Effect on Fasting Serum Glucose Levels of Adding Ezetimibe to Statins in Patients With Nondiabetic Hypercholesterolemia

Statin therapy is associated with a slightly increased risk of developing diabetes mellitus and insulin resistance in patients without diabetes. Ezetimibe combined with statins may be considered for high-risk patients who do not achieve optimal low-density lipoprotein cholesterol lowering on statin monotherapy or who are statin intolerant. Changes in fasting serum glucose (FSG) levels during ezetimibe, ezetimibe/statin, and statin treatments were assessed using data pooled from clinical trials in hypercholesterolemic and heterozygous familial hypercholesterolemic patients, who were or were not receiving statin therapy. Study types included first-line trials in statin-naive/wash-out patients and second-line add-on and uptitration studies in patients on stable statin therapy. Similar analyses of FSG changes were performed separately for each study type in patients who were nondiabetic at baseline. Across all study types and treatments, mean FSG increases from baseline were small (0.5 to 3.7\ua0mg/dl with ezetimibe/statin; 0.2 to 4.6\ua0mg/dl with statins) and decreased over time; between-treatment differences (0.3 to 1.4\ua0mg/dl) were nonsignificant for all comparisons. Proportions of patients with elevated FSG 65126\ua0mg/dl during therapy were low and similar for all treatments in the overall cohort (1.2% to 4.3%). Elevations were highest (3.3% to 25.7%) among patients with baseline factors characteristic of metabolic syndrome and prediabetes, including higher FSG, body mass index, and triglyceride levels, and numerically lower baseline high-density lipoprotein cholesterol; however, these factors were not related to FSG increases. Changes in low-density lipoprotein cholesterol, body mass index, high-density lipoprotein cholesterol, triglycerides, and apolipoprotein B were not significantly correlated with FSG increases. In conclusion, statin therapy was associated with small FSG increases, and the addition of ezetimibe did not further increase FSG levels beyond those of statins when given to patients who are statin naive or those on statin therapy

Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes.

International audienceStatin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization), or nonfatal stroke. The median follow-up was 6 years. The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P=0.016). Rates of prespecified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit. (Funded by Merck; IMPROVE-IT ClinicalTrials.gov number, NCT00202878.)

Sotakarjut : Roolipelin visuaalinen taide ja ammatillinen vuorovaikutus projektityöympäristössä.

Opinnäytetyöni pohjautuu vuonna 2012 julkaistavaan roolipelikirjaan nimeltä Sotakarjut. TAMKista valmistuvana visuaalisena suunnittelijana olin mukana piirtämässä sekä konseptitaiteidetta, että kuvituskuvia kyseistä teosta varten. Kyseisen projektin aikana työskentelin sekä taiteellisen johdon alaisuudessa, että osana useamman kuvittajan/konseptitaiteilijan muodostamaa työryhmää, jolloin taiteellisesta ja ammatillisesta vuorovaikutuksesta tuli selkeä osa projektin kulkua. Näistä lähtökohdista päätin myös kirjoittaa opinnäytetyöni kirjallisen osuuden. Opinnäytetyöni tarkoitus on valaista monin tavoin vuorovaikutteiseksi muodostuvien projektityöympäristöjen vaikutusta taiteilijaan niin kuvittajan, kuin konseptitaiteilijan ammattissa. Valitsemaani aihetta lähestyn tekemäni projektin rajaaman kontekstin sisällä käymällä aluksi läpi nämä kaksi visuaalisen suunnittelun ammattihaaraa kartoittamalla taiteilijan roolia osana laajempaa projektityöympäristöä, ja tarjoamalla käytännön kautta lähestyvää näkökantaa esittelemilleni asioille. Tutkin sekä ulkoisen, että sisäisen vuorovaikutuksen merkitystä ja niiden luomia mahdollisuuksia luovalla alalla toimivan taiteilijan näkökulmasta. Esitän myös käytännön tapoja siitä, miten nämä vuorovaikutukselliset elementit voidaan valjastaa palvelemaan yksilön omaa ammatillista ja taiteellista kehitystä.My thesis work is based on a traditional role-playing-game that is set to be published in the year 2012, a book titled Sotakarjut. About to graduate from TAMK, Tampere University of Applied Sciences, as a visual designer I took part in this project, in a role that covered two distinct fields of profession: concept art and a illustration. As an single artist I worked under a artistic supervision and within a project that had several illustrators/consept artist in its ranks, thus making it essential to work as a singular creative team. In this thesis I will try to shed some light on how project-related work enviroments involves a specific kind of artististic approach from professional consept artists and illustrators. Having my project part work as my general context, I will start by making a general introduction on both of these creative professions, giving an overview on the subject of artististic work within project enviroments. I will also present a practical approach by adding examples from my actual project to support the theory based information I am presenting. In addition I will write about the many effects that professional interaction has within a working eviroment, from the artist view-point. Through this I will also explain how it is possible to assert yourself as a professional artist, so that this interaction can be made beneficial to the indivudual, both artistically and professional