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Pavanello C.,Centro Dislipidemie | Mombelli G.,Centro Dislipidemie
Clinical Lipidology | Year: 2015

Numerous clinical studies with objectives such as mortality and morbidity of cardiovascular (CV) have reported the benefit of treatment for dyslipidemia with lipid-lowering therapy, in particular using the statins. But the trials conducted in past years did not consider the gender differences of statin effect, because women were poorly represented. All the results in terms of response, efficacy, reduction of LDL cholesterol and CV risk in primary and secondary prevention refer to men. In these recent years, it emerges the need to consider the different lipoprotein profile during lifetime and CV risk between men and women. Furthermore it is necessary to consider that, in patients with coronary artery disease, the lipid goal achieved is different between the two genders. Finally, we have to evaluate the side effects mostly present in women. In conclusion, there is a different prescription of these treatments in particular in the dosage used, that it is insufficient in women with cardiovascular disease. More recently it has emerged the exigency to use new guidelines that clearly indicate how should be the medical care, therefore, the specific way to treat men and women. © 2015 Future Medicine Ltd.

Magni P.,University of Milan | Magni P.,Centro Dislipidemie | Macchi C.,University of Milan | Morlotti B.,Centro Dislipidemie | And 4 more authors.
European Journal of Internal Medicine | Year: 2015

The use of statins for cardiovascular disease prevention is clearly supported by clinical evidence. However, in January 2014 the U.S. Food and Drug Administration released an advice on statin risk reporting that "statin benefit is indisputable, but they need to be taken with care and knowledge of their side effects". Among them the by far most common complication is myopathy, ranging from common but clinically benign myalgia to rare but life-threatening rhabdomyolysis. This class side effect appears to be dose dependent, with more lipophilic statin (i.e., simvastatin) carrying a higher overall risk. Hence, to minimize statin-associated myopathy, clinicians should take into consideration a series of factors that potentially increase this risk (i.e., drug-drug interactions, female gender, advanced age, diabetes mellitus, hypothyroidism and vitamin D deficiency). Whenever it is appropriate to stop statin treatment, the recommendations are to stay off statin until resolution of symptoms or normalization of creatine kinase values. Afterwards, clinicians have several options to treat dyslipidemia, including the use of a lower dose of the same statin, intermittent non-daily dosing of statin, initiation of a different statin, alone or in combination with nonstatin lipid-lowering agents, and substitution with red yeast rice. © 2015 European Federation of Internal Medicine. All rights reserved.

Ruscica M.,University of Milan | Ruscica M.,Centro Dislipidemie | MacChi C.,University of Milan | MacChi C.,Centro Dislipidemie | And 5 more authors.
European Journal of Internal Medicine | Year: 2014

The use of statins for cardiovascular disease (CVD) prevention is clearly supported by clinical evidence. Although statin therapy is rather well tolerated, recent data from prospective and retrospective clinical trials and related meta-analyses suggest an increased incidence of new-onset type 2 diabetes mellitus (T2DM) in association with such treatment. The incidence of this adverse effect is not negligible, especially for specific subsets of patients, such as women, elderly, presence of familial history of T2DM and Asian ethnicity. Statin-driven T2DM appears to be a medication class-effect, mostly not related to potency nor to individual statin, as well as to be independent of previous history of CVD. Therefore, implementation of strategies for identification of patients using statins and at specific risk of incident T2DM, as well as of different therapeutic options is important and is discussed in this article. As most authors emphasized that benefits of CVD reduction by statin therapy seem to far exceed the risk of T2DM development itself, these medications remain the cornerstone for primary and secondary CVD prevention, although a specific attention to glucose metabolism and metabolic syndrome features should be payed before and during statin treatment, especially in cohorts at greater risk. © 2014 European Federation of Internal Medicine.

Ruscica M.,Centro Dislipidemie | Ruscica M.,University of Milan | Gomaraschi M.,Centro Dislipidemie | Gomaraschi M.,University of Milan | And 14 more authors.
Journal of Clinical Lipidology | Year: 2014

Background Primary cardiovascular prevention may be achieved by lifestyle/nutrition improvements and specific drugs, although a relevant role is now emerging for specific functional foods and nutraceuticals. Objectives The aim of this study was to evaluate the usefulness of a nutraceutical multitarget approach in subjects with moderate cardiovascular risk and to compare it with pravastatin treatment. Subjects Thirty patients with moderate dyslipidemia and metabolic syndrome (according to the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) were included in an 8-week randomized, double-blind crossover study and took either placebo or a nutraceutical combination that contained red yeast rice extract, berberine, policosanol, astaxanthin, coenzyme Q10, and folic acid (Armolipid Plus). Subsequently, they were subjected to another 8-week treatment with pravastatin 10 mg/d. This dosage was selected on the basis of its expected -20% efficacy in reducing low-density lipoprotein-cholesterol. Results Treatment with Armolipid Plus led to a significant reduction of total cholesterol (-12.8%) and low-density lipoprotein-cholesterol (-21.1%), similar to pravastatin (-16% and -22.6%, respectively), and an increase of high-density lipoprotein-cholesterol (4.8%). Armolipid Plus improved the leptin-to-adiponectin ratio, whereas adiponectin levels were unchanged. Conclusions These results indicate that this nutraceutical approach shows a lipid-lowering activity comparable to pravastatin treatment. Hence, it may be a safe and useful option, especially in conditions of moderate cardiovascular risk, in which a pharmacologic intervention may not be appropriate. © 2014 National Lipid Association. All rights reserved.

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