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Articles by M. L Bots
Total Records ( 2 ) for M. L Bots
  M Vergeer , R Zhou , M. L Bots , R Duivenvoorden , J Koglin , F Akdim , Y. B Mitchel , R Huijgen , A Sapre , E de Groot , E. J. G Sijbrands , R. C Pasternak , C Gagne , A. D Marais , C. M Ballantyne , J. L Isaacsohn , A. F Stalenhoef and J. J. P. Kastelein
  Background—

Until recently, patients with heterozygous familial hypercholesterolemia (HeFH) were considered the best subjects for the assessment of changes in carotid intima-media thickness (cIMT) in randomized intervention trials. Our aims were to investigate whether contemporary statin-treated HeFH patients still show accelerated cIMT increase and to assess the impact of statin treatment, before and after random assignment, on atherosclerosis progression.

Methods and Results—

We retrospectively evaluated cIMT change, and prior statin treatment and postbaseline LDL-C change as predictors of cIMT change, in 1513 HeFH patients who were randomly assigned to the statin arms of the early ASAP and more recent RADIANCE 1, CAPTIVATE, and ENHANCE studies. In the 3 recent studies combined, mean cIMT increased at only 33%of the rate of the simvastatin-treated patients in the ASAP study (0.014 mm/2 years [95% confidence interval, –0.0003–0.028] versus 0.041 mm/2 years [95% confidence interval, 0.020–0.061]; P<0.05). Patients whose statin therapy could be intensified, as evidenced by an LDL-C decrease after the initiation of on-trial statin therapy, showed cIMT decrease in the first 6 to 12 months and a much lower cIMT increase measured over the full 2 years. In line with this, previously statin-naive HeFH patients showed a lower overall cIMT increase.

Conclusions—

Over the years, intensification of statin therapy in HeFH patients has resulted in an impressive decrease in carotid atherosclerosis progression. In studies that assess other antiatherosclerotic modalities, statin therapy may still induce rapid changes in cIMT. For future cIMT studies, our analyses suggest that patient populations other than intensively pretreated HeFH patients should be selected and that the statin regimen should not be changed on study initiation.

  E. L Penne , N. C van der Weerd , P. J Blankestijn , M. A van den Dorpel , M. P.C Grooteman , M. J Nube , P. M ter Wee , R Levesque , M. L Bots and on behalf of the CONTRAST investigators
 

Background and objectives: Removal of β2-microglobulin (β2M) can be increased by adding convective transport to hemodialysis (HD). The aim of this study was to investigate the change in β2M levels after 6-mo treatment with hemodiafiltration (HDF) and to evaluate the role of residual kidney function (RKF) and the amount of convective volume with this change.

Design, setting, participants, & measurements: Predialysis serum β2M levels were evaluated in 230 patients with and 176 patients without RKF from the CONvective TRAnsport STudy (CONTRAST) at baseline and 6 mo after randomization for online HDF or low-flux HD. In HDF patients, potential determinants of change in β2M were analyzed using multivariable linear regression models.

Results: Mean serum β2M levels decreased from 29.5 ± 0.8 (±SEM) at baseline to 24.3 ± 0.6 mg/L after 6 mo in HDF patients and increased from 31.9 ± 0.9 to 34.4 ± 1.0 mg/L in HD patients, with the difference of change between treatment groups being statistically significant (regression coefficient –7.7 mg/L, 95% confidence interval –9.5 to –5.6, P < 0.001). This difference was more pronounced in patients without RKF as compared with patients with RKF. In HDF patients, β2M levels remained unchanged in patients with GFR >4.2 ml/min/1.73 m2. The β2M decrease was not related to convective volume.

Conclusions: This study demonstrated effective lowering of β2M levels by HDF, especially in patients without RKF. The role of the amount of convective volume on β2M decrease appears limited, possibly because of resistance to β2M transfer between body compartments.

 
 
 
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