Health science and medicine - Assignment Example

? Health science and medicine A: The role of fibrate plus statin on postprandial triglycerides (PPTG) levels in patients with Diabetes Mellitus (DM) Abstract Based on a study carried out, combined with references from previously carried out researches on cardiovascular disease. This article tries to explain the role of fibrate plus statin on PPTG (postprandial triglycerides) levels in patients with DM (diabetes mellitus). To begin with the article gives a brief preview of the various studies that have been carried out earlier on, it give the various findings that were deducted from this studies. These have been clearly stated to with only the important points regarding the study to be carried out stated. Basically, a larger part of this study is to approve of the various results, in studies that were carried out earlier and also to clarify the truth in the various theories formulated earlier, specifically in relation to the roles of fibrate plus statin on PPTG, because this is an area that has not been looked into carefully especially with the clinical trials. Further we then discus the in detail the methods that were used in carrying out the study which was approved by Columbia university medical centre institutional board. A randomized exercise was used in selecting the subjects of a subset enrolled in ACCORD lipid, this were 150 out of a potential participants, but only 139 were used in the study because some participants did not, based on the entry LDL-C (Low density lipoprotein- cholesterol), receive any simvastatin: those individuals amounting to 11 were excluded from the final analysis. In this study, the hypothesis was that combination therapy with fenofibrate and simvastatin (FENO-S) would result in lower (postprandial lipemia) PPL compared to therapy with placebo and simvastatin (PL-S). we have further illustrated and explained how the subjects were treated and the various variables that were used such as fenofibrate and simvastatin and placebo simvastatin, methods and quantities used to the subjects have been explained in detail and results carefully presented. The results comprise of the laboratory results which have been stated out clearly, the statistical explanations which have also been outlined with errors having been minimized as much as possible, and to top it up a variety of tables and graphs have been used to explaining the findings of the study. The results found in the study have not completely exhausted the explanation behind the role of fibrate plus statin on PPTG (postprandial triglycerides) levels in patients with DM (diabetes mellitus), but have given a strong ground on which other studies can be based on. This article also provides an extensive collection of articles and books that can aid in other studies related to this. Summary of the Results Putting in mind, many other studies have been carried out in this field with different results and conclusions drawn. The purpose of this study is to clarify most of the conflicting conclusions reached at regarding atherosclerotic cardiovascular disease and diabetes. Our hypothesis for this study was that fenofibrate plus simvastatin would result in a significantly lower PP lipoprotein levels compared to placebo plus simvastatin. We tried to be specific and precise as much as possible in presenting our results. The laboratory results were carefully analyzed and various testing and measurement methods used such as standard enzymatic techniques on a Roche Hitachi 912 chemistry analyzer, other methods were as per the requirements stated in various articles such as Low density lipoprotein (LDL) C levels were calculated by the Friedewald method which has been approved in earlier study by Friedewald, Levy and Drederickson (1972). Also ApoB48 levels, ApoCIII levels and HbA1c were measured in the laboratory. The statistics were used to come up with various tables and graphs which have been included in this article. While drawing the graphs for the postprandial incremental area under the curve (IAUC) for TG, apoB48, and apoCIII were calculated as previously described in an earlier study (Goldberg, Bittner, Pepine, Kelly, Thakker, Setze, Lele, & Sleep, 2011). Except ±for TG and ApoB48 all other results were presented in mean and standard deviation format, and the IAUC's for TG, which were log-transformed to achieve normal distributions prior to statistical analysis; results for these measures are reported as medians and inter-quartile (IQ) ranges. The statistics were finally summarized in graphs where the fenofibrate effect was displayed graphically by (log-log) scatter plots of IAUC for TG as clearly seen in the graphs provided at the end of the article and a semi-log scatter plot for apoB48 vs day of study fasting TG, with separate regression lines for the placebo and fenofibrate groups. Of the 139 individuals whose PPL was evaluated sixty six were on the FENO-S treatment while seventy three were on the PL-S treatment. The characteristics of each group were tabled with 40% of the cohort being female, the mean age and diabetes duration being 61± 7 and 10.3±7.3 respectively. To ensure accuracy the groups were well balanced with no significant differences in gender, age, ethnicity, BMI, or statin dose between the FENO-S and PL-S groups. To start with we carried out the PPL studies on the subjects after at least 4 months on either FENO-S or PL-S treatment; with the median time from randomization to the PPL study being 7.5 months. Also at the subjects’ screening lipid level were obtained when the subjects were first enrolled into the ACCORD lipid; with 64% of them on lipid altering medication and a further 90% of those receiving a statin. Although there was no difference in screening plasma lipid for the two groups FENON-S and PL-S, there was a significant difference of about 29mg/dl in the triglycerides median for the subjects used in the study which had a higher proportion of blacks, as compared to the whole ACCORD lipid subjects, this led to another conclusion based on race which was discovered in an earlier research stating that Blacks have lower plasma TG levels than other racial groups (Sumner, 2009). Another important result was that the Feno-S group had a significant reduction in TG IAUC (p=0.008) and apoB48 IAUC (p=0.003) vs. the PL-S group; apoCIII IAUCs were not different between Feno-S and PL-S. This result led to a further study being carried out to ascertain whether the effect of FENO-S on PPTG was independent of fasting TG, this called for another study to sample participants with a much wider range of TG. These findings are very important considering that in an earlier study had shown the importance of increased non-fasting or postprandial (PP) TG levels (Bansal, Buring, Rifai, Mora, Sacks and Ridker, 2007) as predictors of ASCVD. The results from our findings indeed showed the relationship between this variables because it was found that in the two groups the correlation were r=0.73 in FENO-S and r=0.62 in PL-S; p Read More