Abstract P195: Combination Therapy not the Intensity of Statin Therapy Improves LDL Goal Attainment in Clinical Practice

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Brett Victor ◽  
Lilian Ahedor ◽  
Longjian Liu ◽  
Dean G Karalis
Keyword(s):  
Clinical Practice ◽  
Combination Therapy ◽  
Statin Therapy ◽  
Goal Attainment ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
High Potency ◽  
Lipid Lowering Drug ◽  
Lowering Drug ◽  
The Impact

Background: In clinical practice most coronary heart disease (CHD) patients (pts) are not achieving their recommend LDL goal of < 70 mg/dL. We assessed the impact of statin dose and combination therapy in achieving optimal LDL levels in CHD pts. Methods: We conducted a retrospective analysis of outpatient electronic health records (EHR) from a large cardiology practice from September 2008 to September 2009. The most recent lipid profile, lipid-lowering medications and doses were extracted from the EHR. Statin potency was assessed based on the brand and dose of statin. Results: We identified 9,950 CHD pts; 59% were on a statin alone (SA), 27% on a statin + another lipid-lowering drug, 4% on no statin but on another lipid-lowering drug and 10% were on no lipid-lowering drugs. Only 37% of SA pts achieved an LDL < 70 mg/dL, but did so more often than pts on no statin but on another lipid-lowering drug (37 vs. 18%; p < 0.0001). Among SA pts, 70% were on moderate to high potency statins. The intensity of statin therapy did not improve LDL goal attainment. Among pts on combination therapy, 41% on statin + ezetimibe (S+E) and 46% on statin + niacin (S+N) achieved an LDL < 70 mg/dL (p = 0.01 and < 0.0001 vs. SA). Only 14% of pts were on S+E and 9% on S+N. Statin plus fibrate did not improve LDL goal attainment compared to SA (35 vs. 37%; p = 0.23). Few pts were taking bile acid sequestrants (< 0.5%). If pts were switched to a high potency statin LDL goal attainment of < 70 mg/dL would increase to 46% and would increase further to 65% with combination therapy. Conclusions: Most CHD pts in clinical practice do not attain an LDL < 70 mg/dL, even among pts on high potency statins. The number of CHD pts on no statin is high. The combination of statin plus either ezetimibe or niacin is the most effective regimen to achieve an LDL < 70 mg/dL; however these drug combinations are used infrequently in clinical practice. Combination lipid-lowering therapy is needed to improve LDL goal attainment in CHD pts.

scholarly journals Use of Lipid-Lowering Medications and the Likelihood of Achieving Optimal LDL-Cholesterol Goals in Coronary Artery Disease Patients

Cholesterol ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Dean G. Karalis ◽  
Brett Victor ◽  
Lilian Ahedor ◽  
Longjian Liu
Keyword(s):  
Coronary Artery Disease ◽  
Clinical Practice ◽  
Coronary Artery ◽  
Combination Therapy ◽  
Goal Attainment ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
High Potency ◽  
Cholesterol Goal ◽  
Artery Disease

Background. In clinical practice, most coronary artery disease patients are not achieving their recommend LDL-cholesterol goal of <70 mg/dL. Methods. We conducted a retrospective analysis of outpatient electronic health records and the most recent lipid profile, lipid-lowering medications and doses were collected. Results. We identified 9950 coronary artery disease patients. Only 37% on a statin alone achieved an LDL-cholesterol of <70 mg/dL, and most were on moderate-to-high-potency statins. The intensity of statin therapy did not improve LDL-cholesterol goal attainment. Among patients on combination therapy, 41% on statin plus ezetimibe and 46% on statin plus niacin achieved an LDL-cholesterol of <70 mg/dL ( and <0.0001 versus statin alone). If patients were switched to a high-potency statin LDL-cholesterol goal attainment of <70 mg/dL would increase to 46% and would increase up to 72% with combination therapy. Conclusions. Most coronary artery disease patients in clinical practice do not attain an LDL-cholesterol of <70 mg/dL, even among patients on high potency statins. The combination of statin plus either ezetimibe or niacin is the most effective regimen to achieve an LDL-cholesterol of <70 mg/dL, however, these drug combinations are used infrequently in clinical practice.

The role of bempedoic acid in the management of dyslipidaemia

2021 ◽  
Vol 3 (12) ◽  
pp. 484-488
Author(s):  
Beverley Bostock
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Technology Appraisal ◽  
The United Kingdom ◽  
Lipid Lowering Drug ◽  
Lowering Therapy ◽  
Lowering Drug

Bempedoic acid is a new oral lipid-lowering therapy which has been licenced for use in the United Kingdom. It can be used alone, with a statin, or with other lipid-lowering therapies where the target level for low density lipoprotein has not been achieved with these therapies alone. Bempedoic acid with ezetimibe can be prescribed for people who are unable to tolerate statins. This combination has received NICE approval following a technology appraisal. This paper discusses the place for of bempedoic acid as a lipid lowering drug and consider the mode of action, licensed indications, adverse drug reactions and the NICE technology appraisal recommendations.

Effect of Lipid-Lowering Drug Therapy on Small-Dense Low-Density Lipoprotein

2005 ◽  
Vol 39 (3) ◽  
pp. 523-526 ◽  
Author(s):  
James M Backes ◽  
Cheryl A Gibson
Keyword(s):  
Drug Therapy ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Search Terms ◽  
Lipid Lowering Drug ◽  
Mixed Dyslipidemia ◽  
Lowering Drug

OBJECTIVE: To review the effects of lipid-lowering therapy on small-dense low-density lipoprotein cholesterol (sdLDL-C). DATA SOURCES: Literature was obtained from MEDLINE (1989–September 2004) and references of selected articles. Key search terms included small-dense LDL-C and lipid-lowering drug therapy. DATA SYNTHESIS: Statins, fibrates, and niacin have demonstrated favorable effects on sdLDL-C, especially among patients with mixed dyslipidemia or hypertriglyceridemia. These effects include a reduction of sdLDL-C and/or a shift to the larger, less atherogenic LDL-C. CONCLUSIONS: Data suggest that statins, fibrates, and niacin are effective at reducing concentrations of sdLDL-C and possibly normalizing LDL-C subclasses.

Umbrella Review on Non-Statin Lipid-Lowering Therapy

2021 ◽  
pp. 107424842110029
Author(s):  
Semira Abdi Beshir ◽  
Nadia Hussain ◽  
Asim Ahmed Elnor ◽  
Amira S. A. Said
Keyword(s):  
Unmet Need ◽  
Lipid Lowering ◽  
Current Evidence ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Icosapent Ethyl ◽  
Lipid Lowering Drug ◽  
Increased Risk ◽  
Lowering Drug

Dyslipidemia, particularly increased low-density lipoprotein cholesterol (LDL-C) levels, are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) events. There is an unmet need for ASCVD risk reduction even with the optimal use of statin therapy, which has led to an ongoing search for novel targets for cholesterol reduction to decrease ASCVD events. Objectives: The main aim of this review was to summarize current evidence on approved and emerging non-statin lipid-lowering therapies. Methods and Materials: Recent literature on U.S. FDA approved non-statin lipid-lowering therapies and evolving lipid-lowering drugs currently under development was reviewed. Results and Discussion: In the past 20 years, the emergence of non-statin cholesterol-lowering drugs has changed the landscape of dyslipidemia management. Food and Drug Administration approval of non-statin lipid-lowering therapies such as ezetimibe, proprotein convertase subtilisin/Kexin type 9 (PCSK9) inhibitors (evolocumab, alirocumab), bempedoic acid and combination of bempedoic acid and ezetimibe, evinacumab and other triglyceride-lowering agents (eg, icosapent ethyl) has emerged. The European Commission has also recently approved inclisiran for treatment of hypercholesterolemia and mixed hypercholesterolemia even though FDA has put the approval of this drug on hold. Recent guidelines have incorporated PCSK9 inhibitors to treat patients with primary hyperlipidemia and patients with very high-risk ASCVD, who could not achieve adequate lipid-lowering with combination therapy of maximally tolerated statin and ezetimibe. Icosapent ethyl use as an adjunct therapy to statins is also recommended to reduce the risk of ASCVD in patients with hypertriglyceridemia. Conclusion: Despite cost limitations, the uptake of PCSK9 inhibitors is increasing. Approval of bempedoic acid alone or in combination with ezetimibe has provided additional oral lipid-lowering drug alternatives to ezetimibe. Various lipid-lowering drug targets are under investigation.

scholarly journals Lipid-Lowering Drug Therapy: Critical Approach for Implementation in Clinical Practice

2021 ◽  
Author(s):  
Maddalena Rossi ◽  
Enrico Fabris ◽  
Davide Barbisan ◽  
Laura Massa ◽  
Gianfranco Sinagra
Keyword(s):  
Clinical Practice ◽  
Drug Therapy ◽  
Lipid Lowering ◽  
Critical Approach ◽  
Lipid Lowering Drug ◽  
Lowering Drug

Effect of evolocumab on acute arterial events across all vascular territories : results from the FOURIER trial

2021 ◽  
Author(s):  
Kazuma Oyama ◽  
Robert P Giugliano ◽  
Minao Tang ◽  
Marc P Bonaca ◽  
Jeffrey L Saver ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Limb Ischaemia ◽  
Lipid Lowering Therapy ◽  
Peripheral Vascular ◽  
Pcsk9 Inhibitor ◽  
Acute Limb Ischaemia ◽  
The Impact ◽  
Over Time

Abstract Aims We assessed the impact of the proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitor evolocumab on acute arterial events across all vascular territories, including coronary, cerebrovascular, and peripheral vascular beds, in patients with established atherosclerotic cardiovascular disease (ASCVD). Methods and results In the FOURIER trial, 27 564 patients with stable ASCVD on statin therapy were randomly assigned to evolocumab or placebo. Acute arterial events were a composite of acute coronary (coronary heart disease death, myocardial infarction, or urgent coronary revascularization), cerebrovascular (ischaemic stroke, transient ischaemic attack, or urgent cerebral revascularization), or peripheral vascular (acute limb ischaemia, major amputation, or urgent peripheral revascularization) events. Of the 2210 first acute arterial events, 74% were coronary, 22% were cerebrovascular, and 4% were peripheral vascular. Evolocumab reduced first acute arterial events by 19% (hazard ratio [HR] 0.81 [95% confidence interval 0.74–0.88]; P &lt; 0.001), with significant individual reductions in acute coronary (HR 0.83 [0.75–0.91]), cerebrovascular (HR 0.77 [0.65–0.92]), and peripheral vascular (HR 0.58 [0.38–0.88]) events. There were 3437 total events (first plus recurrent), with evolocumab reducing total events by 24% (incidence rate ratio 0.76 [0.69–0.85]). The magnitude of reduction in acute arterial events with evolocumab numerically increased over time, with a 16% reduction (HR 0.84 [0.75–0.95]) in the first year followed by a 24% reduction (HR 0.76 [0.67–0.85]) thereafter. Conclusion The addition of the PCSK9 inhibitor evolocumab to statin therapy reduced acute arterial events across all vascular territories with a robust effect over time, indicating a pan-vascular impact of aggressive lipid-lowering therapy on these acute and clinically meaningful events. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01764633.

Dyslipidemia: Management Using Optimal Lipid-Lowering Therapy

2012 ◽  
Vol 46 (10) ◽  
pp. 1368-1381 ◽  
Author(s):  
Matthew K Ito
Keyword(s):  
Cardiovascular Risk ◽  
Combination Therapy ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Density Lipoprotein ◽  
Lifestyle Changes ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Intensive Statin Therapy

Objective: To evaluate current approaches and explore emerging research related to dyslipidemia management. Data Sources: MEDLINE (2004-April 2012) was searched for randomized controlled trials using the terms dyslipidemia and lipid-lowering therapy or statin (>1000 hits). Separate searches (MEDLINE, Google) identified meta-analyses (2010–2011), disease prevalence statistics, and current consensus guidelines (2004–July 2011). Additional references were identified from the publications reviewed. Study Selection and Data Extraction: English-language articles on large multi-center trials were evaluated. Data Synthesis: National Cholesterol Education Program Adult Treatment Panel III guidelines for the reduction of cardiovascular risk recommend the attainment of specific low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein cholesterol (non–HDL-C) target values, based on an individual's 10-year risk of coronary heart disease or global risk. For most patients unable to achieve recommended lipid level goals with therapeutic lifestyle changes, statins are the first option for treatment. Results of large, well-controlled clinical trials have demonstrated that statins are effective in primary and secondary prevention of cardiovascular disease in diverse populations, including patients with diabetes and the elderly, and that intensive statin therapy provides more effective lipid goal attainment and significantly greater risk reduction in patients with coronary artery disease. Stalin therapy is generally well tolerated but may increase the risk of myopathy. Statin use has been associated with increases in hepatic transaminases and an increased risk of diabetes, although the absolute risk of diabetes is low compared with the risk reduction benefit. Combination therapy including a statin may be appropriate for certain populations, but the risk reduction benefits of combination therapy remain unclear. Ezetimibe is an important treatment option for patients with hypercholesterolemia who do not tolerate intensive statin therapy. Although fibrates or niacin improves overall lipid profiles in patients with hypertriglyceridemia or dyslipidemia who are receiving statin therapy, their efficacy in reducing cardiovascular risk remains questionable and their use raises safety and tolerability concerns. Conclusions: Intensifying lifestyle changes and statin dose should be utilized first in patients not achieving their LDL-C and non-HDL-C goals.

scholarly journals The Effects of Combination Therapy with Niceritrol and Pravastatin on Hyperlipidaemia

2002 ◽  
Vol 30 (3) ◽  
pp. 271-281 ◽  
Author(s):  
M Kinoshita ◽  
Y Mikuni ◽  
M Kudo ◽  
M Mori ◽  
E Horie ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Total Cholesterol ◽  
Density Lipoprotein ◽  
Initial Therapy ◽  
Lipid Lowering ◽  
Cholesterol Levels ◽  
Lipid Lowering Drug ◽  
Therapeutic Value ◽  
N Treatment ◽  
Lowering Drug

In the present study, we evaluated the effects of combination therapy with niceritrol and pravastatin in patients with hyperlipidaemia. A total of 62 patients with hyperlipidaemia, defined as total cholesterol levels above 220 mg/dl or triglyceride levels above 150 mg/dl, were recruited. Patients were divided into two groups: Group N received initial therapy with niceritrol 750–1500 mg/day, and those in Group P, pravastatin 10 mg/day. After 8 weeks, pravastatin 10 mg/day was added to the Group N treatment regimen for a further 8 weeks, while patients in Group P were given niceritrol 750–1500 mg/day in addition to pravastatin for 8 weeks. After the 8-week combination therapy study period, total cholesterol levels were 209.6 mg/dl in Group N and 220.7 mg/dl in Group P. Decreased triglyceride and lipoprotein(a) levels and increased high-density lipoprotein cholesterol levels, neither of which were achieved by pravastatin administration alone, were achieved with the combination of pravastatin and niceritrol. We conclude that when a single lipid-lowering drug fails to show therapeutic value, attempting combination therapy with a nicotinic acid preparation and a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) is worthwhile.

scholarly journals Identifying Clusters of Adherence to Cardiovascular Risk Reduction Behaviors and Persistence with Medication in New Lipid-Lowering Drug Users. Impact on Healthcare Utilization

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 723
Author(s):  
Sara Malo ◽  
María José Rabanaque ◽  
Lina Maldonado ◽  
Belén Moreno-Franco ◽  
Armando Chaure-Pardos ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mediterranean Diet ◽  
Healthcare Utilization ◽  
Drug Users ◽  
Healthy Lifestyle ◽  
Lipid Lowering ◽  
Health Study ◽  
Lipid Lowering Therapy ◽  
Lipid Lowering Drug ◽  
Lowering Drug

We sought to identify specific profiles of new lipid-lowering drug users based on adherence to a healthy lifestyle and persistence with medication, and to characterize co-morbidities, co-treatments, and healthcare utilization for each of the profiles identified. Observational study in 517 participants in the Aragon Workers’ Health Study (AWHS) without previous cardiovascular disease (CVD) and who initiated lipid-lowering therapy. Data were collected from workplace medical examinations and administrative health databases (2010–2018). Using cluster analysis, we identified distinct patient profiles based on persistence with therapy and lifestyle. We then compared characteristics, morbidity, and healthcare utilization across clusters. Participants were aggregated into four clusters based on persistence with therapy, smoking status, adherence to Mediterranean diet, and physical activity. In cluster 1 (n = 113), comprising those with a healthiest lifestyle (14.2% smokers, 84.0% with medium-high adherence to Mediterranean diet, high physical activity), 16.8% were persistent. In cluster 3 (n = 108), comprising patients with the least healthy lifestyle (100% smokers, poor adherence to the Mediterranean diet, low level of physical activity), all were non-persistent. Clusters 2 (n = 150) and 4 (n = 146) both comprised patients with intermediate lifestyle behaviors, but differed in terms of persistence (100 and 0%, respectively). Compared with other clusters, the burden of morbidity, cardiovascular score, and healthcare utilization were lower in cluster 1. The healthy adherer effect was only observed in new lipid-lowering drug users of certain profiles. Furthermore, we found that differences in adherence to lifestyle and medication recommendations for CVD prevention influenced morbidity burden and healthcare utilization.

The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 182-189
Author(s):  
Tae-Jin Song ◽  
Seung-Hun Oh ◽  
Jinkwon Kim
Keyword(s):  
Statin Therapy ◽  
Coil Embolization ◽  
Primary Outcome ◽  
Cox Regression ◽  
Cerebral Aneurysms ◽  
Time Dependent ◽  
Lipid Lowering ◽  
Surgical Clipping ◽  
The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

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