BACKGROUND
Cardiovascular disease (CVD) begins early in life and is associated with both the number of risk factors present and length of exposure to these risk factors including hyperlipidemia.
OBJECTIVES
The clinical benefit of intensive lipid therapy over 25 years was investigated in the Familial Atherosclerosis Treatment Study – Observational Study (FATS-OS).
METHODS
Of 175 CAD subjects with mean LDL-C of 191 mg/dl and mean age of 50 years, who completed the randomized and placebo-controlled FATS, 100 choose receiving lipid management by their physicians (UC) and 75 elected to receive an intensive lipid therapy (IT) with lovastatin (40mg/day), niacin (2.5g/day) and colestipol (20g/day) from 1989 to 2004, followed by double therapy with simvastatin (40–80mg/day) and niacin from 2005 to 2006 and by triple therapy of ezetimibe 10 mg and simvastatin 40–80 mg/day plus niacin during 2007–2012. Death from CVD, non-CVD and any cause were compared between UC and IT using Cox proportional hazards model.
RESULTS
UC and IT groups were similar in risk factors with the exception that IT had more sever CAD. Mean LDL-C levels were 167 mg/dl from 1988 to 2004, 97 from 2005 to 2006, and 96 from 2007 to 2012 in surviving subjects receiving UC. IT lowered LDL-C to 119 mg/dl, 97, and 83 in the 3 time periods. Compared to UC, IT significantly reduced total mortality (11.1 vs. 26.3 per 1,000 PY, HR=0.45, 95% CI: 0.26–0.77, p=0.003) and CVD mortality (10.6 vs. 27.7 per 1,000 PY, HR=0.34, 95% CI: 0.15–0.80, p=0.009). The non-CVD mortality was also reduced, but was not of statistical significance (6.8 vs. 12.7 per 1,000 PY, HR=0.55, 95% CI: 0.27–1.14, p=0.11).
CONCLUSIONS
Long-term intensive lipid therapy significantly reduced total and cardiovascular mortality in FATS-OS. These results support the importance of lifetime risk management to improve long-term outcome.
All cases were reviewed and demographic data and case details were analyzed.RESULTS: 1000 consecutive aPNL cases were reviewed, identifying 488 men and 512 women, 460 right side and 535 left, mean age 57 years (15-86), mean BMI 30 (15-49), mean ASA of 2.3 (1-4) and mean stone burden 31 mm (4-170), mean fluoroscopy time 84 sec (0-322). Mean OR time was 95 min (32-305) and mean treatment time was 14.9 min (1-262). Mean PACU time was 91 min (37-247). A mini-PNL (mPNL) procedure was conducted in 255 (25.5%) patients. The remaining 745 cases were standard tract size of which 449 were 30Fr and 296 were 24Fr. Stone free rate was 83%. Thirty nine patients had complications ranging from Clavien II-IVa, of which 15 were hospital transfers.CONCLUSIONS: These consecutive 1000 cases may serve as a landmark series demonstrating the feasibility of aPNL. Transitioning PNL to an ambulatory setting is a paradigm shift in the treatment of complex kidney stones. 39 patients experienced complications of Clavien II or higher. Each complication that occurred was managed in an appropriate fashion and the site of service did not lead to an alteration in the outcomes of the adverse events. With an experienced surgeon, well trained operative team and with modifications to the procedure focusing on post-operative pain control, PNL can be safely and effectively performed in a free standing ASC. 1. Davalos JG,
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