Treating Mixed Hyperlipidemia and the Atherogenic Lipid Phenotype for Prevention of Cardiovascular Events (original) (raw)
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The American Journal of Cardiology, 2002
Achieving recommended cholesterol and triglyceride targets for the prevention of cardiovascular events is difficult and frequently requires the use of >1 lipidlowering medication. This study evaluated the tolerability and effectiveness of combination regimens in highrisk dyslipidemic patients resistant to monotherapy. A retrospective chart review of all patients referred to a cardiovascular risk reduction clinic over a 7.5-year period identified 136 patients who received combination therapy with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) plus fibrate (n ؍ 106) or a statin plus niacin (n ؍ 30) regimen. During follow-up (mean 18.5 months), 28 patients (20.6%) discontinued combination therapy: 11 (8.1%) experienced myalgia with or without elevated creatine kinase, 3 had gastrointestinal upset, and 1 had asymptomatic creatine kinase elevation. No patient had combination therapy discontinued due to elevated liver enzymes. Medications were stopped in 8 patients for reasons other than reported adverse effects or biochemical abnormalities, and 5 patients were switched to alternate monotherapy. Mean percent change from baseline to treatment with combination therapy for total cholesterol (؊35%), lowdensity lipoprotein cholesterol (-37%), high-density lipoprotein cholesterol (؉23%), triglycerides (؊62%), and total cholesterol/high-density lipoprotein cholesterol ratio (؊41%) were all statistically significant (p <0.01). These results demonstrate that combination statin-fibrate and statin-niacin regimens are safe and effective in managing dyslipidemias in most patients at risk for cardiovascular events who are inadequately treated with one of these agents alone. ᮊ2002 by Excerpta Medica, Inc.
Use of Niacin, Statins, and Resins in Patients With Combined Hyperlipidemia
The American Journal of Cardiology, 1998
Patients in the original Familial Atherosclerosis Treatment Study (FATS) cohort were subgrouped into those with triglyceride levels <120 mg/dL (n ؍ 26) and those with triglyceride levels >190 mg/dL (n ؍ 40). Their therapeutic responses to niacin plus colestipol, lovastatin plus colestipol, colestipol alone, or placebo were determined. Therapeutic response was also determined in the same 2 triglyceride subgroups (n ؍ 12 and n ؍ 27, respectively) of patients selected for low levels of highdensity lipoprotein (HDL) cholesterol and coronary artery disease. These triglyceride criteria were chosen to identify patient subgroups with high likelihood of "pattern A" (normal-size low-density lipoprotein [LDL] particles and triglyceride <120 mg/dL) or "pattern B" (small dense LDL and triglyceride >190 mg/dL). Our findings in these small patient subgroups are consistent with the emerging understanding that coronary artery disease patients presenting with high triglyceride levels have lower HDL-C, smaller less buoyant LDL-C, and greater very low-density lipoprotein (VLDL) cholesterol and VLDL apolipoprotein B, and are more responsive to therapy as assessed by an increase in HDL-C and reduction in triglycerides, VLDL-C, and VLDL apolipoprotein B. In the FATS high-triglyceride subgroup with these characteristics, a tendency toward greater therapeutic improvement in coronary stenosis severity was observed among those treated with either of the 2 forms of intensive cholesterol-lowering therapy. This improvement is associated with therapeutic reduction of LDL-C and elevation of HDL-C, but also appears to be associated with druginduced improvement in LDL buoyancy. ᮊ1998 by Excerpta Medica, Inc.
Statins: The Backbone of Treatment of Dyslipidemia
American Journal of Internal Medicine, 2021
Statins are a panacea for secondary prevention of atherosclerotic cardiovascular disease and primary prevention in high-risk individuals. They are very well tolerated and side effects like muscle toxicity and increased risk of new onset of diabetes are seen in a minority of cases. They are also recommended in diabetic patient because the benefit is many times more than the risk of diabetes. Statins reduce total cholesterol, LDL cholesterol, Apo B, non-HDL cholesterol, and triglycerides, and also increase high-density lipoprotein (HDL) cholesterol levels in most patients with hypercholesterolemia and combined hyperlipidemia. Statins are not indicated in individuals with Frederickson Class I and V hyperlipidemias. Extensive literature supports use of statins in coronary heart disease (CHD) patients for treatment of dyslipidemia and secondary prevention. It has also been recognized that in secondary prevention and ACS populations lower LDL may be better. Trials have compared moderate w...
International Journal of Cardiology, 2008
Combined hyperlipidemia results from overproduction of hepatically synthesized apolipoprotein B in very low-density lipoproteins in association with reduced lipoprotein lipase activity. Thus, this condition is typically characterized by concurrent elevations in total cholesterol and triglycerides with decreased high-density lipoprotein cholesterol. High levels of apolipoprotein B-containing lipoproteins, most prominently carried by low-density lipoprotein (LDL) particles, are an important risk factor for coronary heart disease. Statin therapy is highly effective at lowering LDL cholesterol. Despite the benefits of statin treatment for lowering total and LDL cholesterol, many statin-treated patients still have initial or recurrent coronary heart disease events. In this regard, combined therapy with statins and fibrates is more effective in controlling atherogenic dyslipidemia in patients with combined hyperlipidemia than either drug alone. Furthermore, statins and fibrates activate PPARα in a synergistic manner providing a molecular rationale for combination treatment in coronary heart disease. Endothelial dysfunction associated with cardiovascular diseases may contribute to insulin resistance so that there may also be additional beneficial metabolic effects of combined statin/fibrates therapy. However, there has been little published evidence that combined therapy is synergistic or even better than monotherapy alone in clinical studies. Therefore, there is a great need to study the effects of combination therapy in patients. When statins are combined with gemfibrozil therapy, this is more likely to be accompanied by myopathy. However, this limitation is not observed when fenofibrate, bezafibrate, or ciprofibrate are used in combination therapy.
Combined therapy in the treatment of dyslipidemia
Fundamental & Clinical Pharmacology, 2010
Dyslipidemia is undoubtedly the most important modifiable risk factor for cardiovascular diseases (CVD), particularly for coronary heart disease (CHD) [1]. The link between lowering high total and especially LDL-cholesterol and therefore reduction of CVD risk is today established as is 'the lower-the better' paradigm in hypercholesterolemia management. Statin treatment is the cornerstone of dyslipidemia management and statins are nowadays generally accepted as the golden standard for hypercholesterolemia treatment and thus CVD prevention. However, despite clear clinical evidence of the benefits of LDL-cholesterol lowering, particularly in secondary prevention, many high-risk patients do not reach LDLcholesterol goals as defined in guidelines [2]. Recent data indicate that, for example, a large majority of coronary patients with dyslipidemia is still inadequately treated and on average half of them do not reach the recommended LDL-cholesterol levels [3,4]. This is happening although the lipid control is much better than some years ago and the use of lipid-lowering therapy, particularly statins, over the past decade in this type of patients in Europe has significantly increased from 32.3% to 88.8% [5]. Without any doubt, one of the reasons for this is hesitation of their physicians to increase the dose of statins, mainly because they are afraid of adverse effects of high doses of statins, especially muscle toxicity, including myopathy and rhabdomyolysis. Indeed, the reported incidence of adverse effects of statins increases with increasing doses but it has to be stressed also that doubling the doze of a statin causes only about 6% additional decrease of LDL-cholesterol. Therefore, often just increasing the dose does not solve the problem. Although few, there are also patients who are statin intolerant or are not able to tolerate higher statin doses. In spite of the fact that quite a number of patients, as data show, need more intensive LDL-lowering treatment
HDL-C and triglyceride levels: relationship to coronary heart disease and treatment with statins
Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy, 2003
The association between low-density lipoprotein cholesterol (LDL-C) levels and risk of coronary heart disease (CHD) is well established and LDL-C-lowering is currently the primary target for the treatment of dyslipidemia. However, low levels of high-density lipoprotein cholesterol (HDL-C), and high levels of triglycerides (TG) are also risk factors for CHD and modifying levels of these lipid subfractions, in addition to LDL-C lowering, may have clinical benefits in many patients. Statins are the first-line drug therapy for the treatment of dyslipidemia because of their efficacy in lowering LDL-C and good tolerability. Statins also have beneficial effects on TG and HDL-C levels although they differ in the degree to which they modify the levels of these lipoproteins. Improvements across the atherogenic components of the lipid profile may be optimized by the co-administration of a statin with a fibrate, niacin or omega-3 fatty acids; however, particular combination therapies have been ...
Journal of Evolution of medical and Dental Sciences, 2014
Dyslipidemia is one of the leading causes of various cardiovascular and central nervous system disorders. Death from cardio-vascular disorders accounted for 36.3% of the 2.4 million deaths world-wide. Recognition that dyslipidemia is a risk factor has led to the development of drugs that modify cholesterol level. The intensity of therapy should be sufficient to achieve 30-40% reduction in LDL - C without side effects and low cost. The prescription order is an important therapeutic transaction between the prescriber and the patient. It has been well accepted that inadequate and irrational prescriptions could lead to serious consequences. The study was carried out by observing and analyzing data of 100 consecutive patients admitted in ICU and receiving lipid lowering agents for a period of eighteen months. From the study it is found that statins are the cornerstone of pharmacotherapy of dyslipidemias. At the same time the importance of dietary manipulations can't be ignored in man...
Statin and fibrate treatment of combined hyperlipidemia: the effects on some novel risk factors
Thrombosis and Haemostasis, 2004
Conventional risk factors such as hyperlipidemia, hypertension, and cigarette smoking do not account for all cases of cardiovascular diseases (1). Novel coronary artery disease risk factors, including homocysteine (2, 3), inflammatory (4-7) and haemostatic proteins (6) have been found to be independent predictors of future coronary artery events in apparently healthy males as well as in patients with coronary artery disease.