References of "SCHEEN, André"
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See detailThe postprandial state and risk of cardiovascular disease.
Lefebvre, Pierre ULg; Scheen, André ULg

in Diabetic Medicine : A Journal of the British Diabetic Association (1998), 15 Suppl 4

Metabolism in man is regulated by complex hormonal signals and substrate interactions, and for many years the clinical focus has centred on the metabolic and hormonal picture after an overnight fast. More ... [more ▼]

Metabolism in man is regulated by complex hormonal signals and substrate interactions, and for many years the clinical focus has centred on the metabolic and hormonal picture after an overnight fast. More recently, the postprandial state, i.e. 'the period that comprises and follows a meal', has received more attention. The oral glucose tolerance test (OGTT), although highly non-physiological, has been used largely as a model of the postprandial state. Epidemiological studies have shown that, when 'impaired', oral glucose tolerance is associated with an increased risk of cardiovascular disease. Postprandial hyperlipidaemia has been investigated more recently in epidemiological, mechanistical and intervention studies, most of which indicate that high postprandial triglyceride levels, and particularly postprandial rich triglyceride remnants, constitute an increased risk for cardiovascular disease. Recent studies have shown that excessive postprandial glucose excursions are accompanied by oxidative stress and, less well known, activation of blood coagulation (increase in circulating D-dimers and prothrombin fragments). The mechanisms through which increased postprandial glucose levels and lipid concentrations may damage endothelial cells on blood vessel walls appear to be complex. These mechanisms include the activation of protein kinase C, increased expression of adhesion molecules, increased adhesion and uptake of leucocytes, increased production of proliferative substances such as endothelin, increased proliferation of endothelial cells, increased synthesis of collagen IV and fibronectin, and decreased production of nitric oxide (NO). In conclusion, the 'postprandial state' cumulatively covers almost half of the nycthemeral period, and its physiology involves numerous finely regulated motor, secretory, hormonal and metabolic events. Epidemiological and mechanistical studies have suggested that perturbations of the postprandial state are involved in cardiovascular disease. Correcting the abnormalities of the postprandial state must form part of the strategy for the prevention and management of cardiovascular diseases, particularly those that are associated with diabetes mellitus. [less ▲]

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See detailComment j'explore ... la néphropathie diabétique. Deuxième partie: suivi de la filtration glomérulaire
Weekers, Laurent ULg; Scheen, André ULg; Godon, J. P.

in Revue Médicale de Liège (1998), 53(9), 571-5

The natural history of diabetic renal disease can be divided into different stages according to the degree of albuminuria and the level of glomerular filtration rate (GFR). Assessment of the early ... [more ▼]

The natural history of diabetic renal disease can be divided into different stages according to the degree of albuminuria and the level of glomerular filtration rate (GFR). Assessment of the early hyperfiltration state, as well as determination of the rate of decline in kidney function at a later stage require precise and accurate methods to measure GFR. In this article, we briefly remind the reader of the physiological basis of GFR. We then review the different techniques for the monitoring of kidney function (inulin clearance, endogenous creatinine clearance, plasma disappearance of a radiolabelled tracer) and discuss the pro and cons of each of them in different clinical settings. Finally, we try to define a rational use of these techniques in everyday clinical practice. [less ▲]

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See detailAdverse effect of hyperinsulinemia on cardiovascular risk profile in middle-aged belgian population
Saint-Remy, Annie ULg; Scheen, André ULg; Jeanjean, Michel et al

in Acta Cardiologica (1998), 53(5), 299

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See detailLes thiazolidinediones : quel avenir dans le traitement du diabète de type 2 ?
SCHEEN, André ULg; PAQUOT, Nicolas ULg; LETIEXHE, Michel ULg et al

in Médecine et Hygiène (1998), 56

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See detailTraitement ultime du diabete de type 2: insulinotherapie intensive ou chirurgie bariatrique?
Scheen, André ULg; Paquot, Nicolas ULg; Triches, K. et al

in Journées Annuelles de Diabetologie de l'Hôtel-Dieu (1998)

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See detailComment j'explore ... la nephropathie diabetique. Premiere partie: micro- et macro-albuminurie.
Weekers, Laurent ULg; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1998), 53(8), 494-8

Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as ... [more ▼]

Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as an albumin excretion rate between 30 and 300 mg/24 h (on a 24-hour urine collection) or between 20 and 200 micrograms/min (on an overnight collection) in at least two out of three consecutive collections made within a 6-month period. Alternative screening techniques use either dipstick (Micral-Test II) or the albumin to creatinine ratio on an early morning urine sample (30-300 mg/g creatinine). Once persistent microalbuminuria is confirmed, 80% of type 1 diabetic patients and 20 to 50% of type 2 diabetic patients will progress to DN. In D2, microalbuminuria also represents a powerful predictor of early mortality from cardiovascular disease. Macroalbuminuria (AER > 300 mg/24 h, corresponding to a total protein excretion > 500 mg/24 h) will eventually lead to a end-stage renal insufficiency within 10 to 20 years. In D2, numerous patients will die from cardiovascular disease before reaching end-stage renal failure. Angiotensin-converting enzyme inhibitors can slow down the evolution toward DN when prescribed when microalbuminuria appears. Screening for microalbuminuria should therefore be a part of the annual clinical assessment in every diabetic patient. [less ▲]

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See detailOral antidiabetic agents. A guide to selection.
Scheen, André ULg; Lefebvre, Pierre ULg

in Drugs (1998), 55(2), 225-36

Type 2 diabetes mellitus (formerly named non-insulin-dependent diabetes mellitus or NIDDM) is a heterogeneous disease resulting from a dynamic interaction between defects in insulin secretion and insulin ... [more ▼]

Type 2 diabetes mellitus (formerly named non-insulin-dependent diabetes mellitus or NIDDM) is a heterogeneous disease resulting from a dynamic interaction between defects in insulin secretion and insulin action. Various pharmacological approaches can be used to improve glucose homeostasis via different modes of action: sulphonylureas essentially stimulate insulin secretion, biguanides (metformin) act by promoting glucose utilisation and reducing hepatic-glucose production, alpha-glucosidase inhibitors (acarbose) slow down carbohydrate absorption from the gut and thiazolidinediones (troglitazone) enhance cellular insulin action on glucose and lipid metabolism. These pharmacological treatments may be used individually for certain types of patients, or may be combined in a stepwise fashion to provide more ideal glycaemic control for most patients. Selection of oral antihyperglycaemic agents as first-line drug or combined therapy should be based on both the pharmacological properties of the compounds (efficacy and safety, profile) and the clinical characteristics of the patient (stage of disease, bodyweight, etc.). Mildly hyperglycaemic patients should preferably be treated with metformin, acarbose or thiazolidinediones (which are not associated with any hypoglycaemic risk), while more severely hyperglycaemic individuals should receive a sulphonylurea. In moderately hyperglycaemic patients, sulphonylureas should be preferred in nonobese patients while metformin, and probably also thiazolidinediones, should have priority in obese insulin-resistant type 2 diabetic patients. Acarbose is mainly indicated to reduce post-prandial glucose fluctuations and improve glycaemic stability. Each antihyperglycaemic agent may also be combined with insulin therapy to improve glycaemic control and/or reduce the insulin requirement of diabetic patients after secondary failure to oral treatment. Finally, safety should be taken into account in elderly patients and/or those with renal impairment, especially as far as the use of sulphonylureas (higher risk of hypoglycaemia) and metformin (higher risk of lactic acidosis) is concerned. [less ▲]

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See detailThe roles of time of day and sleep quality in modulating glucose regulation: clinical implications.
Scheen, André ULg; Van Cauter, E.

in Hormone Research (1998), 49(3-4), 191-201

Consistent variations in glucose regulation across the 24-hour cycle are present in normal subjects. These diurnal variations are altered in various states of impaired glucose tolerance (aging, obesity ... [more ▼]

Consistent variations in glucose regulation across the 24-hour cycle are present in normal subjects. These diurnal variations are altered in various states of impaired glucose tolerance (aging, obesity, diabetes). Changes in insulin secretion, clearance and/or action across the day have been demonstrated. Studies in subjects receiving continuous intravenous glucose infusion have shown that major alterations of glucose tolerance occur during sleep and that sleep quality markedly influences glucose utilization. Diurnal variations in glucose tolerance result from the alternation of wake and sleep states as well as from intrinsic effects of circadian rhythmicity. The important roles of physiological variations in levels of counterregulatory hormones which are markedly dependent on sleep (i.e. growth hormone) or circadian rhythmicity (i.e. cortisol) have only begun to be appreciated. The modulatory effects of sleep and circadian rhythmicity on glucose regulation may have important clinical implications for the diagnosis and treatment of abnormalities of carbohydrate metabolism. [less ▲]

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See detailAggressive weight reduction treatment in the management of type 2 diabetes.
Scheen, André ULg

in Diabètes & Métabolism (1998), 24(2), 116-23

Most patients with Type 2 diabetes are significantly overweight, and diet-induced weight loss can provide marked improvement in their glycaemic control. As conventional therapy combining diet and exercise ... [more ▼]

Most patients with Type 2 diabetes are significantly overweight, and diet-induced weight loss can provide marked improvement in their glycaemic control. As conventional therapy combining diet and exercise usually has a poor long-term success rate, more aggressive weight reduction programmes have been proposed for the treatment of severely obese diabetic patients, including very-low-calorie diets, anti-obesity drugs and bariatric surgery. Very-low-calorie diets usually have a remarkable short-term effect, and energy restriction and weight reduction are positive factors for the glycaemic control of obese diabetic subjects. However, the long-term efficacy of these methods remains doubtful since weight regain is a common phenomenon. Although anti-obesity (anorectic) drugs may help patients to follow a restricted diet and lose weight, their overall efficacy on body weight and glycaemia is generally modest, and their long-term safety still questionable. Interestingly, serotoninergic anorectic agents have been shown to improve both the insulin sensitivity and glycaemic control of obese diabetic patients independently of weight loss. Bariatric surgery may be helpful in well-selected patients. The correction of weight excess after successful gastroplasty fully reverses the abnormalities of insulin secretion, clearance and action on glucose metabolism present in markedly obese non-diabetic patients, and allows interruption or reduction of insulin therapy and antidiabetic oral agents in most obese diabetic patients. In conclusion, weight loss is a major goal in treating obese patients with Type 2 diabetes, and aggressive weight reduction programmes may be used in selected patients refractory to conventional diet and drug treatment. However, long-term prospective studies are needed for more precise determination of the role of such a strategy in the overall management of obese diabetic patients. [less ▲]

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See detailClinical efficacy of acarbose in diabetes mellitus: a critical review of controlled trials.
Scheen, André ULg

in Diabètes & Métabolism (1998), 24(4), 311-20

Acarbose, an alpha-glucosidase inhibitor, is a new antihyperglycaemic agent which has been proposed as add-on therapy in Type 2 diabetic patients not well-controlled with diet alone, sulphonylurea ... [more ▼]

Acarbose, an alpha-glucosidase inhibitor, is a new antihyperglycaemic agent which has been proposed as add-on therapy in Type 2 diabetic patients not well-controlled with diet alone, sulphonylurea, metformin or insulin, and in Type 1 diabetic patients with large meal-related plasma glucose excursions. Numerous controlled studies investigating the clinical effects of acarbose in Type 2 diabetes versus either placebo or, more rarely, versus a reference drug (sulphonylurea or metformin) have been published during the last 10 years. All placebo-controlled studies have demonstrated the superiority of acarbose, at a dose of 150-600 mg/day, in decreasing fasting and postprandial glucose levels as well as HbA1c concentrations (mean decrease of 0.7%), whether acarbose was given as first-line therapy in diet-treated diabetic patients or in combination in individuals already receiving a sulphonylurea, metformin or insulin. Only a few controlled studies have compared the effects of acarbose with those of either sulphonylurea or metformin, yielding controversial results. In Type 1 diabetic patients, a small reduction of HbA1c levels was also reported after addition of acarbose to insulin therapy, which in some cases allowed a slight reduction of daily insulin needs. All these favourable biological effects occurred without exposing the patient to hypoglycaemia or weight gain. A few studies have also reported favourable effects on postprandial lipid profile and some other vascular risk factors. However, it is not clear whether the extra cost of acarbose, when compared to that of older oral antidiabetic agents, is justified since no study has yet demonstrated its potential benefit on the complications and long-term prognosis of diabetic patients. [less ▲]

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See detailEffects of gastroplasty on body weight and related biological abnormalities in morbid obesity.
Luyckx, Françoise ULg; Scheen, André ULg; Desaive, Claude ULg et al

in Diabètes & Métabolism (1998), 24(4), 355-61

Obesity is a prevalent metabolic disorder associated with high morbidity and mortality rates. Medical treatment rarely succeeds, and bariatric surgery has been proposed as an alternative therapy. The ... [more ▼]

Obesity is a prevalent metabolic disorder associated with high morbidity and mortality rates. Medical treatment rarely succeeds, and bariatric surgery has been proposed as an alternative therapy. The purpose of this non-controlled retrospective study was to evaluate time-course changes in body weight in severely obese patients who underwent vertical ring gastroplasty or adjustable silicone gastric banding, and to assess the prevalence and potential reversibility of several of the biological abnormalities associated with morbid obesity. From an initial cohort comprising 658 patients, regular body weight measurements and biological data were obtained in 505 patients [419 females, 86 males; age 36 +/- 11 years; body mass index 42.7 +/- 6.9 kg/m2; (mean +/- SD)] with a mean follow-up of 26 +/- 14 months. Mean weight loss was 32 +/- 16 kg. Most weight reduction occurred within the first 6 months, followed by near-stabilisation or even slight weight regain. Most biological parameters were obtained before surgery and after at least 6 months of follow-up. The high prevalence and severity of metabolic disturbances associated with the insulin resistance syndrome (hyperglycaemia, hyperinsulinaemia, decreased HDL cholesterol, hypertriglyceridaemia, elevated fibrinogen levels and hyperuricaemia) before gastroplasty were significantly decreased after weight loss. No major biological deficiencies were observed following gastroplasty, except low iron serum levels. It is concluded that marked weight loss associated with gastroplasty involved a remarkable reduction in the prevalence and severity of several biological abnormalities classically considered as cardiovascular risk factors. [less ▲]

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See detailEffects of exercise on neuroendocrine secretions and glucose regulation at different times of day.
Scheen, André ULg; Buxton, O. M.; Jison, M. et al

in American Journal of Physiology (1998), 274(6 Pt 1), 1040-9

To study the effects of time of day on neuroendocrine and metabolic responses to exercise, body temperature, plasma glucose, insulin secretion rates (ISR), and plasma cortisol, growth hormone (GH) and ... [more ▼]

To study the effects of time of day on neuroendocrine and metabolic responses to exercise, body temperature, plasma glucose, insulin secretion rates (ISR), and plasma cortisol, growth hormone (GH) and thyrotropin (TSH) were measured in young men, both at bed rest and during a 3-h exercise period (40-60% maximal O2 uptake). Exercise was performed at three times of day characterized by marked differences in cortisol levels, i.e., early morning (n = 5), afternoon (n = 8), and around midnight (n = 9). The subjects were kept awake and fasted, but they received a constant glucose infusion to avoid hypoglycemia. Exercise-induced elevations of temperature were higher in the early morning than at other times of day. The exercise-induced glucose decrease was approximately 50% greater around midnight, when cortisol was minimal and not stimulated by exercise, than in the afternoon or early morning (P < 0.05). This effect of time of day appeared unrelated to decreases in ISR or increases in temperature and GH. Robust TSH increases occurred in all exercise periods and were maximal at night. The results demonstrate the existence of circadian variations in neuroendocrine and metabolic responses to exercise. [less ▲]

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See detailL'image du mois. Quelle chute!
Scheen, André ULg

in Revue Médicale de Liège (1998), 53(12), 725-6

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See detailL'erytheme necrolytique migrateur.
Dandrifosse, J. F.; Dandrifosse, A. C.; Pierard, Gérald ULg et al

in Revue Médicale de Liège (1998), 53(12), 778-83

Necrolytic migratory erythema (NME) is generally associated with glucagonoma. It waxes and wanes by successive relapses and remissions. The clinical and microscopical diagnosis is complex. In addition to ... [more ▼]

Necrolytic migratory erythema (NME) is generally associated with glucagonoma. It waxes and wanes by successive relapses and remissions. The clinical and microscopical diagnosis is complex. In addition to glucagonoma treatments, the administration of corticoids, aminoacids, zinc or essential fatty acids can be helpful. There exist several etiological hypotheses for NME. These are based on modifications of pancreatic enzyme activities and on variations of aminoacids, fatty acids, zinc or glucagon concentrations. [less ▲]

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See detailPlace de l'acarbose dans le traitement du diabete sucre.
Scheen, André ULg

in Diabètes & Métabolism (1998), 24(4), 385-90

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See detailLa neuropathie diabetique: donnees epidemiologiques et predictives.
Scheen, André ULg

in Diabètes & Métabolism (1998), 24 Suppl 3

Neuropathy is a classical complication of diabetes mellitus, to the same extent as micro- and macroangiopathy. Diabetic neuropathy can be schematically divided into peripheral neuropathy, especially in ... [more ▼]

Neuropathy is a classical complication of diabetes mellitus, to the same extent as micro- and macroangiopathy. Diabetic neuropathy can be schematically divided into peripheral neuropathy, especially in the lower limbs (distal polyneuropathy), and autonomic neuropathy, present in all systems (cardiovascular, gastrointestinal, urogenital and even pulmonary abnormalities). Detection should be based on an oriented anamnesis and a careful physical examination. Complementary exams may be performed in order to confirm the diagnosis and assess the severity of the neuropathy. While the diagnosis of peripheral neuropathy is essentially based on clinical examination, that of autonomic neuropathy has been markedly facilitated by simple standardised tests for early detection of cardiac autonomic neuropathy. Depending on the terminology, the diagnostic criteria and the characteristics of the population, the prevalence of diabetic neuropathy can range from 15 to 100%. However, all studies agree that prevalence is important in both types of diabetes (Type 1 and Type 2), that it increases with age and disease duration, and that it is inversely related to the quality of glycaemic control. Detection of neuropathy is an essential step in the clinical approach to diabetic patients, mainly because of the prognosis linked to such a diagnosis, at both an early and late stage of the disease. Once neuropathy is diagnosed, the physician should provide specific advice to diabetic patients in order to prevent possible dramatic complications. [less ▲]

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See detailPharma-Clinics. Essais cliniques medicamenteux: importance et role du medecin generaliste .
Scheen, André ULg

in Revue Médicale de Liège (1998), 53(1), 17-20

Clinical trials are an essential step in the development of a drug. They must be conducted according to strict rules called "Good Clinical Practice" or GCP. GCP requirements aim to guarantee a perfect ... [more ▼]

Clinical trials are an essential step in the development of a drug. They must be conducted according to strict rules called "Good Clinical Practice" or GCP. GCP requirements aim to guarantee a perfect methodology in the planning, realization and interpretation of clinical trials. The latter can be divided in four phases: phase 1 aiming to demonstrate the safety and to investigate the pharmacokinetics/metabolism of the drug in healthy volunteers; phase 2 aiming to study the intrinsic activity (generally versus a placebo) and safety of the compound in a rather small number of (hospitalized) patients; phase 3 aiming to confirm the comparative efficacy (versus a placebo or a reference drug) and safety of the pharmacological agent in a quite large number of (ambulatory) patients; and phase 4 carried out after commercialization, to verify the clinical utility of the drug in conditions of daily practice. Because he/she occupies a crucial position in the recruitment and follow-up of outpatients, the general practitioner should play a more active role in clinical trials, provided that he/she could work in collaboration with academic centers specialized in clinical pharmacology which can help to perform studies in accordance with GCP requirements. [less ▲]

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See detailLe syndrome X, a la croisee des maladies metaboliques et cardio-vasculaires.
Scheen, André ULg

in Revue Médicale de Liège (1998), 53(1), 29-32

The relationships between metabolic disorders and cardiovascular diseases are very strong. Hypercholesterolaemia and diabetes mellitus, for instance, are well-known risk factors. The multifaceted ... [more ▼]

The relationships between metabolic disorders and cardiovascular diseases are very strong. Hypercholesterolaemia and diabetes mellitus, for instance, are well-known risk factors. The multifaceted metabolic syndrome or syndrome X, originally described by Reaven in 1988, comprises several abnormalities which are associated to insulin resistance and compensatory hyperinsulinaemia. Syndrome X results in an increased vascular risk by at least two mechanisms. On the one hand, it favours atherosclerosis and is associated to angiographic lesions, especially in the coronary arteries. On the other hand, it is associated to endothelial dysfunction which may contribute to myocardial ischaemia even in presence of angiographically normal arteries, a phenomenon named also syndrome X by the cardiologists. Thus, metabolic syndrome X and cardiological syndrome X are very close and syndrome X may be considered as a crossing between metabolic disorders and cardiovascular diseases. [less ▲]

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See detailPharma-Clinics. Le medicament du mois. La ranitidine bismuth citrate (Pylorid).
Scheen, André ULg

in Revue Médicale de Liège (1998), 53(1), 41-4

Ranitidine bismuth citrate (Pylorid, Glaxo-Wellcome) is a novel salt of ranitidine which provides a unique combination of properties: inhibition of secretion of gastric acid by competitive antagonism of ... [more ▼]

Ranitidine bismuth citrate (Pylorid, Glaxo-Wellcome) is a novel salt of ranitidine which provides a unique combination of properties: inhibition of secretion of gastric acid by competitive antagonism of the action of histamine at the histamine H2-receptor on the gastric parietal cell, mucosal protective effects and anti-Helicobacter pylori action. Ranitidine bismuth citrate provides effective healing and symptom relief, both in duodenal ulcer disease and in gastric ulcer disease. When coprescribed with certain antibiotics (clarithromycin alone or combined with amoxicillin or nitro-imidazole), it heals ulcers, eradicates Helicobacter pylori and prevents recurrence of the disease. Several clinical studies demonstrated that ranitidine bismuth citrate is well-tolerated and has quite similar efficacy as proton pump inhibitors. [less ▲]

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See detailPharma-clinics. Le medicament du mois. L'atorvastatine (Lipitor).
Scheen, André ULg

in Revue Médicale de Liège (1998), 53(6), 374-7

Atorvastatin, commercialized by the pharmaceutical companies Parke-Davis and Pfizer under the trade name Lipitor, is a new statin acting as a potent hypolipidaemic drug. By inhibiting HMG-CoA reductase ... [more ▼]

Atorvastatin, commercialized by the pharmaceutical companies Parke-Davis and Pfizer under the trade name Lipitor, is a new statin acting as a potent hypolipidaemic drug. By inhibiting HMG-CoA reductase, the key-enzyme of cellular synthesis of cholesterol, it increases the expression of LDL receptors and promotes the hepatic extraction of circulating LDL. It has a more potent action than other available statins, both on LDL cholesterol and triglyceride levels. Atorvastatin is indicated, after diet failure, in the treatment of primary hypercholesterolaemia or combined hyperlipidaemia. Lipitor is available as tablets of 10 and 20 mg. The usual doses is 10 mg once a day, to be increased up to 20 mg/day if necessary. In rare severe cases, the doses may be increased up to 80 mg/day. [less ▲]

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