An Evaluation of Lipex as a Health Intervention for Decreasing Mortality in Patients with Cardiovascular Disease


 


Introduction


            Cardiovascular disease (CVD) is one of the leading causes of death among the peoples in New Zealand. The pathology of this disease is important to take note off, as further understanding would provide medical professionals and citizens alike to increase awareness and prevention as well. It has been reported that of the cardiovascular diseases, coronary artery disease is the major cause of death, followed by stroke, which is the greatest cause of disability in older people, and accounts for 33% of life years lost between 45 and 64 years of age (2005). In addition, cardiovascular disease is the leading cause of death, with 40% of incidence among the population in New Zealand, and with more than twice as high in men as in women (2004). Risk factors or causes of such an increase rate of cardiovascular diseases include the significant changes in the diet and lifestyle of many individuals in New Zealand, brought about by industrialization, urbanization, development in the economy and society, and globalization of the food market. Such changes in diet and lifestyle result to decrease in physical activity, intake of nutrient-poor food, and increase incidence of smoking, taking alcohol and other substances, resulting to obesity, increased blood sugar levels and blood pressure.


            Given this problem at hand, this assignment will discuss the pathophysiology of cardiovascular disease. In addition, three studies will be presented, which would provide evidence for the use of Lipex, as an effective health intervention in reducing major heart complications and total mortality. The summary and findings from these three studies will be reviewed in the context of the New Zealand population.


 


General Pathophysiology of Cardiovascular Disease


            It has been reported that research on cardiovascular diseases is one of the most developed areas of inquiry in the study of behavioral influences on health (1983). In this regard, to be able to further understand the use of Liptex as a health intervention for CVD, its pathology and physiology must first be understood. Cardiovascular Disease or CVD encompasses a number of dysfunctional conditions of the heart, arteries, and veins, which are responsible for supplying oxygen to the vital organs and systems in the body. Some diseases associated with cardiovascular diseases include atherosclerosis, congenital heart disease, coronary heart disease, hypertensive heart failures, inflammatory heart diseases, and valvular cardiomyopathy. Such diseases of the heart are mainly caused by plaque or fat build up in the blood vessels, which obstructs the flow of blood to all parts of the body. Obstruction of the flow of the blood in the blood vessels leads the heart to pump more blood, causing stress and excessive effort.


            The occurrence of cardiovascular diseases is predominantly caused by the excessive build-up of fats or plaque in the blood vessels.  (2004) reports the significant link between lipids and cardiovascular disease, such as coronary heart disease. This particular study suggests that the significant increase in the density of lipoprotein cholesterol (LDL-C) levels increases the risk of major coronary events. Total blood cholesterol above 200 mg/dl, LDL cholesterol above 130 mg/dl, HDL cholesterol below 35 mg/dl, and lipoprotein(a) level greater than 30 mg/dl are indicators of problematic cholesterol (2007). In this regard, it is best to take note of blood cholesterol levels in order to reduce the risks for cardiovascular diseases.  


            Aside from high cholesterol levels, there are other risk factors or causes of cardiovascular diseases, which must be taken note off, in order to increase prevention and awareness. Some of the uncontrollable risk factors include heredity, age, and sex. Some have higher risks of acquiring cardiovascular diseases than others due to the high tendency of inheriting it. In this regard, prevention and awareness for such individuals must be more efficient. Another uncontrollable risk factor is age, as the older a person gets, the more he or she is susceptible to cardiovascular disease. This is because due to aging, blood vessels tend to be more damaged and brittle. The third uncontrollable risk factor is sex. Men are more likely to acquire cardiovascular diseases than women are in general. This is maybe due to the collective risk factors, from which men are more susceptible. On the other hand, Controllable risks factors include obesity, diabetes, sedentary lifestyle, smoking, and stress. Diabetes is a disorder associated with the excess of glucose or blood sugar levels in the body. Diabetes is one risk factor of cardiovascular disease because the high levels of sugar in the blood catalyze the build-up of cholesterol in the blood vessels. The build-up of sugar and cholesterol in the body is caused by obesity and sedentary lifestyles, which means that an individual lacks the opportunity to do vigorous exercises, which would reduce cholesterol and sugar levels in the blood. Smoking and stress are also risk factors of cardiovascular diseases, as nicotine in cigarettes and tobaccos contribute to the narrowing of blood vessels, while stress increases heart rate and blood pressure levels. From this, it can be perceived that the continuously changing environment contributes significantly to the exposure of individuals to such risk factors.


 


Lipex and Its Action against Cardiovascular Diseases


            It was emphasized in the previous discussion that one of the major causes of cardiovascular diseases is the build-up of plaque due to the increase in cholesterol in the body. In this regard, one of the perceived solutions to reduce the risk of cardiovascular diseases is to provide a health intervention that would reduce cholesterol levels. As such, using Lipex as a health intervention and as a form of treatment would be essential and significant in addressing cardiovascular diseases. LIPEX, or also known as simvastatin or MSD is a lipid-lowering agent derived synthetically from a fermentation product of Aspergillus terreus. After taking it, Lipex, an inactive lactone, is hydrolyzed to its corresponding beta-hydroxyacid form, which is a principal metabolite and inhibitor of HMG-CoA reductase, the enzyme that catalyzes an early and rate-limiting step in the biosynthesis of cholesterol. Several studies have shown that Lipex is highly effective in reducing LDL-C or very low-density lipoprotein cholesterol, and in increasing HDL-C or the good cholesterol. Marked responses are seen within 2 weeks, and maximum therapeutic responses occurring within 4-6 weeks, being maintained during continuation of therapy. When therapy with Lipex is stopped, cholesterol and lipids return to pre-treatment levels. The use of Lipex is perceived to reduce the risk of total mortality by reducing CHD deaths, reduce the risk of major vascular events, reduce the risk of major coronary and non-coronary events, reduce the risk of stroke, and reduce the risk of hospitalization for angina pectoris. These perceived effects have been proven in some studies, as administering Lipex reduced the risk of death by 30%, reduced the risk of CHD death by 42%, and of having a hospital-verified non-fatal myocardial infarction by 37%. In addition, administering Lipex reduced the risk for undergoing myocardial revascularization processes, including coronary artery bypass and angioplasty by 37%, and in diabetic patients, the risk of a major coronary event was reduced by 55% (2006). The good thing about using Lipex is that it is safe to all individuals, regardless of age or gender. In patients 10-17 years old, there were no detectable effects on growth or sexual maturation in the adolescent boys or girls, or any effect on menstrual cycle length in girls. In patients over 65 years old, there is no apparent increase in the frequency of clinical or laboratory adverse findings. Lipex is also presumed to be safe and unlikely to produce an effect on the ability to drive or use machinery. However, safety of usage of Lipex has not yet been established (2006).


            From this discussion, it can be perceived that the biological action of Lipex or simvastatin focuses or targets the reduction of levels of bad cholesterol and the increase of levels of good cholesterol. In this regard, it can be understood that the use of Lipex as a health intervention in combating cardiovascular diseases is an effective means of prolonging and preserving the lives of many individuals. However, it must be taken note of that therapy using Lipex should be supervised by a medical professional to ensure appropriate results and dosages.


 


Supporting Lipex through Key Studies


            It has been emphasized in the theory of epidemiological transition that the association between modernization and mortality is due to deaths caused by infectious diseases. However, this is not the case in the population of New Zealand, for although infectious diseases account for deaths, most New Zealanders dies of chronic diseases. Chronic disease mortality is dominated by cardiovascular diseases, including ischemic heart disease and stroke, and cancers, accounting for 40% and 27% of total mortality in 1996 (1999). In this regard, the implementation and the use of Lipex as a health intervention for the increasing incidence of cardiovascular disease would be valuable and significant. To be able to determine the claimed success of Lipex, three relevant studies would be discussed, with an emphasis on the mortality and social situation of New Zealand. In addition, certain issues on the use of Lipex in New Zealand would also be provided.


            All three articles discuss the use and administration of Liptex as a health intervention for cardiovascular diseases. All three articles have emphasized that cardiovascular diseases, including stroke, ischemic heart disease, and other heart diseases account for the increase in mortality among New Zealanders. In addition, all articles state and emphasize the significant reduction of LDL-C levels in all the participants of studies, based on the prescribed dosages of medical professionals and based on clinical trials. In one of the articles being referred to, it has been reported that a meta-analysis of 90,056 participants in 14 randomized statin trials in New Zealand has shown that statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularization, and stroke by about 20% for each 1 mmol/L reduction in LDL cholesterol achieved (2006).


Another article used in this assignment also emphasized on the results of a specific meta-analysis, which involves the examination of the effectiveness of statin therapy in adults with coronary heart disease. In this particular meta-analysis of studies, it has been indicated that use of statins at doses equivalent to 40mg simvastatin lowers overall mortality by 16%, cardiovascular mortality by 23%, and coronary heart disease mortality by 25%, and such benefits were seen within 2 years of starting statin therapy (S2005). The third article shows a diagram, indicating the significant decrease in LDL-C with the use of simvastatin. It has been explained in a specific meta-analysis that all randomized trials of statins shows that beneficial effects on cardiovascular diseases are all explained by the extent of their efficacy in lowering cholesterol levels ( 2004). The diagram showing such an observation is illustrated below:


 


Diagram showing lowered cholesterol levels due to simvastatin.


 


            From such analysis and presentation of findings, it can be perceived that the use of statins, including Lipex or simvastatins serves to be a useful health intervention for cardiovascular diseases. It effectively targets the primary cause of such diseases, which is the build-up of fats and plaques in the blood vessels of the individual. In this regard, the use of simvastatins, such as Lipex must be introduced and supported in the medical profession to be able to provide direct intervention, convenience and treatment to all individuals with higher risks of having cardiovascular diseases, most especially in New Zealand.


            However, despite the perceived advantages of employing the use of simvastatins, such as Lipex in the society of New Zealand based on the increased risk of CVD and mortality rates, a number of issues and problems are being encountered, which serves to be the hindrance to its use. Primarily, the increase in the cardiovascular diseases in New Zealand was worsened due to the country’s poor access to statins. This was in turn worsened, as the country needs additional resources for financial support on obtaining statins. In this regard, New Zealand supported the weakest statin available, namely, fluvastatin, which has no proven positive effects, proven mortality or patient outcome benefit ( 2006). In this regard, the availability of health interventions that would help the decrease of cardiovascular diseases were not provided to the citizens of New Zealand, thus, contributing to the increase of CVD incidence among the population. In addition, consultation from doctors and other medical professionals are too expensive for many New Zealanders, thus, hindering many citizens to deal with diseases with their own means. Worse, their cardiovascular conditions are being worsened due to the lack of medications, and health and medical interventions. Such problems are being augmented also with the poor lifestyles of many New Zealanders. The aging population and the changes in the way of life of many individuals are worsening their cardiovascular problems and conditions. The changes in terms of the occupations and nutrition of New Zealanders have contributed to the increasing prevalence of obesity and diabetes in the population, thus, also contributing to the increasing incidences of cardiovascular diseases. As such, the last problem in terms of the access of the citizens with statins, such as Lipex must be increased in order to provide convenience and treatment to many. This led to the proposal that statins must be made available over-the-counter to increase availability to consumers. In this regard, more individuals having an increased risk for acquiring cardiovascular diseases can have easy access to medications, even without the prescriptions of a medical professional.


 


Conclusion


            In the point of view of a person with lesser risk to acquire cardiovascular diseases, it can be perceived that the motive and intention for making statins more highly available to consumers is one good way of reducing the risks and the incidences for cardiovascular diseases in New Zealand. However, it must be realized that over-dosages and inappropriate use and intake of such drugs may present adverse effects and complications on the part of the user. In this regard, the use and intake of such drugs without the prescription or guidance of a physician or medical professional may present unwanted side effects and other diseases on the patient. Instead of making the lives of the patient easier and more convenient, the over-dosage of the drug may lead the patient to undergo more complicated and tedious medical processes for further examination and diagnosis. As such, what can be done in order to provide understanding of the drug, of the disease, and of the situation be through provision of effective and proper education and communication with the patients and all those who have increased risks for having cardiovascular diseases. In this regard, the society would have the opportunity to obtain relevant and appropriate information about Lipex and other statins that may provide them with good health. In addition, this can be taken as a good opportunity for the government to dissipate the information of the need for New Zealanders to engage in diet and exercise in order to live effectively and healthily in the society. 


     


           


 



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