النَتائِج: كانت الفروقات بين متوسط مستويات الهيموغلوبينِ الغليكوزيلاتي في مجموعةِ مرضى السكري الذين يعالجون بأدوية الستاتينات مقابلْ مجموعةِ مرضى السكري الذين لا يعالجون بأدوية الستاتينات لايعتد بها أحصائيا ( 8.61 ± 1.82 % مقابل 9.1 ± 1.26 % على التوالي ). لم يكن هنالك فرق يعتد به أحصائيا في متوسط مستويات مكونات مرتسم الشحوم لمجموعتي الدراسة بأستثناء ثُلاَثِيُّ الغليسريد الذي كان أعلى في مجموعة مرضى السكري الذين يعالجون بأدوية الستاتينات مقابلْ مجموعةِ مرضى السكري الذين لا يعالجون بأدوية الستاتينات ( 151 ± 55 مقابل 122.4 ± 34.4 ملغرام % على التوالي ، P < 0.01 ).أن متوسط القِيَم لدوال اللوحة السنية ِ،القَلَحٌ أوالتكلس السِنِّيّ ، و الْتِهابُ دَوَاعِمِ السِّنّ كَانْ أوطأ في مجموعةِ مرضى السكري الذين يعالجون بأدوية الستاتينات مِنْ مجموعةِ مرضى السكري الذين لا يعالجون بأدوية الستاتينات وكان 1.31 ± 0.57 مقابل 1.7 ± 0.5 ، P < 0.01 لدالة اللوحة السنية وكان 0.61 ± 0.47 مقابل 0.87 ± 0.65 ، P < 0.05 لدالة القلح السني وكان 2.57 ± 0.89 مقابل 3.16 ± 0.78 ، P < 0.05 لدالة دواعم السن على التوالي.الا ستنتاج : أن مرضى السكري الذين يعالجون بأدوية الستاتينات أظهروا علامات سريريةَ خاصة بمرضِ الْتِهابِ دَوَاعِمِ السِّنّ أقل مِنْ مرضى السكري الذين لا يعالجون بأدوية الستاتينات.


Article
An Assessment of Oral Health in Hypertensive Patients Treated with HMG-CoA Reductase Inhibitors (Statins)

Authors: Amir A. M. Al-Joboury --- Rafil H. Rasheed
Journal: Journal of baghdad college of dentistry مجلة كلية طب الاسنان بغداد ISSN: 16800087 Year: 2015 Volume: 27 Issue: 4 Pages: 85-89
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated, it'sclassified as either primary (essential) hypertension or secondary hypertension, and it increases the risk of ischemicheart disease, peripheral vascular disease and other cardiovascular diseases. Several classes of medicationscollectively referred to as antihypertensive drugs like beta blockers, calcium channel blockers, angiotensinconverting enzyme (ACE) inhibitors, angiotensin receptor blockers, renin inhibitors and statins (HMG-CoA) reductaseinhibitor. Statin medication may have some beneficial effects when subjects have dental plaque or signs ofperiodontitis as gingival bleeding. The purpose of this study were to assess the oral health in hypertensive patients aretreated with statins in terms of salivary flow rate, pH and oral health indices.Materials and Methods: Ninety saliva specimens collected from three groups of subjects (thirty healthy patients"control" Group I), thirty hypertensive patients treated with anti-hypertensive medications without taking statins(Group II) and thirty hypertensive patients treated with anti-hypertensive medications with statins (Group III).Unstimulated saliva was collected from each patients and participants for assessment of salivary flow rate andsalivary pH.Results: Salivary flow rate is reduced in Group II and III patients compared with Group I. Significant low salivary flowrate observed in Group III patients (hypertensive treated with statins) compared with Group II (hypertensiveuntreated with statins) and Group I (healthy subjects); The median value of gingival index is significantly higher inGroup II compared with corresponding value in Group I, while it attended a significant low value in Group IIIpatients; There is no significant difference in DMF score between Group I and Group III, while a significant high scoreobserved in Group II compared with Group I ; The percent of carries restoration in patients of Group II is significantlylow compared with corresponding value of Group I . Although the percent of carries restoration in patients ofGroup III is less than corresponding value of Group I but it does not reach significant level.Conclusions: Patients using statins therapy are more likely have an improvement in gingival index, DMF score andcarries restoration. The salivary flow rate is reduced in patients treated with statins medications, statins therapy havea beneficial effect on the oral cavity


Article
Frequency Of Potential Adverse Effects Of A Semisynthetic Statin (Simvastatin) Compared To A Synthetic Statin (Atorvastatin) Used To Reduce Cardiovascular Risk For Patients In Basra

Authors: Abdullah S. Asia --- Al-Mahdi A. Modar --- Hadi M. Ali
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2015 Volume: 8 Issue: 2 Pages: 2235-2239
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: The confirmed benefits of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) for cardiovascular and cerebrovascular disease are well recognized in the medical literature.Objectives: This study aimed at examining the frequency of potential side-effects seen as a result of statins therapy, because of the importance of statins adverse effects.Therefore, this paper aims to evaluate the frequency of potential adverse effects reported by patients using a semi synthetic statin (Simvastatin) and the synthetic statin (Atorvastatin) in Al-shafaa general Hospital in Basra.Patients and Methods: A total of 350 patients were included in this cross – sectional study to evaluate the frequency of potential adverse effects reported by patients using a semi synthetic statin (simvastatin) and the synthetic statin (atorvastatin) from November 2014 to March 2015 at the out-patient departments of Al-shafaa general Hospital in Basra.Results & discussion: 246 patients (70.3%) report about 302 symptoms, overall symptoms reported were similar between the two types of statins and included muscle pain, joint pain, increased serum transaminase enzymes, gastrointestinal effects, respiratory effects and hair falling effects. The only adverse effects significantly reported for simvastatin more than atorvastatin were headache and dizziness. The side-effects were not severe enough to discontinue administration of statins.Conclusions: There is no significant difference in the frequency of potential side effects reported by patients using a semi synthetic statin (simvastatin) and the synthetic statin (atorvastatin), apart from headache and dizziness reported significantly with simvastatin more than atorvastatin.


Article
THE ROLE OF ATORVASTATIN IN THE TREATMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH ELEVATED HIGH SENSITIVE C-REACTIVE PROTEIN

Author: Ali S. Baay علي صالح مهدي بيعي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2016 Volume: 14 Issue: 4 Pages: 383-392
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:There is a growing interest in the potential beneficial effects of 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors drugs (statins) in chronic obstructive pulmonary disease (COPD) as anti-inflammatory agent. The basis of the systemic inflammation in COPD comes from two possibilities: spill-over effect or inherent systemic-based pro-inflammatory state conferred by a genetic disposition. The inhaler-based therapy for COPD aims to reduce symptoms, improve quality of life and reduce hospitalization, but does not substantially change disease progression or reduce mortality.Objective:To assess the efficacy and safety of statin therapy in COPD patients with evidence of inflammatory markers.Methods:Ninety patients were included in the study, aged 40 years or more, who visit the outpatient private clinic in Babylon government, Iraq from September 2012 to April 2016. They were divided randomly for 3 groups (receiving 40 mg, 10 mg atorvastatin or placebo, respectively), in addition to their baseline treatment. Severity reassessment performed after 6 months' duration of treatment as well as hospitalization frequency and mortality. Results: Statin therapy showed a significant improvement in the both doses treated groups regarding the HsCRP, CAT (chronic obstructive airway disease assessment test) score and forced expiratory volume in first second after 6 months of treatment. This improvement fails to be reported significant effect on CAT score when compared to placebo group. Thus, statin treatment doesn’t show any symptomatic improvement as measured by CAT score over placebo treatment.Conclusion:The statin treatment in patient with chronic obstructive pulmonary disease can be useful in form of improvement of hospitalization, number of exacerbations but not mortality.Keywords: Atorvastatin, statins, COPD, high sensitive C-reactive protein.

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