Bisher AKIL, MD

Posts Tagged ‘Statins’

HIV Related High Lipids is Difficult to Treat

In Heart on April 1, 2009 at 12:30 am

Dyslipidemia (abnormal lipids in blood) is common in HIV-infected patients, but treatment outcomes are often unsatisfactory. In this study from Kaiser Permanente in California, investigators compared responses to lipid-lowering therapy between 829 HIV-infected patients and 6941 uninfected controls, all with laboratory evidence of dyslipidemia. The HIV-infected patients had significantly smaller LDL (low density lipoprotein) declines in response to statin therapy than their HIV-negative counterparts (reduction, 25.6% vs. 28.3%); within the HIV population, pravastatin (Pravachol®) was less effective than other agents (simvastatin – Zocor®, lovastatin – Mevacor®, or atorvastatin- Lipitor®). Response to fibrate therapy (gemfibrozil – Lopid®) was also worse among HIV-infected patients, particularly those receiving PIs. Three cases of rhabdomyolysis occurred in the HIV-infected group versus one in the control group; laboratory abnormalities occurred in fewer than 5% of those with HIV infection.

Treatment Induced Changes in HDL , LDL and Heart Disease

In Heart on March 22, 2009 at 11:06 pm

High-density lipoprotein (HDL) cholesterol level is associated independently and inversely with coronary heart disease risk. However, evidence that treatment-mediated increases in HDL cholesterol levels lower risk for heart disease is lacking. In analysis of 108 randomized trials (Briel M et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: Systematic review and meta-regression analysis. BMJ 2009 Feb 16; 338:b92.), involving nearly 300,000 patients, investigators assessed whether changes in HDL and Low -density lipoprotein (LDL) as a result of medical treatment was associated with changes in the risk for heart disease.
All but five trials involved lipid-modifying drugs. After adjustment for changes in LDL cholesterol levels related to treatment and drug class, no associations were noted between treatment-mediated changes in HDL cholesterol levels and all-cause death. However, changes in LDL cholesterol levels were associated with significant outcomes: For a 10 mg/dL reduction in LDL cholesterol level, relative risks were lowered for all-cause death by 4.4%, for coronary heart disease-related death by 7.2%.
Comments: the good news is that is the LDL is lowered using medications, there is clear and significant benefit; on the other hand, changes in HDL did not seem to make a difference, in this analysis. This analysis may not reveal hidden benefits for increasing HDL, but it makes it clear that the goal of treatment should be lowering LDL _ BA