LDL-cholesterol lowering efficacy of atorvastatin® in primary prevention. Real-world experience in a developing country; a program based on evidence, personalization, and empowerment

2021 ◽  
Vol 9 (11) ◽  
Author(s):  
Enrique Morales-Villegas ◽  
Abigail Vega-Velasco ◽  
Gualberto Moreno-Virgen
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cardiovascular Prevention ◽  
Scientific Quality ◽  
Atherosclerotic Cardiovascular Disease ◽  
Net Benefit ◽  
Therapeutic Class ◽  
Risk Patients

Despite the iconoclasts of the LDL-centric principle and the net benefit of statins, the plurality, quantity, and especially the scientific quality of the evidence that supports the causal role of low-density lipoprotein cholesterol (LDL-C) in atherosclerosis, as well as the net benefit of statins in its prevention, make these two concepts, universal principles accepted by all guidelines worldwide. The efficacy, safety, and cost-effectiveness of statins have been confirmed in multiple randomized and controlled clinical trials. However, paradoxically, and especially in developing countries like Mexico, the use of this therapeutic class is suboptimal. The reasons to explain this paradox are multiple and are analyzed in this article, which has the purpose of confirming the efficacy, safety, and significant potential impact of statins in the "real developing world." To fulfill this purpose, this article presents our center experience using statins, especially atorvastatin®, in patients without atherosclerotic cardiovascular disease (ASCVD). Founded on an evidence-based, personalization, and empowerment program, our results in almost four hundred patients in primary cardiovascular prevention are as follows. In intermediate-risk patients, atorvastatin® 10 mg/day with a baseline LDL-C of 111.6 mg/dL (±25.1), reduced LDL-C by 38.0% (±13.9); atorvastatin® 20 mg/day with a baseline LDL-C of 124.4 mg/dL (±25.3), reduced LDL-C by 44.9% (±15.0) (p <0.005 for both). In the atorvastatin® 10/20 mg/day cohort (a total of 294 patients), 87.7% (258 patients) achieved a ≥30% LDL-C reduction, and 36.7% (108 patients) a ≥50% reduction. In the atorvastatin 10/20 mg/day cohort, with an average baseline LDL-C of 122.6 mg/dL (±25.6), 92.5 and 55.7% achieved LDL-C of ≤100 and ≤70 mg/dL, respectively. In high-risk patients, atorvastatin® 40 mg/day with a baseline LDL-C of 151.7 mg/dL (±31.6), there was an LDL-C average reduction of 54.7% (±12.2). Atorvastatin 80mg/day with a baseline LDL-C of 160.2 mg/dL (±41.5) produced an LDL-C average reduction of 62.5% (±10.8) (P <0.005 for both). In the atorvastatin® 40/80 mg/day cohort (89 patients), 98.8% (88 patients) achieved a ≥30% LDL-C reduction, and 76.4% (68 patients) achieved a ≥50% reduction. In the atorvastatin 40/80 mg/day cohort, with an average baseline LDL-C of 153.0 mg/dL (±33.2), 95.8 and 62.9% achieved LDL-C of ≤100 and ≤70 mg/dL, respectively.

scholarly journals BLOOD CHOLESTEROL, LDL AND HDL IN CROSSBRED LOCAL CHICKEN FEED INULIN OF DAHLIA TUBERS AS A PREBIOTIC

2016 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Nurul Fajrih
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Dietary Treatment ◽  
Blood Cholesterol ◽  
Randomized Design ◽  
Completely Randomized Design ◽  
Local Chicken ◽  
Low Cholesterol

The feeding inulin of dahlia tubers as a prebiotic related to the quality of the resulting product is a product low cholesterol. The research was aimed to examine the role of inulin as a prebiotic derived from dahlia flower tuber in the form of powder and extract on blood cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) of crossbred local chicken. The research was assigned in a completely randomized design with 7 treatments and 4 replications (10 birds each), treatments applied were T0: basal ration, T1: ration + 0.4% powder of dahlia tuber, T2: ration + 0.8% powder of dahlia tuber, T3: ration + 1.2% powder of dahlia tuber, T4: ration + 0.39% extract of dahlia tuber, T5: ration + 0.78% extract of dahlia tuber, T6: ration + 1.17% extract of dahlia tuber. The birds were reared for conditioning from day 1 until 3 week, and dietary treatment was given thereafter until 11 week of age. Parameters observed were blood cholesterol, LDL and HDL. The data were statistically analyzed according to ANOVA and continued to Duncan test at the level of 5% probability. The results showed that feeding inulin in the form of powder or extract significantly (P<0,05) decreased LDL and HDL, but not on blood cholesterol. In conclusion, feeding inulin in the form of powder in 1.2% (T3) and extract in 1.17% (T6), able to reduce levels of LDL and HDL but not yet capable of lowering blood cholesterol of crossbred local chicken.

scholarly journals New players in the treatment of hypercholesterolaemia: focus on bempedoic acid and inclisiran

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E59-E62
Author(s):  
Massimiliano Ruscica ◽  
Cesare Riccardo Sirtori ◽  
Nicola Ferri ◽  
Alberto Corsini
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Oral Drug ◽  
Atherosclerotic Cardiovascular Disease ◽  
Atherosclerotic Burden ◽  
Risk Patients ◽  
Ascvd Risk ◽  
Coa Reductase ◽  
Interfering Rna ◽  
Hydroxymethylglutaryl Coa Reductase

Abstract Dyslipidaemias and in particular elevated plasma low-density lipoprotein cholesterol (LDL-C) levels are major risk factors for atherosclerotic cardiovascular disease (ASCVD). Indeed, the more LDL-C is reduced the larger will be the ASCVD risk reduction. Although statins represent the first-line intervention to reduce the atherosclerotic burden driven by raised levels of LDL-C, adherence is not optimal and most patients do not follow guidelines and recommended doses. Thus, to achieve optimal LDL-C goals, especially in very high-risk patients, there is a need for new and safe agents, more tolerable than statins with low risk of myalgia. Thus, the present review will address the most recent clinical trials with bempedoic acid and inclisiran. Bempedoic acid is an oral drug acting at a biochemical step preceding hydroxymethylglutaryl-CoA reductase and not associated with muscular side effects. Inclisiran, the first-in-class small interfering RNA-based approach, has the ability to effectively reduce LDL-C by inhibiting the hepatic synthesis of proprotein convertase subtilisin/kexin type 9, with the advantage of requiring subcutaneous of a single dose on Day 1, Day 90, and every 6 months thereafter.

scholarly journals Apolipoprotein B-containing lipoproteins and atherosclerotic cardiovascular disease

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 134 ◽  
Author(s):  
Michael D. Shapiro ◽  
Sergio Fazio
Keyword(s):  
Cardiovascular Disease ◽  
Apolipoprotein B ◽  
Cholesterol Efflux ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
High Density Lipoproteins ◽  
Atherosclerotic Cardiovascular Disease ◽  
Low Density ◽  
Lines Of Evidence

Cholesterol-rich, apolipoprotein B (apoB)-containing lipoproteins are now widely accepted as the most important causal agents of atherosclerotic cardiovascular disease. Multiple unequivocal and orthogonal lines of evidence all converge on low-density lipoprotein and related particles as being the principal actors in the genesis of atherosclerosis. Here, we review the fundamental role of atherogenic apoB-containing lipoproteins in cardiovascular disease and several other humoral and parietal factors that are required to initiate and maintain arterial degeneration. The biology of foam cells and their interactions with high-density lipoproteins, including cholesterol efflux, are also briefly reviewed.

scholarly journals Hydrophilic or Lipophilic Statins?

2021 ◽  
Vol 8 ◽  
Author(s):  
Elisenda Climent ◽  
David Benaiges ◽  
Juan Pedro-Botet
Keyword(s):  
Clinical Evidence ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cardiovascular Prevention ◽  
Cardiovascular Outcomes ◽  
The Other ◽  
Solubility Profile ◽  
Other Regarding ◽  
Secondary Cardiovascular Prevention

Drugs can be classified as hydrophilic or lipophilic depending on their ability to dissolve in water or in lipid-containing media. The predominantly lipophilic statins (simvastatin, fluvastatin, pitavastatin, lovastatin and atorvastatin) can easily enter cells, whereas hydrophilic statins (rosuvastatin and pravastatin) present greater hepatoselectivity. Although the beneficial role of statins in primary and secondary cardiovascular prevention has been unequivocally confirmed, the possible superiority of one statin or other regarding their solubility profile is still not well-established. In this respect, although some previously published observational studies and clinical trials observed a superiority of lipophilic statins in cardiovascular outcomes, these results could also be explained by a greater low-density lipoprotein cholesterol reduction with this statin type. On the other hand, previous studies reported conflicting results as to the possible superiority of one statin type over the other regarding heart failure outcomes. Furthermore, adverse events with statin therapy may also be related to their solubility profile. Thus, the aim of the present review was to collect clinical evidence on possible differences in cardiovascular outcomes among statins when their solubility profile is considered, and how this may also be related to the occurrence of statin-related adverse effects.

scholarly journals Inclisiran—Silencing the Cholesterol, Speaking up the Prognosis

2021 ◽  
Vol 10 (11) ◽  
pp. 2467
Author(s):  
Sylwester Rogula ◽  
Ewelina Błażejowska ◽  
Aleksandra Gąsecka ◽  
Łukasz Szarpak ◽  
Milosz J. Jaguszewski ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cholesterol Metabolism ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
General Information ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cardiovascular Risk Reduction ◽  
Speaking Up ◽  
Pcsk9 Inhibitor

The reduction of circulating low-density lipoprotein-cholesterol (LDL-C) is a primary target in cardiovascular risk reduction due to its well-established benefits in terms of decreased mortality. Despite the use of statin therapy, 10%–20% of high- and very-high-risk patients do not reach their LDL-C targets. There is an urgent need for improved strategies to manage dyslipidemia, especially among patients with homozygous familial hypercholesterolemia, but also in patients with established cardiovascular disease who fail to achieve LDL goals despite combined statin, ezetimibe, and PCSK9 inhibitor (PCSK9i) therapy. Inclisiran is a disruptive, first-in-class small interfering RNA (siRNA)-based therapeutic developed for the treatment of hypercholesterolemia that inhibits proprotein convertase subtilisin–kexin type 9 (PCSK9) synthesis, thereby upregulating the number of LDL receptors on the hepatocytes, thus lowering the plasma LDL-C concentration. Inclisiran decreases the LDL-C levels by over 50% with one dose every 6 months, making it a simple and well-tolerated treatment strategy. In this review, we summarize the general information regarding (i) the role of LDL-C in atherosclerotic cardiovascular disease, (ii) data regarding the role of PCSK9 in cholesterol metabolism, (iii) pleiotropic effects of PCSK9, and (iv) the effects of PCSK9 silencing. In addition, we focus on inclisiran, in terms of its (i) mechanism of action, (ii) biological efficacy and safety, (iii) results from the ORION trials, (iv) benefits of its combination with statins, and (v) its potential future role in atherosclerotic cardiovascular disease.

scholarly journals Dietary and Blood Lipids in Cardiovascular Disease

2020 ◽  
pp. 11-21
Author(s):  
Sheikh Salahuddin Ahmed
Keyword(s):  
Cardiovascular Disease ◽  
Blood Lipids ◽  
Cardiovascular Health ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Atherosclerotic Cardiovascular Disease ◽  
Structural Protein ◽  
Lipoprotein Particles ◽  
Increased Risk

Blood lipids are essential for life; at the same time, elevated or reduced levels of some of the components of lipid are related to risk of atherosclerotic cardiovascular disease (ASCVD). This article provides a review on dietary and blood lipids with their impact on cardiovascular health. The role of apolipoprotein B (ApoB), Lipoprotein(a) ((Lp(a)) and other lipoprotein particles in the development of ASCVD has been reviewed. There are new evidences that ApoB the structural protein of most of the lipoprotein particles (carrier of blood lipids), in addition to low density lipoprotein-cholesterol (LDL-C), plays a central role in the pathogenesis of atherosclerosis with increased risk for ASCVD. Elevated levels of Lp(a) concentrations are associated with an increased risk of ASCVD, but it appears to be a weaker risk factor than ApoB or LDL-C.

Comparability of 11 different equations for estimating LDL cholesterol on different analysers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Helgard M. Rossouw ◽  
Susanna E. Nagel ◽  
Tahir S. Pillay
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Low Density Lipoprotein Cholesterol ◽  
Predictive Equations ◽  
Parametric Statistics ◽  
Friedewald Equation ◽  
Abbott Architect

Abstract Objectives Low-density lipoprotein cholesterol (LDL-C) estimation is critical for risk classification, prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). Predictive equations and direct LDL-C are used. We investigated the comparability between the Martin/Hopkins, Sampson, Friedewald and eight other predictive equations on two analysers, to determine whether the equation or analyser influences predicted LDL-C result. Methods In two unpaired datasets, 9,995 lipid profiles were analysed by the Abbott Architect and 4,782 by the Roche Cobas analysers. Non-parametric statistics and Bland Altman plots were used to compare LDL-C. Results On the Abbott analyser; the Martin/Hopkins, Sampson and Friedewald LDL-C were comparable (median bias ≤1.8%) over a range of 1–4.9 mmol/L. On the Roche platform, Martin/Hopkins LDL-C was comparable to Friedewald (median bias 0.3%) but not to Sampson LDL-C (median bias 25%). In patients with LDL-C <1.8 mmol/L and triglycerides (TG) ≤1.7 mmol/L, predicted LDL-C using Abbott reagents was similar between Martin/Hopkins, Sampson and Friedewald equations but not comparable using Roche reagents. Abbott reagents classified 10–20% of patients in the 1.0–1.8 mmol/L range (Martin/Hopkins 13.4%; Sampson 14.5%; Friedewald 16%; direct LDL-C 13.2%). Roche reagents classified 11–30% in the 1.0–1.8 mmol/L range (Martin/Hopkins 23%; Sampson 11%; Friedewald 25%; direct LDL-C 17%). Conclusions Performance of predictive equations is influenced by the choice of analyser for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and TG. Replacement of the Friedewald equation with Martin/Hopkins estimation to improve quality of LDL-C results can be safely implemented across analysers, whereas caution is advised regarding the Sampson equation.

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