The document summarizes the COMBOS study which evaluated the effects of adding prescription omega-3 ethyl esters (Lovaza) to stable statin therapy in patients with persistent hypertriglyceridemia. The study found that Lovaza plus simvastatin led to greater reductions in non-HDL cholesterol and other lipid parameters compared to simvastatin alone. Non-HDL cholesterol is a measure of total cholesterol carried by LDL, VLDL, and their remnants, and is a better predictor of cardiovascular risk than LDL alone, especially in patients with high triglycerides.
Abstract—Abnormalities that characterizes lipoprotein metabolism in non-insulin dependent diabetes mellitus (NIDDM) patients, fasting concentration of triglyceride rich lipoprotein especially very low density lipoprotein (VLDL) are higher and those of HDL, commonly measured as HDL-c, are lower than among people without diabetes, which leads to increased triglyceride HDL-c ratio and insulin resistance. This type of diabetic dyslipidemia is a major cause of oxidative stress which promote and accelerate atherosclerosis and thus, end organ damage AMI. This present study was carried at the Central Clinical Laboratory MIMSR Medical College Latur, with the aim to find out the role of lipoprotein-triglyceride in myocardial infarction in NIDDM. For this study, patient with myocardial infarction with NIDDM were selected after admitting in MIMSR Medical College Latur. These 25 cases were included in study group and age-matched to these cases 50 healthy subjects were selected as Control group. The lipid profile and total serum lipid peroxides (malondialdehyde) of study and control groups were assessed & compared. It was found that in the control group mean values of total cholesterol was 180.21 ± 18.13 mg % whereas it was 229.21± 23.58 in study group, which was significantly higher in study group. Likewise, mean Serum Triglycerides and Serum Lipid Peroxides (MDA) of study group were also found significantly (p<0.001) higher that of control group (228.14 v/s 99.9 and 410.22 v/s 180.96 respectively). It was also revealed in this study that mean Serum HDL-Cholesterol was found significantly lower in study group whereas LDL-Cholesterol (28.72 v/s 53.83) and VLDL-Cholesterol were found significantly higher in study group that control group (150.61 v/s 106.60 and 46.30 v/s 19.8). So it can be concluded that AMI patients with NIDDM have higher Total Serum Cholesterol, Serum Triglycerides, Serum Lipid Peroxides (MDA), LDL- Cholesterol and VLDL- Cholesterol with lower HDL- Cholesterol.
ABSTRACT- Diabetes mellitus is associated with hyperglycemia and patients are at an increased risk of cardiovascular disease. The present study
was carried out to evaluate the diagnostic value of Glycated hemoglobin (HbA1c) in predicting risk of development of diabetic dyslipidemia. 70 clinically
diagnosed cases of type 2 diabetes mellitus with the age range 30-75 years were included in the study group. Out of which 35 diabetic patients
with good glycemic control were included under Group A and 35 diabetic patients with poor glycemic control were included under Group B. 70 age
and sex matched healthy individuals served as controls. HbA1c demonstrated positive and significant correlation with total cholesterol (TC), low
density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and LDL/HDL-C, non-HDL-C and TC/HDL-C ratio. Patients
with HbA1c value > 7.0% had significantly higher value of TC, Triacylglycerol (TAG), LDL-C, LDL-C/HDL-C ratio, non-HDL-C and TC/HDL-C
ratio as compared to the patients with HbA1c ≤ 7.0%. However, there was no significant difference in value of HDL-C between two groups. Thus
HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus.
Keywords: - Type2 Diabetes Mellitus, Glycated hemoglobin, Dyslipidemia, Cardiovascular disease, Lipid Profile panel
Abstract—Abnormalities that characterizes lipoprotein metabolism in non-insulin dependent diabetes mellitus (NIDDM) patients, fasting concentration of triglyceride rich lipoprotein especially very low density lipoprotein (VLDL) are higher and those of HDL, commonly measured as HDL-c, are lower than among people without diabetes, which leads to increased triglyceride HDL-c ratio and insulin resistance. This type of diabetic dyslipidemia is a major cause of oxidative stress which promote and accelerate atherosclerosis and thus, end organ damage AMI. This present study was carried at the Central Clinical Laboratory MIMSR Medical College Latur, with the aim to find out the role of lipoprotein-triglyceride in myocardial infarction in NIDDM. For this study, patient with myocardial infarction with NIDDM were selected after admitting in MIMSR Medical College Latur. These 25 cases were included in study group and age-matched to these cases 50 healthy subjects were selected as Control group. The lipid profile and total serum lipid peroxides (malondialdehyde) of study and control groups were assessed & compared. It was found that in the control group mean values of total cholesterol was 180.21 ± 18.13 mg % whereas it was 229.21± 23.58 in study group, which was significantly higher in study group. Likewise, mean Serum Triglycerides and Serum Lipid Peroxides (MDA) of study group were also found significantly (p<0.001) higher that of control group (228.14 v/s 99.9 and 410.22 v/s 180.96 respectively). It was also revealed in this study that mean Serum HDL-Cholesterol was found significantly lower in study group whereas LDL-Cholesterol (28.72 v/s 53.83) and VLDL-Cholesterol were found significantly higher in study group that control group (150.61 v/s 106.60 and 46.30 v/s 19.8). So it can be concluded that AMI patients with NIDDM have higher Total Serum Cholesterol, Serum Triglycerides, Serum Lipid Peroxides (MDA), LDL- Cholesterol and VLDL- Cholesterol with lower HDL- Cholesterol.
ABSTRACT- Diabetes mellitus is associated with hyperglycemia and patients are at an increased risk of cardiovascular disease. The present study
was carried out to evaluate the diagnostic value of Glycated hemoglobin (HbA1c) in predicting risk of development of diabetic dyslipidemia. 70 clinically
diagnosed cases of type 2 diabetes mellitus with the age range 30-75 years were included in the study group. Out of which 35 diabetic patients
with good glycemic control were included under Group A and 35 diabetic patients with poor glycemic control were included under Group B. 70 age
and sex matched healthy individuals served as controls. HbA1c demonstrated positive and significant correlation with total cholesterol (TC), low
density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and LDL/HDL-C, non-HDL-C and TC/HDL-C ratio. Patients
with HbA1c value > 7.0% had significantly higher value of TC, Triacylglycerol (TAG), LDL-C, LDL-C/HDL-C ratio, non-HDL-C and TC/HDL-C
ratio as compared to the patients with HbA1c ≤ 7.0%. However, there was no significant difference in value of HDL-C between two groups. Thus
HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus.
Keywords: - Type2 Diabetes Mellitus, Glycated hemoglobin, Dyslipidemia, Cardiovascular disease, Lipid Profile panel
HYPERLIPIDAEMIA--LIPID PROFILE, TYPE OF HYPERLIPIDAEMIA ,LIPOPROTEINS, CLASSIFICATION OF DRUGS AND MECHANISM OF ACTION, ETIOPATHOLOGY,
METABOLISM OF LIPIDS, SIGN AND SYMPTOMS, PHARMACOKINETIC ,THERAPEUTIC USE, ADVERSE EFFECTS,CONTRAINDICATION .
Atherotech’s VAP+ is a simple non-fasting blood test that directly measures your cardiovascular risk and disease progression that breaks down lipid abnormalities into three categories: triglycerides, cholesterol and hereditary components. The basic lipid does NOT fully assess cardiovascular risk/disease. Often, misclassifying the high risk patients approximately 60% of the time; and inaccurately reports a falsely low LDL, the main target of therapy. Why would anyone with family history of cardiovascular disease NOT want this complete assessment at NO additional cost????
Call 202-527-1953 to find out where to get your VAP+ test done, today!
*Additional markers included in the VAP+ report are LDL-P, Lp(a), remnants (IDL, VLDL3), ApoB and Apo A1.
Raised Lipid Profile In Rheumatoid Arthritis- A Risk For CVDiosrjce
IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB) covers studies of the chemical processes in living organisms, structure and function of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules, chemical properties of important biological molecules, like proteins, in particular the chemistry of enzyme-catalyzed reactions, genetic code (DNA, RNA), protein synthesis, cell membrane transport, and signal transduction. IOSR-JBB is privileged to focus on a wide range of biotechnology as well as high quality articles on genetic engineering, cell and tissue culture technologies, genetics, microbiology, molecular biology, biochemistry, embryology, cell biology, chemical engineering, bioprocess engineering, information technology, biorobotics.
Impact of Hemodialysis on lipid profile among chronic renal failure patients ...Neeleshkumar Maurya
Chronic Renal Failure (CRF) patients are at risk of cardiovascular diseases due to the elevation of various forms of lipids. Many a time CRF patients live on hemodialysis on regular basis. Chronic renal failure (CRF) is complicated by characteristic dyslipidemias. We sought to evaluate the pattern of lipid profile in CRF patients with and without hemodialysis. Study were divided into 2 groups, Group-I: CRF patients who never undergone hemodialysis (24) and Group-II: CRF patients on hemodialysis (24). We obtained serum samples from patients in the morning after an overnight fast and were analyzed for total cholesterol (TC), triglycerides (TGs), HDL, LDL and VLDL. Significant change (p<0.05) was found in Total cholesterol (TC), HDL-C, VLDL-C, HDL-C(level) between first and second group.
Keywords: Chronic renal failure, cardiovascular disease, Haemodialysis, CKD stage – 5
Correlations between Some Anthropometric Parameters, the Lipid Profile and Gl...inventionjournals
The study aimed to investigate the correlations between some anthropometric and lipid profile parameters, as well the glycated hemoglobin (HbA1c) values of Bulgarian females with type 2 Diabetes mellitus (T2DM). 212 women of Bulgarian ethnicity with T2DM of the age groups 40-60 and 61-80 years were included in the research. The anthropometric parameters: waist and hip circumferences were measured, and body mass index (BMI) and waist/hip ratio (WHR) were calculated. We also studied the lipid profile parameters: total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL). A comparative study of the lipid profile criteria revealed significant differences in the levels of triglycerides, HDL-cholesterol and VLDL between the two age groups. Differences were found with regard to the values of glycated hemoglobin too. Correlations between the above anthropometric parameters and the lipid profile of patients with T2DM were examined. In patients of the age group 40-60 years a moderate strength correlation in opposite direction (negative or inverse correlation) was found between HbA1c and BMI (Pearson correlation coefficient 0.30-0.50, p<0.05). In the age group 61-80 years a low strength negative correlation was found between BMI and total cholesterol, as well as between BMI and LDL.
sdLDL-C - Size Matters: The True Weight of Risk in Lipid Profiling MAY19Randox Reagents
LDL Cholesterol (LDL-C) is a low density lipoprotein involved in cholesterol and triglycerides transfer from the liver to peripheral tissues. LDL-C consists of two parts: the bigger part with phenotypic pattern A is light and almost rich in cholesterol (lbLDL-C or large buoyant LDL cholesterol) and the smaller
part with more special weight and phenotypic pattern B (sdLDL-C) composed of less cholesterol. The two types of LDL-C vary in size through genetic determination and dietary lipid intake and their atherogenesis varies according to size. These smaller particles can more readily permeate the inner arterial
wall and are more susceptible to oxidation.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
When it comes to management of cardiovascular diseases, are achieving lipid lowering targets sufficient. Here Dr Vivek Baliga, Consultant Internal medicine discusses the additional benefits of statins in CVD in India.
Diabetes is often accompanied by high triglyceride and high cholesterol levels. Saroglitazar (Lipaglyn) is a novel molecule that not only reduces elevated TG levels; it also reduces blood glucose levels. This presentation by Dr Vivek Baliga discusses this novel molecule.
HYPERLIPIDAEMIA--LIPID PROFILE, TYPE OF HYPERLIPIDAEMIA ,LIPOPROTEINS, CLASSIFICATION OF DRUGS AND MECHANISM OF ACTION, ETIOPATHOLOGY,
METABOLISM OF LIPIDS, SIGN AND SYMPTOMS, PHARMACOKINETIC ,THERAPEUTIC USE, ADVERSE EFFECTS,CONTRAINDICATION .
Atherotech’s VAP+ is a simple non-fasting blood test that directly measures your cardiovascular risk and disease progression that breaks down lipid abnormalities into three categories: triglycerides, cholesterol and hereditary components. The basic lipid does NOT fully assess cardiovascular risk/disease. Often, misclassifying the high risk patients approximately 60% of the time; and inaccurately reports a falsely low LDL, the main target of therapy. Why would anyone with family history of cardiovascular disease NOT want this complete assessment at NO additional cost????
Call 202-527-1953 to find out where to get your VAP+ test done, today!
*Additional markers included in the VAP+ report are LDL-P, Lp(a), remnants (IDL, VLDL3), ApoB and Apo A1.
Raised Lipid Profile In Rheumatoid Arthritis- A Risk For CVDiosrjce
IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB) covers studies of the chemical processes in living organisms, structure and function of cellular components such as proteins, carbohydrates, lipids, nucleic acids and other biomolecules, chemical properties of important biological molecules, like proteins, in particular the chemistry of enzyme-catalyzed reactions, genetic code (DNA, RNA), protein synthesis, cell membrane transport, and signal transduction. IOSR-JBB is privileged to focus on a wide range of biotechnology as well as high quality articles on genetic engineering, cell and tissue culture technologies, genetics, microbiology, molecular biology, biochemistry, embryology, cell biology, chemical engineering, bioprocess engineering, information technology, biorobotics.
Impact of Hemodialysis on lipid profile among chronic renal failure patients ...Neeleshkumar Maurya
Chronic Renal Failure (CRF) patients are at risk of cardiovascular diseases due to the elevation of various forms of lipids. Many a time CRF patients live on hemodialysis on regular basis. Chronic renal failure (CRF) is complicated by characteristic dyslipidemias. We sought to evaluate the pattern of lipid profile in CRF patients with and without hemodialysis. Study were divided into 2 groups, Group-I: CRF patients who never undergone hemodialysis (24) and Group-II: CRF patients on hemodialysis (24). We obtained serum samples from patients in the morning after an overnight fast and were analyzed for total cholesterol (TC), triglycerides (TGs), HDL, LDL and VLDL. Significant change (p<0.05) was found in Total cholesterol (TC), HDL-C, VLDL-C, HDL-C(level) between first and second group.
Keywords: Chronic renal failure, cardiovascular disease, Haemodialysis, CKD stage – 5
Correlations between Some Anthropometric Parameters, the Lipid Profile and Gl...inventionjournals
The study aimed to investigate the correlations between some anthropometric and lipid profile parameters, as well the glycated hemoglobin (HbA1c) values of Bulgarian females with type 2 Diabetes mellitus (T2DM). 212 women of Bulgarian ethnicity with T2DM of the age groups 40-60 and 61-80 years were included in the research. The anthropometric parameters: waist and hip circumferences were measured, and body mass index (BMI) and waist/hip ratio (WHR) were calculated. We also studied the lipid profile parameters: total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL). A comparative study of the lipid profile criteria revealed significant differences in the levels of triglycerides, HDL-cholesterol and VLDL between the two age groups. Differences were found with regard to the values of glycated hemoglobin too. Correlations between the above anthropometric parameters and the lipid profile of patients with T2DM were examined. In patients of the age group 40-60 years a moderate strength correlation in opposite direction (negative or inverse correlation) was found between HbA1c and BMI (Pearson correlation coefficient 0.30-0.50, p<0.05). In the age group 61-80 years a low strength negative correlation was found between BMI and total cholesterol, as well as between BMI and LDL.
sdLDL-C - Size Matters: The True Weight of Risk in Lipid Profiling MAY19Randox Reagents
LDL Cholesterol (LDL-C) is a low density lipoprotein involved in cholesterol and triglycerides transfer from the liver to peripheral tissues. LDL-C consists of two parts: the bigger part with phenotypic pattern A is light and almost rich in cholesterol (lbLDL-C or large buoyant LDL cholesterol) and the smaller
part with more special weight and phenotypic pattern B (sdLDL-C) composed of less cholesterol. The two types of LDL-C vary in size through genetic determination and dietary lipid intake and their atherogenesis varies according to size. These smaller particles can more readily permeate the inner arterial
wall and are more susceptible to oxidation.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
When it comes to management of cardiovascular diseases, are achieving lipid lowering targets sufficient. Here Dr Vivek Baliga, Consultant Internal medicine discusses the additional benefits of statins in CVD in India.
Diabetes is often accompanied by high triglyceride and high cholesterol levels. Saroglitazar (Lipaglyn) is a novel molecule that not only reduces elevated TG levels; it also reduces blood glucose levels. This presentation by Dr Vivek Baliga discusses this novel molecule.
CholesLo shows clinical significance in
helping reduce plasma cholesterol and
homocysteine levels and therefore affects
favourably the risk of subsequent development
of cardiovascular disease. Furthermore, our
findings suggest that the dose required to cause
such improvements in plasma lipid profile is
safe enough to be considered for use in general
population.
L. berarducci new cholesterol management guidelinesAlysia Smith
Dr. Laurence Berarducci, MD, FACC presents on "New Cholesterol Management Guidelines" at the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
Heart diseases due to hyperlipidemia (primary or secondary) can lead to cause chest pain, heart attacks,
strokes, cardiac arrhythmias, cardiac failure. Because of these risks, treatment is often recommended for people with
hyperlipidemia, because it is well known factor to increase incidence of heart diseases. This may lead to
development of atherosclerotic plaques which is major etiological factor for establishing coronary artery disease
(CAD). Hypolipidemic drugs used in allopathy include Statins, Fibric acids, Niacin, and Resins but all have their
low compliance due to frequent side effects. Medicinal herbs like Onion and Ginger are hypolipidemic agents
commonly used as flavoring agents and making foods spicy and tasty. We have compared hypolipidemic potential
between these two medicinal herbs. The study was conducted at Ghurki Trust teaching hospital, Lahore from
January to June 2018. Eighty secondary hyperlipidemic patients were enrolled after getting written consent which
was approved by Ethics committee of the hospital. They were divided in two equal groups comprising 40 patients in
each group. Group-I was treated by Ginger 10 grams daily in three divided doses for 2 months. Group-II was
advised to take Onion 200 grams daily in divided amount with each meal i.e.; breakfast, lunch, and dinner for two
months. After two months therapy it was observed by statistical analysis that 10 grams ginger reduced TC (total
cholesterol) of 38 hyperlipidemic patients 12.4 gm/dl and LDL-C (low density lipoprotein cholesterol) 27.3 mg/dl.
In group-II, onion reduced TC in 35 patients 17.9 mg/dl and LDL-C 14.8 mg/dl. Changes in tested parameters are
significant biostatistically with p-values <0.01 to <0.001. We concluded from this research work that Onion and
Ginger reduces risk of CAD by decreasing plasma total cholesterol and LDL cholesterol.
High density lipoprotein cholesterol (HDL-c), often termed “good cholesterol”, is one of the major targets of cardiovascular risk reduction. Constant attempts have been made over the past 3 decades to increase their level in the blood in an attempt to reduce cardiovascular risk. In spite of these efforts, raising HDL-c still remains an enigma.
While several methods are known to raise HDL-c, they are not as dramatic as reduction of low density lipoprotein cholesterol (LDL-c). Statins, fibrates, niacin and cholesteryl-ester transfer protein (CETP) inhibitors are useful in increasing HDL-c. However, it was recently demonstrated that raising HDL-c using these pharmacological means did not have any significant effect on reducing clinical cardiovascular events. The 2013 ACC/AHA guidelines on managing blood cholesterol did not give much importance to HDL-c management too.
An important question is the method with which HDL-c is tested. Is HDL-cholesterol more important or HDL lipoprotein particle number? Are HDL-based therapies dead? Are there newer ongoing techniques that raise HDL cholesterol as well as reduce cardiovascular risk?
Shashikiran Umakanth presented this at the Egyptian Association of Endocrinology, Diabetes & Atherosclerosis (EAEDA) 2014 conference at Alexandria, Egypt. This conference was help in association with Endocrine Society, USA and the European Association for the Study of Diabetes (EASD).
Complications of abnormal lipid levels
Generally, a high total cholesterol level (which includes LDL, HDL, and VLDL cholesterol), particularly a high level of LDL (the "bad") cholesterol, increases the risk of atherosclerosis and thus the risk of heart attack or strok
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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The combos study an expert interview with william s
1. 3/28/12 The COMBOS Study: An Expert Interview With William S. Harris, PhD (printer-friendly)
www.medscape.org
William S. Harris, PhD, Professor of Medicine, Sanford School of Medicine, University of South Dakota, Sioux
Falls
Linda Brookes, MSc, freelance medical writer based in London and New York
Disclosure for Interviewee: William S. Harris, PhD, has disclosed that he has received grants for clinical research
and educational activities from, and has served as an advisor or consultant for, Reliant Pharmaceuticals. He has
also disclosed that he has received grants for clinical research from, and has served as an advisor or consultant for,
Monsanto Company.
Disclosure for Interviewer: Linda Brookes, MSc, has disclosed no relevant financial relationships.
The COMBination of Prescription Omega-3 With Simvastatin
(COMBOS) Study: An Expert Interview With William S. Harris,
PhD
William S. Harris, PhD
Posted: 10/31/2007
Editor's Note:
William S. Harris, PhD, is Director of Nutrition and Metabolic Diseases Research at Sanford Research/USD in Sioux
Falls, South Dakota. The SR/USD is a joint venture between the University of South Dakota Sanford School of
Medicine and Sanford Health System. Until June 2006, he was Professor of Medicine at the University of Missouri-
Kansas City and held the Daniel J. Lauer/Missouri Chair in Lipid Metabolism. He was also Co-director of the Lipid
and Diabetes Research Center at the Mid America Heart Institute of Saint Luke's Hospital in Kansas City.
Over the last 25 years, Dr Harris' research has focused primarily on fish oils (omega-3 fatty acids) and
cardiovascular disease. He has been the principal investigator on 3 National Institutes of Health grants focusing on
omega-3 fatty acids and human lipid metabolism. He has recently been examining the potential value of blood
omega-3 fatty acid levels as a risk factor for cardiovascular disease and will soon be studying these relationships in
the Framingham Heart Study.
In 2002, the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) introduced a new
secondary target of therapy -- non-high-density lipoprotein cholesterol (non-HDL-C) -- in patients with elevated
triglycerides (≥ 200 mg/dL).[1] Non-HDL-C was added as a secondary target of therapy to take into account the
atherogenic potential associated with remnant lipoproteins in patients with hypertriglyceridemia. The non-HDL-C goal
is set at 30 mg/dL higher than the LDL-C goal, based on the assumption that very-low-density lipoprotein (VLDL)
levels < 30 mg/dL are normal and that higher levels are associated with remnant lipoproteins and increased
cardiovascular risk. Patients with elevated serum triglyceride levels often also have elevations in levels of non-HDL-
C, but therapeutic goals may not be reached with statin therapy alone. The COMBination of prescription omega-3
with Simvastatin (COMBOS) study evaluated the effects on non-HDL-C and other variables of adding prescription
omega-3 ethyl esters (Lovaza, formerly known in the United States as Omacor) to stable statin therapy in patients
with persistent hypertriglyceridemia. [2]
Lovaza was already approved by the US Food and Drug Administration (FDA) for the treatment of very high
triglycerides (≥ 500 mg/dL). The COMBOS study was carried out to demonstrate the effect of treatment with Lovaza
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2. 3/28/12 The COMBOS Study: An Expert Interview With William S. Harris, PhD (printer-friendly)
as an adjunct to diet in patients with elevated non-HDL-C and borderline-high triglycerides who were already taking a
statin and were at or near LDL-C treatment goal. The study involved 254 adults who had received 8 or more weeks
of stable statin therapy along with dietary counseling, had fasting triglycerides of 200-499 mg/dL, and were at or
within 10% of their NCEP/ATP III LDL-C goal. Patients were randomized to 8 further weeks of treatment with
simvastatin 40 mg/day plus either Lovaza 4 g/day or placebo. At the end of this period, the median percent change
in non-HDL-C was significantly greater with Lovaza/simvastatin compared with placebo/simvastatin (-9.0% vs
-2.2%, respectively; P < .001) ( Table ).
Table.
Simvastatin + Lovaza Simvastatin + placebo
n = 122 n = 132
Lipid
parameter End of Percent End of Percent P value, percent change
(mg/dL) Baseline treatment change Baseline treatment change between groups
Non-HDL-C 137.0 122.8 -9.0 141.3 133.5 -2.2 < .001
Triglycerides 267.8 182.3 -29.5 270.7 259.5 -6.3 < .001
VLDL-C 51.5 36.5 -27.5 52.0 48.5 -7.2 < .001
LDL-C 90.7 87.5 0.7 88.2 85.0 -2.8 .052
HDL-C 46.0 48.0 3.4 43.3 44.0 -1.2 < .001
TC 184.3 172.0 -4.8 183.5 178.0 -1.7 .001
TC:HDL-C 3.9 3.5 -9.6 4.2 4.1 -0.7 < .001
ratio
apo B 85.5 80.0 -4.2 86.8 84.5 -1.9 .023
COMBOS: Lipid and Lipoprotein Median Values (adapted from Table II: Davidson MH, et al. Clin Ther.
2007;29:1354-1367)
Non-HDL-C = non-high-density lipoprotein cholesterol; VLDL-C = very-low-density lipoprotein cholesterol; LDL-C =
low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein cholesterol; TC = total cholesterol; apoB =
apolipoprotein B
Lovaza/simvastatin was associated with significant reductions in HDL-C (3.4% vs -1.2%) and a significant reduction
in the total cholesterol: HDL-C ratio (9.6% vs 0.7%) (all P < .001 vs placebo). LDL-C showed a 0.7% increase with
Lovaza/simvastatin compared with a decrease of 2.9% with placebo/simvastatin. Adverse events reported by at
least 1% of patients in the Lovaza group that occurred with a higher frequency than in the group that received
simvastatin alone were nasopharyngitis (3.3%), upper respiratory tract infection (3.3%), diarrhea (2.5%), and
dyspepsia (2.5%). There was no significant difference in the frequency of adverse events between treatment groups,
and no serious adverse events were considered treatment-related. Thus, the COMBOS study demonstrated that in
patients with persistent hypertriglyceridemia, administration of Lovaza plus simvastatin and dietary counseling
improved non-HDL-C and other lipid and lipoprotein parameters to a greater extent than simvastatin alone.
Medscape contributor Linda Brookes, MSc, spoke with Dr. Harris about the COMBOS study.
Medscape: What is non-HDL-C and why is it important in the context of the COMBOS study?
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3. 3/28/12 The COMBOS Study: An Expert Interview With William S. Harris, PhD (printer-friendly)
Dr. Harris: Triglycerides are primarily carried by very-low-density lipoproteins (VLDL). People with elevated
triglycerides typically have an associated increase in VLDL remnant particles. Because VLDL remnants appear to
have atherogenic potential similar to that of LDL, The VLDL-C level can be added to the low-density lipoprotein
cholesterol (LDL-C) value to produce a new index of risk and secondary target of therapy: non-HDL-C. The non-HDL
fraction in people with high triglycerides (ie, a large number of VLDL remnant particles) is greatly enriched with
VLDL-C relative to LDL-C compared with patients with a normal triglyceride level. The sum of LDL-C and VLDL-C,
the non-HDL-C value, is really important in predicting risk because these people with elevations in non-HDL-C are at
high risk even if their LDL-C is not terribly high. We are focusing more and more on non-HDL-C as a risk factor. It is
a very good marker of risk, particularly in people with high triglycerides, and even more in women, because high
triglyceride (or high non-HDL-C) levels in a woman attribute more risk for heart disease than the same level does for
a man.
Medscape: Is it as easy to measure non-HDL-C as LDL-C?
Dr. Harris: It is very simple. Just subtract HDL-C from the total cholesterol value. Both measurements are routine in
the laboratory.
Medscape: Is non-HDL-C as good as or even better than LDL-C at predicting cardiovascular disease?
Dr. Harris: There is growing consensus that non-HDL-C is better. People have just now started looking at it, but it
makes sense, because it includes LDL-C and adds additional cholesterol from particles that we know can cause
heart disease, such as intermediate-density lipoprotein (IDL, the other name for VLDL remnants) and VLDL, and
puts them all into one number. So as people look more carefully, they are finding that the non-HDL-C predicts as
well as, if not better than, LDL-C.
Medscape: Is non-HDL-C still as reliable a predictor in people with triglyceride levels as high as 500 mg/dL?
Dr. Harris: Non-HDL-C is not as useful when triglyceride levels are ≥ 1000 mg/dL, because people with levels this
high have other problems that are not heart disease-related but are related to the risk for pancreatitis. However,
there are not many people with triglycerides > 500 mg/dL, let alone > 1000 mg/dL. But yes, in patients with
triglycerides up to 500 mg/dL, the non-HDL-C is quite useful.
Medscape: The patient population in the COMBOS study had LDL-C levels within 10% of goal but
triglyceride levels between 200 and 499 mg/dL. Are these patients that physicians encounter often?
Dr. Harris: Yes; there are many more patients like this than patients with triglycerides > 500 mg/dL.
Medscape: Presumably they would have had dietary counseling at the start of their original statin treatment.
Dr. Harris: Yes, and that would not change.
Medscape: So these patients start on a statin and get the LDL-C level down, but they are left with a residual
atherogenic component. Would there be any other option than omega-3 ethyl esters (Lovaza)?
Dr. Harris: Another drug that targets LDL-C, such as ezetimibe, would not make much of a difference in the level of
non-HDL-C. It might drop it another 10 or 20 points, but in people with triglycerides in the 200-500 mg/dL range,
much of the non-HDL-C is from the VLDL, particularly remnant VLDL, not the LDL which ezetimibe affects. Patients
with triglycerides in this elevated range and taking statins typically have LDL well under control, so adding another
LDL-targeting drug (like ezetimibe) will not be helpful.
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Omega-3 ethyl esters (Lovaza, formerly Omacor), was first submitted to the FDA because there was good evidence
that it could lower triglycerides significantly in people with triglycerides > 500 mg/dL. That was the study that we did
in our laboratory over 10 years ago.[3] We found that Lovaza 4 × 1 g capsules per day over 4 months lowered mean
triglyceride concentrations about 45% in people whose triglycerides averaged around 800 mg/dL. These data were
strong enough for the FDA to approve the indication for treating that patient population, and Lovaza (Omacor) was
approved in the United States in 2005. At the time of the approval for the treatment of very high triglycerides, the
FDA also issued an Approvable Letter citing the requirements for Lovaza to be approved for the treatment of
elevated non-HDL-C and triglycerides (200-499 mg/dL) in adult patients concurrently taking a statin at or near LDL-C
treatment goal, as an adjunct to diet. The COMBOS study was carried out to address this patient population. It
sought to show that Lovaza would not reverse the effect of the statin and that a good overall lowering in non-HDL-C
could be achieved. LDL-C and VLDL-C fell by 9.0% in the Lovaza/simvastatin group, and fell by 2.2% in the
simvastatin/placebo group, a net difference of about 7%; and, as expected, Lovaza produced a significant fall of
29.5% in triglycerides in these patients whose LDL-C was already well controlled with simvastatin (40 mg).
Medscape: The NCEP/ATP III goal for non-HDL-C is 30 mg/dL higher than the LDL-C goal. What would the
LDL-C goal have been in these patients?
Dr. Harris: In some of the patients it would have been 100 mg/dL and in others 130 mg/dL, depending on the other
CHD risk factors present (eg, hypertension, smoking, personal CHD history).
Medscape: The results of the study appear to show a slight increase in LDL-C. How can this be explained?
Dr. Harris: Modest increases in plasma levels of LDL-C are seen with Lovaza monotherapy in people with high
triglycerides (≥ 500 mg/dL), and the FDA wanted to be sure that this did not occur in patients on statins. Ideally LDL-
C levels would decrease or at least not change when Lovaza was added. Because the study was so large, however,
the clinically insignificant change in LDL-C (an increase of 0.7%) was statistically significant when compared with
the 2.8% drop in LDL-C observed in the placebo group. When the results of the study were submitted to the FDA in
June, the FDA issued an Approval Letter permitting the addition of select study data within the clinical studies
section of the label for Lovaza, but it did not approve the additional indication. So it is a confusing situation, to be
able to talk about the COMBOS data (because they are in the package insert), but not to have Lovaza indicated in
this population, What is not confusing, however, is the effect of Lovaza on non-HDL-C, which fell by 9% in the
Lovaza/statin group compared with 2% in the simvastatin/placebo group, for a net decrease of about 7%.
Looking at the bottom line in the study, the Lovaza group started with median LDL-C 91 mg/dL at baseline and
finished the study at 88 mg/dL. This looks like a decrease, but because the median percent changes were reported
it looks like an increase. This is a puzzling message. The median percent change is the percent change that was in
the middle of the group. In other words, for each individual in the study, a percent change in LDL-C was calculated
from baseline to end of treatment. Those percent changes were ranked from the greatest to the least. The value in
the middle happened to be a person who had a 0.7% increase. So that is recorded as the median percent change,
even though the median LDL value actually decreased. If you look at the placebo group, the median LDL-C went
from 88 mg/dL to 85 mg/dL, the same decrease as was seen in the Lovaza group; but it is a -2.8% median percent
change in the placebo group, when compared with the median 0.7% increase in the Lovaza group, that together
produced the final reported net increase 3.5% in LDL-C. It is only an increase because LDL-C in the placebo group
decreased, not because LDL-C in the Lovaza group increased. Because the sample size was so large (254
patients), this small difference was statistically significant, and thus the authors had to conclude that the addition of
Lovaza caused a significant increase in LDL-C. Another problem was that the P value for the difference between
groups was .052, which does not actually meet the < .05 criterion for declaring statistical significance. Hence,
strictly speaking, there was no statistically significant increase in LDL-C in this study. This would have been even
more evident had the study not been so large. If the study had enrolled perhaps 20 less people, that P value would
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have probably been clearly in the nonsignificant zone. It would not have reached statistical significance and the
investigators could have concluded that they did not get a significant change in LDL-C. Here is an example where
statistical significance and clinical significance diverge.
Medscape: So it was a statistical accident?
Dr. Harris: Yes, in a way. The study enrolled a lot of people so that it could show a significant non-HDL-C effect;
but you do not want to have so many people that you can detect a tiny difference in LDL, and they actually did. So it
was a rare example, I think, of a study being too large. I also think it is very important to point out that a percent
increase in LDL-C may be meaningless and driven more by the denominator than the numerator. For example, a 5-
mg/dL increase in a person whose LDL is 100 mg/dL is a 5% increase, but the same increase in another person with
LDL-C 50 mg/dL is a 10% increase. It is still just a 5-mg/dL change, but the percent increase can be huge,
depending on the starting level. As the denominator gets smaller, the percent increase becomes huge. The LDLs
were relatively low in this study (because of the simvastatin) and that contributed to this outcome. However, that is
the way the FDA wanted to see the data, I believe.
Medscape: The patients in the COMBOS study were not particularly high-risk and they had already lowered
their LDL-C.
Dr. Harris: Their LDL-C levels were at target at baseline, and after Lovaza they were all still at the same target. A
typical target for these patients is 100 mg/dL, so on average, they were below target.
Medscape: Some of the patients switched to simvastatin from a different statin at the start of the study.
Would that have had any effect on LDL-C levels?
Dr. Harris: Not likely. Because most patients under "real life" clinical care only imperfectly comply with their statin
prescription, it's likely that the subjects' LDL-C was under better control in the study than before it. This is because
not only was the simvastatin (40 mg) provided at no cost, but patients also are more compliant with medications
when they are in a clinical trial than when they are not. So although their LDL-C levels were probably improved
compared with pre-study, I seriously doubt that this would have altered the study's outcome.
Medscape: Has Lovaza been studied with other statins besides simvastatin?
Dr. Harris: Yes; in a small study from Australia[4] some years ago it was shown to be effective in combination with
atorvastatin. Actually, a study similar to COMBOS is being carried out right now with atorvastatin and Lovaza. Two
hundred patients with high to very high triglycerides and non-HDL-C above NCEP/ATP III goals were randomized --
after a 4-week diet-only lead-in period -- to atorvastatin 10 mg/day plus either Lovaza 4 g per day or placebo for 8
weeks. After the initial 8-week treatment period, the dose of open-label atorvastatin is titrated to 20 mg per day for
an additional 4 weeks, and at week 12, a second titration of atorvastatin to 40 mg is maintained for an additional 4
weeks. The primary outcome measure, again, is change in non-HDL-C, with changes in other lipids and biomarkers
as secondary outcome measures. That study will close in about a couple of weeks and then the data have to be
analyzed. The results are expected within a year.
Medscape: Would you expect the outcome to be the same with an equivalent dose of another statin plus
Lovaza?
Dr. Harris: Yes. As alluded to earlier, there have been other studies with a variety of statins plus Lovaza, and the
outcome was much the same in terms of the effects on non-HDL-C. In one study [5] the addition of Lovaza lowered
LDL-C even further, which was surprising. The patients were on various dosages of different statins. In another
study,[4] when they were on atorvastatin adding a different patient population, there was no change in LDL-C. I do
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not think there will be a change in LDL-C in the Lovaza/atorvastatin study either.
Medscape: Are there any other lipid results in COMBOS that were of particular interest?
Dr. Harris: The apolipoprotein B (apo B) is a different way of looking at non-HDL-C because the particles that
constitute non-HDL-C (LDL, IDL, and VLDL) all contain 1 apo B molecule per particle, so changes in apo B follow
those in non-HDL-C. A statistically significant decrease was seen in apoB, and there was also a significant rise in
HDL-C. This is a really nice pattern of add-on therapy for an agent like Lovaza that has no side effects and no drug
interactions.
Medscape: Do statins and omega-3s have any additive effects?
Dr. Harris: I think they do. If you have a new patient who has high LDL-C and high triglycerides whom you put on a
statin and Lovaza from the start, you are going to get a combined effect, because the statin is going to have some
triglyceride-lowering effect, with Lovaza having a larger effect on top of that. What is suggested from the COMBOS
study is that even though the triglycerides come down with statins (not measured directly in this study), the addition
of 4 g of Lovaza will lower them further.
Medscape: The incidence and nature of adverse effects were reported to be similar in both groups in the
trial. Fasting blood glucose was significantly increased with Lovaza/simvastatin compared with
placebo/simvastatin (P < .002); was this clinically significant?
Dr. Harris: I do not think so. Compared with the net benefit of the fall in non-HDL-C and the rise in HDL-C, a 5-
mg/dL change in glucose, which was about what it was, is irrelevant, especially when no change in fructosamine
was observed.
Medscape: So would there be any reason not to prescribe Lovaza as an add-on therapy in a similar type of
patient to those of the COMBOS study population?
Dr. Harris: There are reasons why you might not. There are convenience issues; some people find that taking 4
capsules a day is inconvenient. Some people get a "fishy burp" after taking the capsules, but this can be avoided
by taking the capsules at bedtime. The alternatives are fibrates or niacin, both of which have more drug-drug
interactions and more potential side effects than Lovaza. Lovaza has no medically significant side effects, and there
are other data suggesting that omega-3 fatty acids may reduce risk for arrhythmias and potentially even lower risk
for Alzheimer's disease and depression. There are therefore significant "pleiotropic effects" of Lovaza that you would
expect to benefit from in addition to triglyceride lowering.
Supported by an independent educational grant from Reliant Pharmaceuticals
1. National Cholesterol Education Program Expert Panel on Detection. Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program
(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
Treatment Panel III): Final report. Circulation. 2002;106;3143-3421. Abstract
2. Davidson MH, Stein EA, Bays HE, et al; the COMBination of prescription omega-3 with Simvastatin
(COMBOS) investigators. Efficacy and tolerability of adding prescription omega-3 fatty acids 4 g/d to
simvastatin 40 mg/d in hypertriglyceridemic patients: an 8-week, randomized, double-blind, placebo-controlled
study. Clin Ther. 2007;29:1354-1367. Abstract
3. Harris WS, Ginsberg HN, Arunakul N, et al. Safety and efficacy of Omacor in severe hypertriglyceridemia. J
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