The Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study was the first large-scale, prospective study to examine the benefits of statin therapy in subjects with elevated levels of high-sensitivity C-reactive protein but with low-to-normal LDL-cholesterol levels, who were not qualified for lipid-lowering treatment according to the current guidelines for primary prevention. The JUPITER study aimed to determine whether rosuvastatin 20 mg daily would reduce the rate of first major cardiovascular events, including cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, hospitalization for unstable angina or arterial revascularization. Rosuvastatin reduced LDL-cholesterol levels by 50% and high-sensitivity C-reactive protein by 37%. Compared with placebo, the combined primary end point was reduced in 44% (p < 0.00001), and total mortality in 20% (p = 0.02). The trial confirmed the relationship between the rates of major cardiovascular events with both high-sensitivity C-reactive protein and LDL-cholesterol levels achieved after statin treatment. Interestingly, this was the first large, prospective statin trial to show benefit in the reduction of venous thromboembolism.
1. Antihypertensive treatment has been demonstrated to result in persistent reductions in morbidity and mortality due to stroke. However, the coronary risk attributable to hypertension has been only partially reversed. We hypothesized that diuretics could have unfavourable effects on atherosclerosis. 2. New Zealand rabbits were fed a 0.5% cholesterol-enriched diet for 12 weeks, followed by a 0.1% cholesterol diet for another 12 weeks. During the last 12 week period, 40 animals were randomly assigned to one of four groups: (i) group I was the control group; (ii) group II received hydrochlorothiazide (10 mg/day); (iii) group III received quinapril (30 mg/day); and (iv) group IV was treated with hydrochlorothiazide (10 mg/day) plus quinapril (30 mg/day). 3. The treatments did not affect either the lipid profile or serum electrolytes and oxidative stress. However, endothelium-dependent vasorelaxation in isolated aortic rings was significantly improved with quinapril (group III) treatment (P < 0.001 vs other groups). In addition, therapy with quinapril promoted a significant reduction in atherosclerosis (intima area, intima/media ratio and perimeter of vessel with plaque; P < 0.05 vs other groups), as well as in cholesterol content of the aorta (P < 0.05 vs groups II and IV). 4. In conclusion, hydrochlorothiazide did not modify atherosclerosis and, when added to quinapril treatment, impaired the anti-atherosclerotic effect seen with quinapril alone.
Atherosclerotic cardiovascular disease is the major cause of death in our country and occurs at earlier ages than that observed in the United States of America 1,2 .The initial results of the Framingham Study have associated serum cholesterol level, smoking, and arterial hypertension with ischemic heart disease 3 . More recently, the National Cholesterol Education Program (NCEP III, USA) 4 published the recommendations for estimating absolute coronary risk, considering the total cholesterol level, age, HDL-C level, values of systolic and diastolic blood pressure, and smoking habit, with different scores for men and women.In the past decade, several studies suggested that a more active lifestyle and higher consumption of fish could be beneficial, because they resulted in a lower incidence of cardiovascular events, a better lipid profile, and a reduction in blood pressure and in thrombotic risk [5][6][7][8] .Among the Eskimos in Greenland and the Japanese of Kohama Island, lower levels of total cholesterol and triglycerides and an extremely low incidence of coronary heart disease were observed as compared with those in the populations living on the continent 9-11 .In Brazil, epidemiological data of the Ministry of Health for the City of Belém, in the State of Pará 12 , showed that mortality due to cardiovascular disease was the major cause of death in that city despite the proximity to rivers and forests, and the high consumption of fish and typical fruits in that region.This study aimed at comparing the cardiovascular risk of the urban population of Belém in the State of Pará with that of an Amazonian riverside population (village of Vigia) living mainly on fish and with very scarce contact with large urban centers.
MethodsThe study sample comprised 100 individuals of both sexes with no personal antecedents of heart disease or diabetes, whose ages ranged from 35 to 65 years, 50 in each municipality. They signed a written consent required by the
Objective -To compare the lipid profiles and coronary heart disease risks of 2 Brazilian Amazonian populations as follows: a riverside population (village of Vigia) and an urban population (city of Belém in the state of Pará).Methods -Fifty individuals controlled for age and sex were assessed in each region, and the major risk factors for coronary heart disease were analyzed.
Results -According to the National Cholesterol Education Program (NCEP III) and using the
The paper summarizes the difficulties to study the rare population of endothelial progenitor cells in clinical trials, based on the experience of our group in many publications in this area.
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