JOHN PAPADAKIS - Academia.edu (original) (raw)

Papers by JOHN PAPADAKIS

Research paper thumbnail of C1q Gene Polymorphism Is Associated with Asymptomatic Bacteriuria in Patients with Type 2 Diabetes Mellitus

Medicina

Background and Objectives: Asymptomatic bacteriuria (ASB) appears to have a higher prevalence in ... more Background and Objectives: Asymptomatic bacteriuria (ASB) appears to have a higher prevalence in diabetics and has been associated with various genetic polymorphisms of the innate immune system. Single nucleotide polymorphisms (SNPs) of the C1q gene that encodes for the trigger molecule of the classical complement pathway increase the risk of bacterial infections as well as other diseases. In the present study, we sought to investigate the association of C1q rs292001 (G > A) SNP with ASB in patients with type 2 diabetes (T2D). Materials and Methods: In this case-control study, performed at the University and the Venizeleion General Hospital of Heraklion, Crete, Greece, 75 adult male and female Cretan patients with T2D and ASB and 75 adult male and female Cretan patients with T2D but without ASB were enrolled and genotyped for rs292001 SNP of C1q gene. Genetic analysis was based on the polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RLFPs) methods. R...

Research paper thumbnail of Case report of rhabdomyolysis possibly associated to the interaction of ciprofloxacin with simvastatin

This is a case report of rhabdomyolysis possibly associated to the administration of ciprofloxaci... more This is a case report of rhabdomyolysis possibly associated to the administration of ciprofloxacin to a patient on chronic lipid-lowering therapy with simvastatin. It is the second case report in the literature. We suggest a mechanism of interaction between the two agents which involves the adenosine-5'-triphosphate (ATP)-binding cassette drug efflux transporter family.

Research paper thumbnail of Epidemiology, Microbiological and Clinical Features, Treatment, and Outcomes of Infective Endocarditis in Crete, Greece

Infection & chemotherapy, 2018

This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, ... more This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, and outcomes of infective endocarditis (IE) on the island of Crete, a region with high levels of antimicrobial resistance. Medical records of all hospitalized patients diagnosed with IE at the University Hospital of Heraklion, Crete, Greece, from 1995 to 2015, were retrospectively reviewed. Patients who met the modified Duke's criteria for definite or possible IE were included. A total of 82 IE patients (median age 67 [range 21-86] years) were included. Most patients suffered from left-sided IE (94%), while most cases of infection occurred in native valves (53.6%). Systemic inflammatory response syndrome criteria were lacking in almost half of the patient population. The leading causative microorganism was Staphylococcus aureus, isolated in 24 cases (29%), followed by Streptococcus spp. in 15 (18%) and Enterococcus spp. in 12 (14.5%). A number of rare and difficult to treat microorga...

Research paper thumbnail of The influence of hypertension and antihypertensive drugs on ?new? cardiovascular risk factors, in dyslipidaemic patients

American Journal of Hypertension, 1999

Dozens of publications have been written on the safety and efficacy of Terazosin (Hytdn@) and Car... more Dozens of publications have been written on the safety and efficacy of Terazosin (Hytdn@) and Carteolol (Cadrol®). However, the good clinical practices (GCPs) employed in monitoring these two antihypertensive drugs have not been discussed. Documentation required for FDA approval and the GCP monitonng practices involved in the dinicel tnals of these two antihypertensive drags will be reviewed. A complete set of standard operating procedures and good GCP training (including protocol development, study design and data analysis) were required. Investigator interest, patient population and a complete site evaluation were also required. Regulatory documentation collection consisted of as many as 10 separate documents necessary for shipping drug and treating the first patient. Current practices may require investigator and sponsor electronic signature verification depending on the type of IND and NDA submission intended. These two antihypertensives required a paper trail, however Terazosin was the fkst electronic NDA submission. Specific mguletory documentation collected (e.g. FDA form 1572, curriculum vitae), mechanisms for source document verification (e.g.medicel histories, odginal charts and records), site, patient and budget trecldng as well as monitonng frequency was managed. The author personally monitored least three Phase I sites, and approximately 20 different Phase II and lU sites every 4-8 weeks depending on the protocol and patient enrollment. Approximately 500 patients were monitored. Decisions regarding their evaluability and payments were made. Consistency between sites, CPA's and the CRO's involved was managed. All adverse events were repoded. A complete review of the required data corrections was made pnor to site close out visits when drug was returned. Statistical analysis and medical summmy were completed. Internal auditing of all key safety and efficacy parameters was completed prior to FDA submission. This wod~ was done at Abbott Labe(1980-1985).

Research paper thumbnail of Effect of anti-hypertensive agents on plasma fibrinogen levels in patients with essential hypertension

American Journal of Hypertension, 2001

In addition to hypertension, dyslipidaemia and smoking, elevated plasma levels of fibrinogen (Fib... more In addition to hypertension, dyslipidaemia and smoking, elevated plasma levels of fibrinogen (Fib) have also been associated with increased risk of cardiovascular (CVD) events. We investigated the influence of antihypertensive treatment on this CVD predictor in 427 patients (177 men) with essential hypertension. Their median age was 60 (range: 18 to 87) years. Of the hypertensive patients, 259 (60.7%) were receiving anti-hypertensive agents. Of the treated hypertensives, 135 patients (52.1%) were under one, 93 (35.9%) under two, 25 (9.7%) under three and 6 (2.3%) under four anti-hypertensive drugs. Only 57 (22.0%) out of 259 treated hypertensives were well controlled (blood pressure levels bellow 140/90mmHg). Anti-hypertensive drug use was associated with significantly lower plasma Fib concentration when compared with untreated hypertensives [median values (range): 250 (170-400) vs 300 (170-540) mg/dl, respectively; pϽ0.01, Mann-Whitney test]. There were no significant differences in serum levels of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides between these two groups of hypertensives. In conclusion: In addition to lowering arterial blood pressure, antihypertensive agents may also decrease plasma levels of Fib, another modifiable cardiovascular risk factor.

Research paper thumbnail of Effect of diuretics addition on metabolic variables and plasma fibrinogen levels, in hypertensive patients treated with ACE inhibitors

American Journal of Hypertension, 2003

Azathioprine-Prednisone [Aza-P], 44 developed ERY (Hematocrit [Hct] of Ն50%). Of these 36 were me... more Azathioprine-Prednisone [Aza-P], 44 developed ERY (Hematocrit [Hct] of Ն50%). Of these 36 were men (82%) and 8 were women (18%), with a M:W ϭ 4.5. PRT ERY developed within 5 months to 10 years after transplantation: 34 (9.0%) were on CsA, 9 (11.7%) on Tacro and 1 (2%) on Aza-P. Red blood cell mass (RBCM) and Plasma Volume (PV) were measured radioisotopically, erythropoietin (EPO) by ELISA. All had expanded RBCM (measured: 2786Ϯ99 ml [SEM], expected: 2124Ϯ66 ml; pϽ0.0001) and PV (measured: 3295Ϯ109 ml, expected: 3015Ϯ70 ml; pϽ0.002). Oral Enalapril 2.5-10.0 mg daily for several weeks dropped Hct from 53.4Ϯ0.5% to 46.7Ϯ5%, pϽ0.0004; RBCM to 2211Ϯ120 ml, pϽ0.0001, but PV was unchanged (3130Ϯ259, pϭ0.37). Demographics of patients with PRT ERY were no different from those without ERY. PRT ERY was observed in 9% of patients, mostly men. ACEi reduced Hct by 13%, RBCM by 20%, but had no effect on PV.

Research paper thumbnail of Effect of hypertension and its treatment on lipid, lipoprotein(a), fibrinogen, and bilirubin levels in patients referred for dyslipidemia

American Journal of Hypertension, 1999

We measured the serum lipid profile, together with plasma fibrinogen and serum lipoprotein(a) (Lp... more We measured the serum lipid profile, together with plasma fibrinogen and serum lipoprotein(a) (Lp[a]), glucose, bilirubin, and albumin levels in 491 patients (310 men) who were referred for the management of primary dyslipidemia. All these variables have been shown to predict vascular events. The patients were not taking lipid-lowering drugs; hypertension was present in 156 (31.7%) of them. Of the hypertensive patients, 52 (33%) were not receiving any treatment to control their blood pressure. This omission was not due to a lower prevalence of established vascular disease. The treated hypertensives were divided into three groups according to their treatment: 62 were taking lipid-hostile antihypertensives (␤-blockers, thiazides), 37 were taking lipid-neutral antihypertensives (angiotensin converting enzyme inhibitors, Ca-channel blockers, angiotensin II receptor blockers, indapamide sustained release), and five were taking lipid-friendly antihypertensives (doxazosin). Lipid-hostile antihypertensive drugs were associated with a significantly higher fibrinogen concentration when compared with untreated hypertensives or those taking lipid-neutral/lipidfriendly drugs (median values: 383, 353, and 336 mg/dL, respectively; P < < .01). Lipid-neutral/lipidfriendly antihypertensive drugs were associated with lower Lp(a) levels when compared with untreated hypertensives (median values: 22 and 45 mg/dL, respectively; P < < .05). The serum bilirubin level was significantly lower in the untreated hypertensives when compared with normotensives or the treated hypertensives. There were no significant differences in lipids, glucose, or albumin among the groups of hypertensives or normotensives. The influence of antihypertensive drugs on additional cardiovascular risk factors should be considered when selecting medication to reduce blood pressure.

Research paper thumbnail of Acute febrile neutrophilic dermatosis (Sweet's syndrome) with erythema nodosum and anterior scleritis. A case report

International Journal of Dermatology, Dec 1, 2005

ABSTRACT

Research paper thumbnail of Unusual causes of intrahepatic cholestatic liver disease

World Journal of Gastroenterology, 2007

chronic liver diseases, such as genetic defects [2] (Table 1). Gallstones, bile duct strictures, ... more chronic liver diseases, such as genetic defects [2] (Table 1). Gallstones, bile duct strictures, and tumours are the most frequent causes of extrahepatic (mechanical) bile duct obstruction [2] (Table 1). Cholestatic liver disease is characterised by a predominant elevation of serum alkaline phosphatase and bilirubin, although serum bilirubin may be normal until a late stage of the disease. In this paper we discuss five patients with unusual causes of intrahepatic cholestatic liver disease. CASES REPORT We retrospectively studied the case notes of 100 patients with intrahepatic cholestatic liver disease who were hospitalised in two divisions of internal medicine for investigation in 2002-2004. Five unusual causes of intrahepatic cholestasis were revealed in our patients. The causes of intrahepatic cholestasis were defined as unusual with a prevalence < 10%. The medical histories of five representative patients with these causes of cholestasis are reported below: Case 1 A 67-year old man was admitted to hospital for a 5-d history of painless jaundice, pruritus, dark urine and light stools. His medical history included fatty liver, associated with hyperlipidemia and the consumption of ethanol, which was confirmed by an abdominal ultrasound scan and liver biopsy performed in the previous year. Consumption of Teucrium polium (family Lamiaceae) in the form of tea for the treatment of hyperlipidemia during the previous 6 mo (increasing to 2 litres per day in the preceding month) was also mentioned. Physical examination revealed yellow pigmentation of the sclera and skin. Laboratory tests showed the following values: haematocrit (Ht) 46%, white blood cell (WBC) count 7000 cells/mm 3 (neutrophils 53%, lymphocytes 29.3%, monocytes 10.2%, eosinophils 6.6%), MCV106 fL (normal range: 80-99 fL), platelet (PLT) count 133 000/mm 3 (normal range: 150 000-450 000/mm 3), international normalized ratio (INR) 2.9

Research paper thumbnail of 2P-0568 Effect of intravenous administration of vitamin B12 on lipids in patients with end-stage renal disease

Atherosclerosis Supplements, 2003

with the B2 allele by 42% (P=0.0022) and those without the B2 allele by 50% (P=0.0009). Irrespect... more with the B2 allele by 42% (P=0.0022) and those without the B2 allele by 50% (P=0.0009). Irrespective of the B2 allele, bezafibrate significantly increased plasma pre-heparin LPL concentrations. However, cholesteryl ester transfer rate (CETR) and CETP masses significantly decreased in subjects without the B2 allele but not in those with the B2 allele. Post-heparin LPL or lecithincholesterol acyl transferase (LCAT) did not alter in both subgroups. Thus, while bezafibrate increased plasma HDL-C levels in hypertriglyceridemics irrespective of TaqIB polymorphism, bezafibrate-induced changes in HDL subfractions differed according to the polymorphism. Though, bezafibrate did not decrease plasma CETP concentration and CETR in subjects with the B2 allele, increased lipid-poor HDL particles associated with decreased HDL-CWR may be responsible for the drug's anti-atherogenicity in B2 (+) patients by favoring reverse cholesterol transport.

Research paper thumbnail of Diet, serum homocysteine levels and ischaemic heart disease in a Mediterranean population

British Journal of Nutrition, 2004

Homocysteine (Hcy) is recognised as a risk factor for IHD. Serum Hcy is negatively correlated wit... more Homocysteine (Hcy) is recognised as a risk factor for IHD. Serum Hcy is negatively correlated with serum folate levels, the main sources of which are fruits, vegetables and legumes. The present case–control study was designed to examine the relationship between serum Hcy levels and IHD and to assess the role of dietary factors in the southern Mediterranean population of Crete, Greece. Serum Hcy, folate, vitamin B12, creatinine and glucose levels and a full lipid profile were measured in 152 patients with established IHD, median age 64 (range 33–77) years, and 152 healthy control subjects, age- and sex-matched. Dietary data were assessed using a 3 d food intake record. Compared with controls, patients with IHD had significantly higher daily intakes of vitamin B12 and MUFA and significantly lower intakes of carbohydrate, fibre, folate, cholesterol, n-3 fatty acids and total trans unsaturated fatty acids. Moreover, patients had significantly higher serum Hcy, vitamin B12 and creatinine...

Research paper thumbnail of Wild chamomile (Matricaria recutita L.) mouthwashes in methotrexate-induced oral mucositis

Phytomedicine, 2005

Oral mucositis is a known complication of methotrexate (MTX) therapy, but a single efficacious in... more Oral mucositis is a known complication of methotrexate (MTX) therapy, but a single efficacious intervention or agent for prophylaxis or management of this side effect has not yet been identified. We report a case of MTX-induced oral mucositis in a patient with rheumatoid arthritis, who was successfully treated with Wild chamomile mouthwashes.

Research paper thumbnail of Validation of the Greek Translation of the Obesity-Specific Moorehead–Ardelt Quality-of-Life Questionnaire II

Obesity Surgery, 2012

Morbid obesity adversely affects quality of life. The assessment of health-related quality of lif... more Morbid obesity adversely affects quality of life. The assessment of health-related quality of life (HRQoL) needs specific measuring instruments. The Moorehead-Ardelt Quality-of-Life Questionnaire II (MA II) is an obesity-specific instrument widely used in bariatric surgery. The objective of this study was to translate and validate the MA II in Greek language. The study included the translation of the MA II followed by cross-validation with the Greek version of 36-item Short Form Health Survey (SF-36) and a Visual Analogue Scale (VAS) in subjects visiting an obesity clinic. Internal consistency was indicated by Cronbach's alpha coefficient and test-retest reliability by intraclass correlation coefficient (ICC). Construct validity was studied using Pearson's correlations between the MA II, the SF-36 and the VAS. A total of 175 patients were enrolled in the study. Test-retest analysis was applied to 40 patients with a 15-day interval. A very good internal consistency with Cronbach's alpha coefficient of 0.85 was shown. Excellent test-retest reliability was observed with an overall ICC of 0.981. Significant correlations between the Greek MA II and the other instruments as well as of each item of the MA II with the scores of SF-36 and the VAS indicated high construct and convergent validity. A negative correlation between the translated MA II total score and BMI confirmed high clinical validity. The Greek version of the MA II questionnaire has been generated and shown to be valid and reliable in measuring HRQoL in morbidly obese patients before and after bariatric surgery.

Research paper thumbnail of Sleeve Gastrectomy—A “Food Limiting” Operation

Obesity Surgery, 2008

Background Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities ... more Background Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities and good weight loss, shows increasing popularity among bariatric surgeons. The aim of this study was to evaluate clinical outcome and the gastric emptying of solid foods, 24 months after SG. Methods Fourteen morbidly obese patients, four males and ten females, median age 41 years (range 29-65), median body mass index (BMI) 49.46 kg/m 2 (range 41.14-55.63), who underwent SG for weight loss, were studied prospectively. Nine patients underwent gastric emptying studies, using radioisotopic technique before, 6 months and 24 months after the operation. The remaining five patients underwent gastric emptying studies, 6 months and 24 months after the operation. Results A significant reduction in patients' weight and BMI was evident at 6, 12 and 24 months postoperatively. In the nine patients who underwent gastric emptying studies pre-, 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50-20.90) min, to 12.50 (range 9.20-18.00) min at 6 months and 12.16 (range 10.90-20.00) min at 24 months postoperatively (P<0.05). The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50-104.60) min, to 62.50 (range 46.30-80.00) min at 6 months and 60.80 (range 54.80-100.00) min at 24 months after SG (P < 0.05). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43-58) % to 72 (range 57-97) % at 6 months and 74 (range 45-82) % at 24 months, following SG (P<0.05). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively. When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively. Conclusions Our study indicates the constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not only in short but also in long-term postoperatively. Such effects on gastric motility, in combination with the reported alterations in gut hormones, may explain how this 'food limiting' operation results in weight loss.

Research paper thumbnail of Aplastic anaemia induced by Epstein-Barr virus infection

Research paper thumbnail of Effect of Diabetes Mellitus on the Clinical and Microbiological Features of Hospitalized Elderly Patients with Acute Pyelonephritis

Journal of the American Geriatrics Society, 2009

OBJECTIVES: To study potential differences in the clinical and microbiological features of hospit... more OBJECTIVES: To study potential differences in the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis with and without diabetes mellitus. DESIGN: Retrospective review of medical records. SETTING: University hospital. PARTICIPANTS: Eighty-eight patients aged 65 and older with diabetes mellitus (DM) (57 female; 64.8%) and 118 controls without DM (75 female; 63.6%), matched for age and sex, hospitalized with acute pyelonephritis between January 1997 and December 2005. MEASUREMENTS: Medical records were reviewed for demographic, clinical, and microbiological characteristics. RESULTS: The median age of both groups was 74 (range 65-95). Twenty-seven people with DM (30.7%) and 13 controls (11.0%) had bacteremia (P 5.001). People with DM had longer fever (median 4.5 vs 2.5 days; Po.001), longer hospitalization (median 10 vs 7 days; Po.001), and greater mortality (12.5% vs 2.5%; Po.01) than controls. Logistic regression analysis proved DM to be an independent predictor of bacteremia, long hospitalization, and mortality. Escherichia coli was the most common microorganism found in both groups, whereas Candida spp. were implicated more frequently in people with DM than controls (12.7% vs 1.7%; Po.01). Antimicrobial resistance did not increase over the study period. CONCLUSION: Acute pyelonephritis in elderly people with DM is associated with risk of bacteremia, long hospitalization, and mortality.

Research paper thumbnail of First case report of Streptococcus suis septicaemia and meningitis from Greece

European Journal of Neurology, 2005

substitution of cystein (TGC) for arginine (CGC) at codon 112. This mutation has been reported pr... more substitution of cystein (TGC) for arginine (CGC) at codon 112. This mutation has been reported previously (Desnick et al., 2001). On the 23rd hospital day follow-up MRI showed asymptomatic hemorrhagic infarction in the left caudate nucleus, in the territory of the anterior cerebral artery (Fig. 2a). On the 59th hospital day, a left medial longitudinal fasciculus (MLF) syndrome appeared. MRI confirmed recurrent infarction in the brainstem, including the left MLF, again in the territory of the basilar artery (Fig. 2b). The patient was treated intravenously with heparin sodium (10 000 U/day) and ozagrel sodium (160 mg/day), as the asymptomatic left caudate hemorrhagic infarction had resolved according to MRI. Symptoms decreased gradually. Recently, safety and effectiveness of recombinant aGal A replacement therapy for Fabry's disease have been reported (Eng et al., 2001; Schiffmann et al., 2001). We would stress that Fabry's disease should be considered amongst possible causes of unexplained ischemic stroke, especially in young patients.

Research paper thumbnail of Nosocomial lower respiratory tract infections: prevalence and risk factors in 14 Greek hospitals

European Journal of Clinical Microbiology & Infectious Diseases, 2004

Nosocomial lower respiratory tract infections (NLRTIs) are associated with significant morbidity ... more Nosocomial lower respiratory tract infections (NLRTIs) are associated with significant morbidity and mortality. The aim of this study was to investigate the epidemiological features of NLRTIs in Greece, where knowledge about these infections is limited. Two pointprevalence studies of hospital-acquired infections were carried out in 14 Greek hospitals located throughout the country, one in 1999 and one in 2000. NLRTIs were diagnosed in accordance with the Centers for Disease Control and Prevention (CDC) definitions. Among the 7,120 hospitalized patients registered during the two studies, 610 (8.6%) cases of hospital-acquired infections were identified, of which 200 (32.8%) were NLRTIs. Sixty-nine (34.5%) patients had pneumonia, and the remaining 131 (65.5%) patients had bronchitis. The greatest prevalence of NLRTI was found in the adult ICUs (30.4%). Male gender, age >65 years, mechanical ventilation, tracheostomy, an intravenous central line, and an indwelling urethral catheter were the main risk factors. There was no significant difference in the incidence of NLRTI among hospital-acquired infections between the 1999 study and the 2000 study. The causative microorganism was identified in 78 of 200 (39%) cases, and 103 strains were isolated. The majority of strains (67%) were gram-negative bacteria. The most frequently isolated microorganisms were Pseudomonas aeruginosa (22.3%), Acinetobacter spp. (19.4%), Klebsiella pneumoniae (12.6%), and Staphylococcus aureus (10.7%). There was no difference between the two prevalence studies in the frequency of isolation of the microorganisms. NLRTI was the leading cause of morbidity and mortality among hospitalized patients with hospital-acquired infections in Greek hospitals. Gram-negative microorganisms were the most frequently isolated pathogens.

Research paper thumbnail of The Relationship Between Circulating Fibrinogen and Lipoprotein (a) Levels in Patients With Primary Dyslipidemia

Clinical and Applied Thrombosis/Hemostasis, 2007

The correlation between 2 predictors of vascular events, plasma fibrinogen and serum lipoprotein ... more The correlation between 2 predictors of vascular events, plasma fibrinogen and serum lipoprotein (a), was evaluated in patients referred to a specialist clinic because of primary hyperlipidemia. A significant correlation existed between fibrinogen and lipoprotein (a) in nonsmokers but not in smokers. Plasma fibrinogen concentration correlated positively and significantly with serum lipoprotein (a) levels in men nonsmokers without cardiovascular disease and in women nonsmokers with cardiovascular disease. Nonsmoker women without cardiovascular disease had significantly higher plasma fibrinogen (3.63 g/L versus 3.07 g/L, P < .0001) than the corresponding men. Nonsmoker women with and without cardiovascular disease had significantly higher lipoprotein (a) levels than the corresponding groups of men (0.36 versus 0.18 g/L; P = .0015 and 0.40 versus 0.26 g/L; P = .008), respectively. The relationship between fibrinogen and lipoprotein (a) levels alters markedly depending on the populat...

Research paper thumbnail of Lipids and stroke: neglect of a useful preventive measure?

Cardiovascular Research, 1998

The epidemiological studies linking lipid variables and stroke are reviewed. These studies indica... more The epidemiological studies linking lipid variables and stroke are reviewed. These studies indicate that serum total cholesterol (TC) levels are associated positively with thrombotic and negatively with haemorrhagic strokes. Relationships for other lipid fractions are not as clearly defined. The results of trials with lipid lowering drugs suggest that only statins effectively reduce the incidence of stroke. Differences between trial results may be due to variation in the extent of reduction of TC levels. Possible underlying mechanisms for benefit and the apparent superiority of statins are also discussed. The reduction in the risk of thrombotic stroke with statins is most evident through meta-analyses (p,0.001) and less impressive in individual trials (p,0.03). This difference is largely attributable to the small number of events in trials primarily aimed at evaluating ischaemic heart disease (IHD) reduction. This also means that benefit may be limited to those with established IHD. IHD and thrombotic stroke share common risk factors and patients with one condition are at high risk of developing the other. Therefore, one additional reason for using statins in these patients is that these drugs can effectively prevent IHD-related events including deaths.

Research paper thumbnail of C1q Gene Polymorphism Is Associated with Asymptomatic Bacteriuria in Patients with Type 2 Diabetes Mellitus

Medicina

Background and Objectives: Asymptomatic bacteriuria (ASB) appears to have a higher prevalence in ... more Background and Objectives: Asymptomatic bacteriuria (ASB) appears to have a higher prevalence in diabetics and has been associated with various genetic polymorphisms of the innate immune system. Single nucleotide polymorphisms (SNPs) of the C1q gene that encodes for the trigger molecule of the classical complement pathway increase the risk of bacterial infections as well as other diseases. In the present study, we sought to investigate the association of C1q rs292001 (G > A) SNP with ASB in patients with type 2 diabetes (T2D). Materials and Methods: In this case-control study, performed at the University and the Venizeleion General Hospital of Heraklion, Crete, Greece, 75 adult male and female Cretan patients with T2D and ASB and 75 adult male and female Cretan patients with T2D but without ASB were enrolled and genotyped for rs292001 SNP of C1q gene. Genetic analysis was based on the polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RLFPs) methods. R...

Research paper thumbnail of Case report of rhabdomyolysis possibly associated to the interaction of ciprofloxacin with simvastatin

This is a case report of rhabdomyolysis possibly associated to the administration of ciprofloxaci... more This is a case report of rhabdomyolysis possibly associated to the administration of ciprofloxacin to a patient on chronic lipid-lowering therapy with simvastatin. It is the second case report in the literature. We suggest a mechanism of interaction between the two agents which involves the adenosine-5'-triphosphate (ATP)-binding cassette drug efflux transporter family.

Research paper thumbnail of Epidemiology, Microbiological and Clinical Features, Treatment, and Outcomes of Infective Endocarditis in Crete, Greece

Infection & chemotherapy, 2018

This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, ... more This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, and outcomes of infective endocarditis (IE) on the island of Crete, a region with high levels of antimicrobial resistance. Medical records of all hospitalized patients diagnosed with IE at the University Hospital of Heraklion, Crete, Greece, from 1995 to 2015, were retrospectively reviewed. Patients who met the modified Duke's criteria for definite or possible IE were included. A total of 82 IE patients (median age 67 [range 21-86] years) were included. Most patients suffered from left-sided IE (94%), while most cases of infection occurred in native valves (53.6%). Systemic inflammatory response syndrome criteria were lacking in almost half of the patient population. The leading causative microorganism was Staphylococcus aureus, isolated in 24 cases (29%), followed by Streptococcus spp. in 15 (18%) and Enterococcus spp. in 12 (14.5%). A number of rare and difficult to treat microorga...

Research paper thumbnail of The influence of hypertension and antihypertensive drugs on ?new? cardiovascular risk factors, in dyslipidaemic patients

American Journal of Hypertension, 1999

Dozens of publications have been written on the safety and efficacy of Terazosin (Hytdn@) and Car... more Dozens of publications have been written on the safety and efficacy of Terazosin (Hytdn@) and Carteolol (Cadrol®). However, the good clinical practices (GCPs) employed in monitoring these two antihypertensive drugs have not been discussed. Documentation required for FDA approval and the GCP monitonng practices involved in the dinicel tnals of these two antihypertensive drags will be reviewed. A complete set of standard operating procedures and good GCP training (including protocol development, study design and data analysis) were required. Investigator interest, patient population and a complete site evaluation were also required. Regulatory documentation collection consisted of as many as 10 separate documents necessary for shipping drug and treating the first patient. Current practices may require investigator and sponsor electronic signature verification depending on the type of IND and NDA submission intended. These two antihypertensives required a paper trail, however Terazosin was the fkst electronic NDA submission. Specific mguletory documentation collected (e.g. FDA form 1572, curriculum vitae), mechanisms for source document verification (e.g.medicel histories, odginal charts and records), site, patient and budget trecldng as well as monitonng frequency was managed. The author personally monitored least three Phase I sites, and approximately 20 different Phase II and lU sites every 4-8 weeks depending on the protocol and patient enrollment. Approximately 500 patients were monitored. Decisions regarding their evaluability and payments were made. Consistency between sites, CPA's and the CRO's involved was managed. All adverse events were repoded. A complete review of the required data corrections was made pnor to site close out visits when drug was returned. Statistical analysis and medical summmy were completed. Internal auditing of all key safety and efficacy parameters was completed prior to FDA submission. This wod~ was done at Abbott Labe(1980-1985).

Research paper thumbnail of Effect of anti-hypertensive agents on plasma fibrinogen levels in patients with essential hypertension

American Journal of Hypertension, 2001

In addition to hypertension, dyslipidaemia and smoking, elevated plasma levels of fibrinogen (Fib... more In addition to hypertension, dyslipidaemia and smoking, elevated plasma levels of fibrinogen (Fib) have also been associated with increased risk of cardiovascular (CVD) events. We investigated the influence of antihypertensive treatment on this CVD predictor in 427 patients (177 men) with essential hypertension. Their median age was 60 (range: 18 to 87) years. Of the hypertensive patients, 259 (60.7%) were receiving anti-hypertensive agents. Of the treated hypertensives, 135 patients (52.1%) were under one, 93 (35.9%) under two, 25 (9.7%) under three and 6 (2.3%) under four anti-hypertensive drugs. Only 57 (22.0%) out of 259 treated hypertensives were well controlled (blood pressure levels bellow 140/90mmHg). Anti-hypertensive drug use was associated with significantly lower plasma Fib concentration when compared with untreated hypertensives [median values (range): 250 (170-400) vs 300 (170-540) mg/dl, respectively; pϽ0.01, Mann-Whitney test]. There were no significant differences in serum levels of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides between these two groups of hypertensives. In conclusion: In addition to lowering arterial blood pressure, antihypertensive agents may also decrease plasma levels of Fib, another modifiable cardiovascular risk factor.

Research paper thumbnail of Effect of diuretics addition on metabolic variables and plasma fibrinogen levels, in hypertensive patients treated with ACE inhibitors

American Journal of Hypertension, 2003

Azathioprine-Prednisone [Aza-P], 44 developed ERY (Hematocrit [Hct] of Ն50%). Of these 36 were me... more Azathioprine-Prednisone [Aza-P], 44 developed ERY (Hematocrit [Hct] of Ն50%). Of these 36 were men (82%) and 8 were women (18%), with a M:W ϭ 4.5. PRT ERY developed within 5 months to 10 years after transplantation: 34 (9.0%) were on CsA, 9 (11.7%) on Tacro and 1 (2%) on Aza-P. Red blood cell mass (RBCM) and Plasma Volume (PV) were measured radioisotopically, erythropoietin (EPO) by ELISA. All had expanded RBCM (measured: 2786Ϯ99 ml [SEM], expected: 2124Ϯ66 ml; pϽ0.0001) and PV (measured: 3295Ϯ109 ml, expected: 3015Ϯ70 ml; pϽ0.002). Oral Enalapril 2.5-10.0 mg daily for several weeks dropped Hct from 53.4Ϯ0.5% to 46.7Ϯ5%, pϽ0.0004; RBCM to 2211Ϯ120 ml, pϽ0.0001, but PV was unchanged (3130Ϯ259, pϭ0.37). Demographics of patients with PRT ERY were no different from those without ERY. PRT ERY was observed in 9% of patients, mostly men. ACEi reduced Hct by 13%, RBCM by 20%, but had no effect on PV.

Research paper thumbnail of Effect of hypertension and its treatment on lipid, lipoprotein(a), fibrinogen, and bilirubin levels in patients referred for dyslipidemia

American Journal of Hypertension, 1999

We measured the serum lipid profile, together with plasma fibrinogen and serum lipoprotein(a) (Lp... more We measured the serum lipid profile, together with plasma fibrinogen and serum lipoprotein(a) (Lp[a]), glucose, bilirubin, and albumin levels in 491 patients (310 men) who were referred for the management of primary dyslipidemia. All these variables have been shown to predict vascular events. The patients were not taking lipid-lowering drugs; hypertension was present in 156 (31.7%) of them. Of the hypertensive patients, 52 (33%) were not receiving any treatment to control their blood pressure. This omission was not due to a lower prevalence of established vascular disease. The treated hypertensives were divided into three groups according to their treatment: 62 were taking lipid-hostile antihypertensives (␤-blockers, thiazides), 37 were taking lipid-neutral antihypertensives (angiotensin converting enzyme inhibitors, Ca-channel blockers, angiotensin II receptor blockers, indapamide sustained release), and five were taking lipid-friendly antihypertensives (doxazosin). Lipid-hostile antihypertensive drugs were associated with a significantly higher fibrinogen concentration when compared with untreated hypertensives or those taking lipid-neutral/lipidfriendly drugs (median values: 383, 353, and 336 mg/dL, respectively; P < < .01). Lipid-neutral/lipidfriendly antihypertensive drugs were associated with lower Lp(a) levels when compared with untreated hypertensives (median values: 22 and 45 mg/dL, respectively; P < < .05). The serum bilirubin level was significantly lower in the untreated hypertensives when compared with normotensives or the treated hypertensives. There were no significant differences in lipids, glucose, or albumin among the groups of hypertensives or normotensives. The influence of antihypertensive drugs on additional cardiovascular risk factors should be considered when selecting medication to reduce blood pressure.

Research paper thumbnail of Acute febrile neutrophilic dermatosis (Sweet's syndrome) with erythema nodosum and anterior scleritis. A case report

International Journal of Dermatology, Dec 1, 2005

ABSTRACT

Research paper thumbnail of Unusual causes of intrahepatic cholestatic liver disease

World Journal of Gastroenterology, 2007

chronic liver diseases, such as genetic defects [2] (Table 1). Gallstones, bile duct strictures, ... more chronic liver diseases, such as genetic defects [2] (Table 1). Gallstones, bile duct strictures, and tumours are the most frequent causes of extrahepatic (mechanical) bile duct obstruction [2] (Table 1). Cholestatic liver disease is characterised by a predominant elevation of serum alkaline phosphatase and bilirubin, although serum bilirubin may be normal until a late stage of the disease. In this paper we discuss five patients with unusual causes of intrahepatic cholestatic liver disease. CASES REPORT We retrospectively studied the case notes of 100 patients with intrahepatic cholestatic liver disease who were hospitalised in two divisions of internal medicine for investigation in 2002-2004. Five unusual causes of intrahepatic cholestasis were revealed in our patients. The causes of intrahepatic cholestasis were defined as unusual with a prevalence < 10%. The medical histories of five representative patients with these causes of cholestasis are reported below: Case 1 A 67-year old man was admitted to hospital for a 5-d history of painless jaundice, pruritus, dark urine and light stools. His medical history included fatty liver, associated with hyperlipidemia and the consumption of ethanol, which was confirmed by an abdominal ultrasound scan and liver biopsy performed in the previous year. Consumption of Teucrium polium (family Lamiaceae) in the form of tea for the treatment of hyperlipidemia during the previous 6 mo (increasing to 2 litres per day in the preceding month) was also mentioned. Physical examination revealed yellow pigmentation of the sclera and skin. Laboratory tests showed the following values: haematocrit (Ht) 46%, white blood cell (WBC) count 7000 cells/mm 3 (neutrophils 53%, lymphocytes 29.3%, monocytes 10.2%, eosinophils 6.6%), MCV106 fL (normal range: 80-99 fL), platelet (PLT) count 133 000/mm 3 (normal range: 150 000-450 000/mm 3), international normalized ratio (INR) 2.9

Research paper thumbnail of 2P-0568 Effect of intravenous administration of vitamin B12 on lipids in patients with end-stage renal disease

Atherosclerosis Supplements, 2003

with the B2 allele by 42% (P=0.0022) and those without the B2 allele by 50% (P=0.0009). Irrespect... more with the B2 allele by 42% (P=0.0022) and those without the B2 allele by 50% (P=0.0009). Irrespective of the B2 allele, bezafibrate significantly increased plasma pre-heparin LPL concentrations. However, cholesteryl ester transfer rate (CETR) and CETP masses significantly decreased in subjects without the B2 allele but not in those with the B2 allele. Post-heparin LPL or lecithincholesterol acyl transferase (LCAT) did not alter in both subgroups. Thus, while bezafibrate increased plasma HDL-C levels in hypertriglyceridemics irrespective of TaqIB polymorphism, bezafibrate-induced changes in HDL subfractions differed according to the polymorphism. Though, bezafibrate did not decrease plasma CETP concentration and CETR in subjects with the B2 allele, increased lipid-poor HDL particles associated with decreased HDL-CWR may be responsible for the drug's anti-atherogenicity in B2 (+) patients by favoring reverse cholesterol transport.

Research paper thumbnail of Diet, serum homocysteine levels and ischaemic heart disease in a Mediterranean population

British Journal of Nutrition, 2004

Homocysteine (Hcy) is recognised as a risk factor for IHD. Serum Hcy is negatively correlated wit... more Homocysteine (Hcy) is recognised as a risk factor for IHD. Serum Hcy is negatively correlated with serum folate levels, the main sources of which are fruits, vegetables and legumes. The present case–control study was designed to examine the relationship between serum Hcy levels and IHD and to assess the role of dietary factors in the southern Mediterranean population of Crete, Greece. Serum Hcy, folate, vitamin B12, creatinine and glucose levels and a full lipid profile were measured in 152 patients with established IHD, median age 64 (range 33–77) years, and 152 healthy control subjects, age- and sex-matched. Dietary data were assessed using a 3 d food intake record. Compared with controls, patients with IHD had significantly higher daily intakes of vitamin B12 and MUFA and significantly lower intakes of carbohydrate, fibre, folate, cholesterol, n-3 fatty acids and total trans unsaturated fatty acids. Moreover, patients had significantly higher serum Hcy, vitamin B12 and creatinine...

Research paper thumbnail of Wild chamomile (Matricaria recutita L.) mouthwashes in methotrexate-induced oral mucositis

Phytomedicine, 2005

Oral mucositis is a known complication of methotrexate (MTX) therapy, but a single efficacious in... more Oral mucositis is a known complication of methotrexate (MTX) therapy, but a single efficacious intervention or agent for prophylaxis or management of this side effect has not yet been identified. We report a case of MTX-induced oral mucositis in a patient with rheumatoid arthritis, who was successfully treated with Wild chamomile mouthwashes.

Research paper thumbnail of Validation of the Greek Translation of the Obesity-Specific Moorehead–Ardelt Quality-of-Life Questionnaire II

Obesity Surgery, 2012

Morbid obesity adversely affects quality of life. The assessment of health-related quality of lif... more Morbid obesity adversely affects quality of life. The assessment of health-related quality of life (HRQoL) needs specific measuring instruments. The Moorehead-Ardelt Quality-of-Life Questionnaire II (MA II) is an obesity-specific instrument widely used in bariatric surgery. The objective of this study was to translate and validate the MA II in Greek language. The study included the translation of the MA II followed by cross-validation with the Greek version of 36-item Short Form Health Survey (SF-36) and a Visual Analogue Scale (VAS) in subjects visiting an obesity clinic. Internal consistency was indicated by Cronbach's alpha coefficient and test-retest reliability by intraclass correlation coefficient (ICC). Construct validity was studied using Pearson's correlations between the MA II, the SF-36 and the VAS. A total of 175 patients were enrolled in the study. Test-retest analysis was applied to 40 patients with a 15-day interval. A very good internal consistency with Cronbach's alpha coefficient of 0.85 was shown. Excellent test-retest reliability was observed with an overall ICC of 0.981. Significant correlations between the Greek MA II and the other instruments as well as of each item of the MA II with the scores of SF-36 and the VAS indicated high construct and convergent validity. A negative correlation between the translated MA II total score and BMI confirmed high clinical validity. The Greek version of the MA II questionnaire has been generated and shown to be valid and reliable in measuring HRQoL in morbidly obese patients before and after bariatric surgery.

Research paper thumbnail of Sleeve Gastrectomy—A “Food Limiting” Operation

Obesity Surgery, 2008

Background Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities ... more Background Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities and good weight loss, shows increasing popularity among bariatric surgeons. The aim of this study was to evaluate clinical outcome and the gastric emptying of solid foods, 24 months after SG. Methods Fourteen morbidly obese patients, four males and ten females, median age 41 years (range 29-65), median body mass index (BMI) 49.46 kg/m 2 (range 41.14-55.63), who underwent SG for weight loss, were studied prospectively. Nine patients underwent gastric emptying studies, using radioisotopic technique before, 6 months and 24 months after the operation. The remaining five patients underwent gastric emptying studies, 6 months and 24 months after the operation. Results A significant reduction in patients' weight and BMI was evident at 6, 12 and 24 months postoperatively. In the nine patients who underwent gastric emptying studies pre-, 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50-20.90) min, to 12.50 (range 9.20-18.00) min at 6 months and 12.16 (range 10.90-20.00) min at 24 months postoperatively (P<0.05). The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50-104.60) min, to 62.50 (range 46.30-80.00) min at 6 months and 60.80 (range 54.80-100.00) min at 24 months after SG (P < 0.05). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43-58) % to 72 (range 57-97) % at 6 months and 74 (range 45-82) % at 24 months, following SG (P<0.05). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively. When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively. Conclusions Our study indicates the constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not only in short but also in long-term postoperatively. Such effects on gastric motility, in combination with the reported alterations in gut hormones, may explain how this 'food limiting' operation results in weight loss.

Research paper thumbnail of Aplastic anaemia induced by Epstein-Barr virus infection

Research paper thumbnail of Effect of Diabetes Mellitus on the Clinical and Microbiological Features of Hospitalized Elderly Patients with Acute Pyelonephritis

Journal of the American Geriatrics Society, 2009

OBJECTIVES: To study potential differences in the clinical and microbiological features of hospit... more OBJECTIVES: To study potential differences in the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis with and without diabetes mellitus. DESIGN: Retrospective review of medical records. SETTING: University hospital. PARTICIPANTS: Eighty-eight patients aged 65 and older with diabetes mellitus (DM) (57 female; 64.8%) and 118 controls without DM (75 female; 63.6%), matched for age and sex, hospitalized with acute pyelonephritis between January 1997 and December 2005. MEASUREMENTS: Medical records were reviewed for demographic, clinical, and microbiological characteristics. RESULTS: The median age of both groups was 74 (range 65-95). Twenty-seven people with DM (30.7%) and 13 controls (11.0%) had bacteremia (P 5.001). People with DM had longer fever (median 4.5 vs 2.5 days; Po.001), longer hospitalization (median 10 vs 7 days; Po.001), and greater mortality (12.5% vs 2.5%; Po.01) than controls. Logistic regression analysis proved DM to be an independent predictor of bacteremia, long hospitalization, and mortality. Escherichia coli was the most common microorganism found in both groups, whereas Candida spp. were implicated more frequently in people with DM than controls (12.7% vs 1.7%; Po.01). Antimicrobial resistance did not increase over the study period. CONCLUSION: Acute pyelonephritis in elderly people with DM is associated with risk of bacteremia, long hospitalization, and mortality.

Research paper thumbnail of First case report of Streptococcus suis septicaemia and meningitis from Greece

European Journal of Neurology, 2005

substitution of cystein (TGC) for arginine (CGC) at codon 112. This mutation has been reported pr... more substitution of cystein (TGC) for arginine (CGC) at codon 112. This mutation has been reported previously (Desnick et al., 2001). On the 23rd hospital day follow-up MRI showed asymptomatic hemorrhagic infarction in the left caudate nucleus, in the territory of the anterior cerebral artery (Fig. 2a). On the 59th hospital day, a left medial longitudinal fasciculus (MLF) syndrome appeared. MRI confirmed recurrent infarction in the brainstem, including the left MLF, again in the territory of the basilar artery (Fig. 2b). The patient was treated intravenously with heparin sodium (10 000 U/day) and ozagrel sodium (160 mg/day), as the asymptomatic left caudate hemorrhagic infarction had resolved according to MRI. Symptoms decreased gradually. Recently, safety and effectiveness of recombinant aGal A replacement therapy for Fabry's disease have been reported (Eng et al., 2001; Schiffmann et al., 2001). We would stress that Fabry's disease should be considered amongst possible causes of unexplained ischemic stroke, especially in young patients.

Research paper thumbnail of Nosocomial lower respiratory tract infections: prevalence and risk factors in 14 Greek hospitals

European Journal of Clinical Microbiology & Infectious Diseases, 2004

Nosocomial lower respiratory tract infections (NLRTIs) are associated with significant morbidity ... more Nosocomial lower respiratory tract infections (NLRTIs) are associated with significant morbidity and mortality. The aim of this study was to investigate the epidemiological features of NLRTIs in Greece, where knowledge about these infections is limited. Two pointprevalence studies of hospital-acquired infections were carried out in 14 Greek hospitals located throughout the country, one in 1999 and one in 2000. NLRTIs were diagnosed in accordance with the Centers for Disease Control and Prevention (CDC) definitions. Among the 7,120 hospitalized patients registered during the two studies, 610 (8.6%) cases of hospital-acquired infections were identified, of which 200 (32.8%) were NLRTIs. Sixty-nine (34.5%) patients had pneumonia, and the remaining 131 (65.5%) patients had bronchitis. The greatest prevalence of NLRTI was found in the adult ICUs (30.4%). Male gender, age >65 years, mechanical ventilation, tracheostomy, an intravenous central line, and an indwelling urethral catheter were the main risk factors. There was no significant difference in the incidence of NLRTI among hospital-acquired infections between the 1999 study and the 2000 study. The causative microorganism was identified in 78 of 200 (39%) cases, and 103 strains were isolated. The majority of strains (67%) were gram-negative bacteria. The most frequently isolated microorganisms were Pseudomonas aeruginosa (22.3%), Acinetobacter spp. (19.4%), Klebsiella pneumoniae (12.6%), and Staphylococcus aureus (10.7%). There was no difference between the two prevalence studies in the frequency of isolation of the microorganisms. NLRTI was the leading cause of morbidity and mortality among hospitalized patients with hospital-acquired infections in Greek hospitals. Gram-negative microorganisms were the most frequently isolated pathogens.

Research paper thumbnail of The Relationship Between Circulating Fibrinogen and Lipoprotein (a) Levels in Patients With Primary Dyslipidemia

Clinical and Applied Thrombosis/Hemostasis, 2007

The correlation between 2 predictors of vascular events, plasma fibrinogen and serum lipoprotein ... more The correlation between 2 predictors of vascular events, plasma fibrinogen and serum lipoprotein (a), was evaluated in patients referred to a specialist clinic because of primary hyperlipidemia. A significant correlation existed between fibrinogen and lipoprotein (a) in nonsmokers but not in smokers. Plasma fibrinogen concentration correlated positively and significantly with serum lipoprotein (a) levels in men nonsmokers without cardiovascular disease and in women nonsmokers with cardiovascular disease. Nonsmoker women without cardiovascular disease had significantly higher plasma fibrinogen (3.63 g/L versus 3.07 g/L, P < .0001) than the corresponding men. Nonsmoker women with and without cardiovascular disease had significantly higher lipoprotein (a) levels than the corresponding groups of men (0.36 versus 0.18 g/L; P = .0015 and 0.40 versus 0.26 g/L; P = .008), respectively. The relationship between fibrinogen and lipoprotein (a) levels alters markedly depending on the populat...

Research paper thumbnail of Lipids and stroke: neglect of a useful preventive measure?

Cardiovascular Research, 1998

The epidemiological studies linking lipid variables and stroke are reviewed. These studies indica... more The epidemiological studies linking lipid variables and stroke are reviewed. These studies indicate that serum total cholesterol (TC) levels are associated positively with thrombotic and negatively with haemorrhagic strokes. Relationships for other lipid fractions are not as clearly defined. The results of trials with lipid lowering drugs suggest that only statins effectively reduce the incidence of stroke. Differences between trial results may be due to variation in the extent of reduction of TC levels. Possible underlying mechanisms for benefit and the apparent superiority of statins are also discussed. The reduction in the risk of thrombotic stroke with statins is most evident through meta-analyses (p,0.001) and less impressive in individual trials (p,0.03). This difference is largely attributable to the small number of events in trials primarily aimed at evaluating ischaemic heart disease (IHD) reduction. This also means that benefit may be limited to those with established IHD. IHD and thrombotic stroke share common risk factors and patients with one condition are at high risk of developing the other. Therefore, one additional reason for using statins in these patients is that these drugs can effectively prevent IHD-related events including deaths.