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Biomedical subjects

C J Lintott

Publications and source records attributed to C J Lintott.

11 recordsLinked to original sources
PubMed1992

Prevalence of diabetes mellitus in an ambulant elderly New Zealand population.

The prevalence of diabetes mellitus (both known and previously undiagnosed) was studied in a population sample, predominantly Caucasoid and resident in the community with an age/sex distribution representative of the New Zealand population aged 65 + years, using WHO criteria. The population sample was randomly selected from the age/sex register of a large urban medical centre in Christchurch, New Zealand. Three hundred and sixty-nine subjects (participation rate 69.4%) were screened by casual glucose and glycated haemoglobin measurement, followed by oral glucose tolerance testing (OGTT) if one or both were elevated. The minimum prevalence rate of diabetes in the study sample was 17.2 +/- 3.3% in men and 12.5 +/- 2.2% in women (since not all patients underwent OGTT). The rate was only significantly higher in men than women in the 70-74 year age group (P less than 0.01). The combined age-adjusted prevalence rates for the New Zealand elderly are estimated to be 9.9% known diabetes, 5.0% previously undiagnosed, with the total prevalence rate 14.9%. Newly diagnosed subjects had a significantly higher body mass index than known diabetic or non-diabetic subjects (P less than 0.01). Eighty-two percent of newly diagnosed subjects had visited their general practitioner at least once during the previous 6 months. Measurement of glycated haemoglobin had a greater positive predictive value than casual blood glucose in the detection of new cases. There was no difference in frequency of attendance with general practitioners or in hospital admission rates between non-diabetic patients, or those with known or newly diagnosed diabetes. This study suggests that diabetes mellitus may be a prevalent disorder amongst the New Zealand elderly.

Age Factors↗
PubMed1992

Plasma non-cholesterol sterols in patients with non-insulin dependent diabetes mellitus.

Plasma plant sterol concentrations (an index of cholesterol absorption efficiency) and plasma lathosterol concentration (an index of cholesterol synthesis rate) were measured in 52 patients with non-insulin dependent diabetes mellitus (NIDDM) and 36 non-diabetic controls. Plasma plant sterol concentrations were significantly (P less than 0.01) lower in diabetic patients (campesterol: men -36%, women -48%; betasitosterol: men -35%, women -42%). Fasting serum insulin levels were inversely correlated with plasma plant sterol concentrations in diabetic patients (campesterol: r = -0.347, P = 0.012; betasitosterol: r = -0.345, P = 0.012) and in non-diabetic men (campesterol: r = -0.578, P = 0.039; betasitosterol: r = -0.702, P = 0.008). Serum insulin levels were also correlated significantly with plasma lathosterol concentration in diabetic patients (r = 0.295, P = 0.034). The results of this study suggest that absorption of plant sterols and possibly cholesterol from the diet may be reduced in hyperinsulinemic diabetics.

Adult↗
PubMed1991

Simvastatin and side effects.

OBJECT: to investigate the symptomatic and biochemical side effect profile of simvastatin (a new cholesterol lowering drug) following routine use in a specialist hospital outpatient clinic. METHODS: all patients (n = 110) newly commenced on simvastatin at the lipid disorders clinic at the Princess Margaret Hospital in the first ten months of prescription availability were asked to complete a side effects questionnaire and biochemical evaluation at six months of therapy. RESULTS: 76.4% of patients reported experiencing no side effects with 8% of patients spontaneously reporting feeling better since commencing therapy. Nineteen point one percent of patients reported experiencing symptoms they attributed to simvastatin but had continued therapy, while a further 4.5% of patients had withdrawn from therapy because of side effects. The most frequently reported side effects were muscle ache (13.6%), and gastrointestinal symptoms (4.5%). No abnormalities in biochemical safety tests occurred. CONCLUSIONS: the rate of side effects reported with prescription use exceeds that previously encountered in clinical trials. Since simvastatin is considered effective and well tolerated it is likely to receive wide acceptance in the management of high risk hypercholesterolaemic patients. However, this study indicates the need for continued physician awareness of the main symptoms and their frequency amongst those treated with simvastatin.

Adult↗
PubMed1991

Treatment of primary hypercholesterolaemia with simvastatin. New Zealand multicentre evaluation.

OBJECTIVE: To assess the efficacy of simvastatin in a large patient cohort. DESIGN: In an open multicentre study, after a four week placebo phase, patients were treated with simvastatin for 24 weeks; a subgroup continued therapy for a further 24 weeks. Efficacy of simvastatin (a) with prolonged use over three years, and (b) in combination with bezafibrate was assessed in an open single site study. SETTING: Lipid or cardiology specialist hospital outpatient clinics. PATIENTS: For the open multicentre study, 228 patients with primary hypercholesterolaemia (total cholesterol level greater than 6.5 mmol/L) were recruited, of whom 224 met entry criteria and completed the study. Forty-seven of these patients continued therapy for one year. In the open single site study, 22 patients (with low density lipoprotein [LDL] cholesterol levels greater than 4.3 mmol/L) participated in studies of long term use (n = 9) or of combined therapy (n = 13). INTERVENTION: Therapy in the open multicentre study began with 10 mg of simvastatin per day, doubling to 20 mg after six weeks and then 40 mg after 12 weeks of therapy if total cholesterol levels persisted above 5.2 mmol/L. In the study of long term use, simvastatin (40 mg daily) was taken continuously over three years. In the study of combination therapy, bezafibrate (600 mg daily) was taken in addition to simvastatin (40 mg daily) for 10 months. MAIN OUTCOME MEASURES: Plasma lipid and lipoprotein concentrations. RESULTS: In the multicentre study, total plasma cholesterol levels were reduced by 32.8% from 9.11 +/- 1.84 (in mmol/L, mean +/- SD) to 6.12 +/- 1.25 (P less than 0.001), and LDL cholesterol levels by 41.4% from 6.90 +/- 1.92 to 4.04 +/- 0.31 (P less than 0.001). The effect of therapy was sustained in those patients continuing therapy to 48 weeks. The study of long term use found no significant attenuation of effect over three years of monotherapy. Combined simvastatin/bezafibrate therapy reduced the LDL cholesterol concentration by a further 19.9% (P less than 0.001) from levels achieved on simvastatin alone. CONCLUSIONS: Simvastatin is an effective, well tolerated lipid lowering drug, without significant attenuation of effect with prolonged use. Simvastatin plus bezafibrate appears to be a potentially useful drug combination.

Adult↗
PubMed1991

Oat bran and cholesterol reduction: evidence against specific effect.

Most placebo-controlled studies testing the hypo-cholesterolaemic action of oat bran have compared high fibre against low fibre diets. To determine whether oat bran had greater cholesterol-lowering action than another source of fibre (wheat bran) we compared the effect of breads of similar total fibre content containing either oat bran or additional wheat bran. Twelve hyperlipidaemic subjects (38-66 years) were stabilised on lipid-lowering diets for at least three months prior to the study. Subjects were given each type of bread for four-week periods in a single-blind, cross-over design. Cholesterol, triglyceride and LDL-cholesterol levels did not change significantly during the oat and wheat bread periods. HDL-cholesterol rose equivalently but only to a just significant level during the oat bran diet. Body weights, lipids and lipoprotein parameters were not significantly different between the two diet periods. Both diet treatments lowered serum cholesterol approximately 4%. We conclude that this oat bran bread consumed as part of a lipid-correcting diet did not influence lipoproteins to any greater extent than wheat bread of similar total fibre content.

Adult↗
PubMed1989

Simvastatin (MK 733): an effective treatment for hypercholesterolemia.

This study describes the efficacy of the drug simvastatin. It is likely to be the first HMG CoA reductase inhibitor in Australia and New Zealand available for the treatment of hyperlipidemia. Twenty-four patients, 12 men and 12 women with primary hypercholesterolemia were randomly allocated to treatment by cholestyramine (eight patients) or to simvastatin (16 patients) for a 12-week period. With simvastatin, total cholesterol levels decreased by 37.5% from a baseline mean of 10.33 mmol/L to 6.4 mmol/L after 12 weeks. Low density lipoprotein (LDL) cholesterol concentration decreased by 48.2% from 8.40 mmol/L to 4.39 mmol/L. These effects were better than observed for cholestyramine alone where cholesterol and LDL-cholesterol reductions were 24.9% and 33.1% respectively. Thirteen patients, however, did not achieve target LDL levels of 3.62 mmol/L, or below, and therefore were treated with a combination of cholestyramine and simvastatin, resulting in a decrease of total cholesterol and LDL-cholesterol by 45.5% and 53.5% of baseline values studied over an eight-week period. No major clinical side-effects were encountered. One patient appeared to have had a change in colour vision at the end of the study at 20 weeks, without loss of visual acuity.

Adult↗
PubMed1989

Treatment of hyperlipidaemia with acipimox.

In an open, uncontrolled study, the hypolipidaemic effect of acipimox was evaluated in 34 patients with Types IIa, IIb, IV or V hyperlipidaemia. Doses of 250 mg twice daily or 250 mg 3-times daily were maintained over a 12-week treatment period. The reduction in total plasma cholesterol levels was small and not statistically significant; however, significant increases in high density lipoproteins were achieved. Triglyceride levels were significantly lowered in patients with Type IV hyperlipidaemia. Acipimox was well tolerated by patients and no biochemical or haematological changes were noted. Considerable resolution in tubo-eruptive xanthomata was observed in 1 patient with Type V hyperlipidaemia.

Adult↗
PubMed1985

Apolipoprotein E phenotypes in hyperlipidaemic patients and their implications for treatment.

Apolipoprotein E phenotypes were determined on 417 consecutive lipid clinic patients using an isoelectric focussing technique. Of the 15 patients with phenotype E2/2, 13 (3.1%) had type III hyperlipoproteinaemia and 2 obese identical twins had type V. A further 20 patients (4.8%) had similar plasma and lipoprotein lipid levels but were E2 heterozygotes (14 E3/2 and 6 E4/2). They displayed a widened pre-beta-band almost confluent with the beta-band rather than the broad beta-band shown in classical E2/2 type III patients. In view of the similarities between these heterozygotes and the classical homozygous (E2/2) type III patients and their occurrence in the same families we suggest the nomenclature homozygous and heterozygous type III. In a subsequent comparison between 30 E2/2, 22 E3/2 and 8 E4/2 type III individuals the only significant difference in plasma and lipoprotein lipid parameters was a lower VLDL cholesterol to triglyceride ratio of 0.85 in E3/2 patients than that of 1.24 in E2/2 patients (P less than 0.01). Both homozygous and heterozygous patients showed premature ischaemic heart disease and both responded dramatically and similarly to treatment with clofibrate. These observations indicate that apo E phenotyping is worthwhile in all patients with combined hyperlipidaemia and that homozygous and heterozygous type III hyperlipoproteinaemia is not uncommon.

Adult↗
PubMedDate not supplied

HMG-CoA reductase inhibitor use in the aged. A review of clinical experience.

While the benefit of cholesterol-lowering in the elderly has yet to be proven in clinical trials, individuals at high risk of coronary events who otherwise enjoy a good quality of life, should not be denied cholesterol-lowering therapy on the basis of age alone. Moreover, hypolipidaemic drugs are already extensively used in the aged. The HMG-CoA reductase inhibitors lovastatin, simvastatin and pravastatin are potent well tolerated hypolipidaemic therapies in young subjects. Although there have been few studies on their use in elderly subjects, the available data suggest the efficacy and safety of HMG-CoA reductase inhibitors in similar to that established for younger age groups.

Age Factors↗