椎野 憲二

Objectives: The clinical benefit of ezetimibe, an intestinal cholesterol transporter inhibitor, for treatment of postprandial hyperlipidemia was assessed in subjects who ingested a high-fat and high-glucose test meal to mimic westernized diet. Methods: We enrolled 20 male volunteers who had at least one of the following: waist circumference >= 85 cm, body mass index >= 25 kg/m(2), or triglycerides (TG) from 150 to 400 mg/dL. After 4 weeks of treatment with ezetimibe (10 mg/day), the subjects ingested a high-fat and high-glucose meal. Then changes in serum lipid and glucose levels were monitored after 0, 2, 4, and 6 h, and the area under the curve (AUC) was calculated for the change in each parameter. Results and conclusion: At 4 and 6 h postprandially, TG levels were decreased (p < 0.01) after 4 weeks of ezetimibe treatment, and the AUC for TG was also decreased (p < 0.01). Apolipoprotein B48 (apo-B48) levels at 4 and 611 postprandially were significantly decreased after ezetimibe treatment (p < 0.01 and p < 0.001, respectively), and the AUC for apo-B48 was also significantly decreased (p < 0.01). Blood glucose and insulin levels at 2 h postprandially were significantly decreased by ezetimibe (p < 0.01). The AUCs for blood glucose and insulin were also significantly decreased (p < 0.05 and p < 0.01, respectively). Since ezetimibe improved postprandial lipid and glucose metabolism, this drug is likely to be beneficial for dyslipidemia in patients with postprandial metabolic abnormalities. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Aims We evaluated the usefulness of left atrial volume index (LAVI) and the degree of changes in LAVI (delta LAVI) during hospitalization for the prediction of prognosis after acute myocardial infarction (AMI). Methods and results We investigated 205 consecutive patients with first AMI. They underwent echocardiography on admission as well as at discharge. Delta LAVI was calculated by subtracting the value on admission from that at discharge. The primary endpoints were major cardiac events (MACE): cardiac death due to heart failure and heart failure hospitalization. During a mean follow-up of 26 months, MACE occurred in 29 patients. Patients were divided into two groups according to the optimal cut-off values of LAVI (32.0 mL/m(2)) at discharge and delta LAVI (2.5 mL/m(2)) derived from receiver operating characteristic curves, respectively; Group I: LAVI <= 32.0 mL/m(2), Group II: LAVI > 32.0 mL/m(2) and Group A: delta LAVI <= 2.5 mL/m(2), Group B: delta LAVI > 2.5 mL/m(2). In comparisons of two groups, respectively, the incidence of MACE between the groups showed significant differences [ Group I (3.8%) vs. Group II (32.0%): P < 0.001, log-rank, Group A (7.4%) vs. Group B (20.0%): P = 0.0079, log-rank]. In multivariate analysis, LAVI at discharge [risk ratio (RR): 1.077, 95% CI: 1.035-1.124, P = 0.0002] and delta LAVI (RR: 1.056, 95% CI: 1.012-1.108, P = 0.0109) were significant. LAVI > 32.0 mL/m(2) at discharge (sensitivity: 93%, specificity: 69%) and delta LAVI > 2.5 mL/m(2) (sensitivity: 79%, specificity: 50%) were predictors of MACE. Conclusion LAVI at discharge and delta LAVI would be useful predictors for MACE after first AMI.