Pharmacotherapy of Mixed Hyperlipidemia with Ezetimibe-Fenofibrate Combination Therapy

2009 ◽  
Vol 1 ◽  
pp. CMT.S2036
Author(s):  
Michel Farnier
Keyword(s):  
Combination Therapy ◽  
Hdl Cholesterol ◽  
Poor Response ◽  
Atherogenic Dyslipidemia ◽  
Cardiovascular Risk Reduction ◽  
Ldl Particles ◽  
Statin Monotherapy ◽  
Alternative Treatment Option ◽  
First Choice ◽  
Mixed Hyperlipidemia

Mixed hyperlipidemia is a frequent atherogenic dyslipidemia characterized by elevated triglycerides, low HDL cholesterol levels, and excess of small, dense LDL particles, often with elevated apolipoproteinB and non-HDL cholesterol concentrations. Although statins are the drug of first choice, many high-risk patients with mixed hyperlipidemia do not achieve the recommended goals with statin monotherapy. Due to the complementary effects of ezetimibe and fenofibrate on the components of atherogenic dyslipidemia, the combination of these two drugs is an alternative treatment option for patients with mixed hyperlipidemia. However, the potential benefit of ezetimibe-fenofibrate combination therapy in cardiovascular risk reduction strategies remains to be established and this combination therapy should only be considered as a second-line therapy and appears to be particularly useful for patients with a poor response or an intolerance to statin monotherapy.

scholarly journals Rosuvastatin and Fenofibrate Combination in The Treatment of Mixed Hyperlipidemia: A Narrative Review

2021 ◽  
Vol 4 (03) ◽  
pp. 867-877
Author(s):  
Kaushik Biswas ◽  
Ajoy Tiwari ◽  
Prachi Jadhav ◽  
Amit Goel ◽  
G V Chanukya
Keyword(s):  
Cardiovascular Risk ◽  
Combination Therapy ◽  
Fenofibric Acid ◽  
Cardiovascular Risk Reduction ◽  
Residual Cardiovascular Risk ◽  
Statin Monotherapy ◽  
Mixed Dyslipidemia ◽  
Lipid Control ◽  
Patient At Risk ◽  
Mixed Hyperlipidemia

Introduction: Patients with mixed dyslipidemia are presented with high levels of low-density lipid cholesterol (LDL-C), triglycerides (TG), and reduced high-density lipid cholesterol (HDL-C). Though useful in lowering LDL-C, therapy with rosuvastatin is insufficient in optimizing the overall lipid profile, thus putting the patient at risk of residual cardiovascular risk. A combination of statin with other lipid-modifying agents has been used with more efficient lipid control and cardiovascular risk prevention. Of these, fenofibric acid is the most frequently used, along with rosuvastatin. Methods: Authors conducted a literature search of published literature to assess the use of rosuvastatin and fenofibrate combination in the management of mixed hyperlipidaemia. Results and discussion: The authors selected a total of 46 articles to be included in the review. Due to the small number of articles and heterogeneity on the combination of rosuvastatin and fenofibrate combination in mixed hyperlipidemia, the findings herein are presented using narrative summaries. Based on the thorough assessment of the selected literature, the essential themes that emerged from the review include safety and efficacy of rosuvastatin and fenofibrate combination, place of therapy of rosuvastatin, and fenofibrate combination, and potential cardiovascular risk reduction with rosuvastatin and fenofibrate combination.   Conclusion: Based on the review, the authors suggested that the combination therapy with fenofibric acid was beneficial, well-tolerated with a similar safety profile compared with statin monotherapy. The combination therapy of moderate dose rosuvastatin and fenofibric acid led to a reduction of cardiovascular risk factors via several pathways.

A Prospective, Multicentric Study to Evaluate the Effects of Saroglitazar on Non-HDL Cholesterol and Small Dense LDL Particles in Patients with Diabetic Dyslipidemia

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 38-LB
Author(s):  
UPENDRA KAUL ◽  
PEEYUSH JAIN ◽  
RANJAN KACHRU ◽  
VINEET BHATIA ◽  
PRIYADARSHINI ARAMBAM ◽  
...  
Keyword(s):  
Hdl Cholesterol ◽  
Diabetic Dyslipidemia ◽  
Multicentric Study ◽  
Small Dense Ldl ◽  
Ldl Particles

scholarly journals High prevalence of low HDL cholesterol concentrations and mixed hyperlipidemia in a Mexican nationwide survey

2001 ◽  
Vol 42 (8) ◽  
pp. 1298-1307 ◽  
Author(s):  
Carlos A. Aguilar-Salinas ◽  
Gustavo Olaiz ◽  
Victoria Valles ◽  
Juan Manuel Ríos Torres ◽  
Francisco J. Gómez Pérez ◽  
...  
Keyword(s):  
Hdl Cholesterol ◽  
Nationwide Survey ◽  
High Prevalence ◽  
Low Hdl ◽  
Mixed Hyperlipidemia

Transcriptomic therapy for dyslipidemias utilizing nucleic acids targeted at ANGPTL3

2021 ◽  
Author(s):  
Gerald F Watts ◽  
Frederick J Raal ◽  
Dick C Chan
Keyword(s):  
Clinical Trials ◽  
Plasma Lipid ◽  
Lipoprotein Metabolism ◽  
New Approach ◽  
Cholesterol Levels ◽  
Ldl Particles ◽  
Severe Hypertriglyceridemia ◽  
Triglyceride Rich Lipoprotein ◽  
Mixed Hyperlipidemia

Angiopoietin-like protein 3 (ANGPTL3) is a key physiological regulator of plasma lipid and lipoprotein metabolism that involves the control of enzymes, lipoprotein and endothelial lipases. Inhibition of ANGPTL3 offers a new approach for correcting the health risks of dyslipidemia, including familial hypercholesterolemia, mixed hyperlipidemia, metabolic syndrome and/or severe hypertriglyceridemia. ANGPTL3 inhibition with nucleic acid-based antisense oligonucleotide and siRNA can correct dyslipidemia chiefly by reducing production and increasing catabolism of triglyceride-rich lipoprotein and LDL particles. Early clinical trials have demonstrated that these agents can safely and effectively lower plasma triglyceride and LDL-cholesterol levels by up to 70 and 50%, respectively. However, the long-term safety and cost–effectiveness of these agents await to be confirmed in an ongoing and future clinical trials.

scholarly journals Lipoprotein Subclass Abnormalities and Incident Hypertension in Initially Healthy Women

2011 ◽  
Vol 57 (8) ◽  
pp. 1178-1187 ◽  
Author(s):  
Nina P Paynter ◽  
Howard D Sesso ◽  
David Conen ◽  
James D Otvos ◽  
Samia Mora
Keyword(s):  
Risk Factors ◽  
Particle Size ◽  
Lower Risk ◽  
Hdl Cholesterol ◽  
Incident Hypertension ◽  
Healthy Women ◽  
Lipoprotein Particle ◽  
Ldl Particles ◽  
Lipoprotein Particle Size ◽  
Lipoprotein Size

BACKGROUND Abnormalities in traditional lipids, particularly decreased HDL cholesterol and increased triglycerides, can precede the onset of hypertension. Whether lipoprotein particle size or subclass concentrations play a role in the development of hypertension is unknown. METHODS We followed 17 527 initially healthy women without baseline hypertension prospectively for 8 years. At baseline, information regarding traditional lipids and hypertension risk factors was obtained, and lipoprotein size and subclass concentrations were measured by nuclear magnetic resonance spectroscopy. RESULTS Baseline lipoprotein size and subclass concentrations were significantly associated with incident hypertension. Although LDL cholesterol was not associated with hypertension [odds ratio (OR) for quintile 5 vs 1: 1.08 (95% CI 0.96–1.20)], increased concentrations of LDL particles were associated with greater risk [OR 1.73 (1.54–1.95)], especially small LDL particles [OR 1.62 (1.45–1.83)]. Increased HDL cholesterol was associated with lower risk of hypertension [OR for quintile 5 vs 1: 0.79 (0.70–0.89)]. By contrast, increased concentrations of HDL particles had greater risk [OR 1.48 (1.32–1.67)], especially small HDL particles [OR 1.36 (1.22–1.53)], whereas large HDL particles had lower risk [OR 0.80 (0.71–0.90)]. Triglycerides and triglyceride-rich VLDL particles were positively associated with hypertension, with large VLDL particles associated with greater risk [OR 1.68 (1.50–1.89)]. Adding particle subclasses improved discrimination over a model with traditional lipids and risk factors (c-statistic 0.671 compared to 0.676; P < 0.001). CONCLUSIONS In this study of initially healthy women, lipoprotein particle size and subclass concentrations were associated with incident hypertension and provided additive information to traditional lipids and risk factors.

scholarly journals LDL subclass lipidomics in atherogenic dyslipidemia: effect of statin therapy on bioactive lipids and dense LDL

2020 ◽  
Vol 61 (6) ◽  
pp. 911-932 ◽  
Author(s):  
M. John Chapman ◽  
Alexina Orsoni ◽  
Ricardo Tan ◽  
Natalie A. Mellett ◽  
Anh Nguyen ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Single Phase ◽  
Cardiometabolic Risk ◽  
Plasma Concentrations ◽  
Statin Treatment ◽  
Atherogenic Dyslipidemia ◽  
Bioactive Lipids ◽  
Ldl Particles ◽  
Pitavastatin Calcium

Atherogenic LDL particles are physicochemically and metabolically heterogeneous. Can bioactive lipid cargo differentiate LDL subclasses, and thus potential atherogenicity? What is the effect of statin treatment? Obese hypertriglyceridemic hypercholesterolemic males [n = 12; lipoprotein (a) <10 mg/dl] received pitavastatin calcium (4 mg/day) for 180 days in a single-phase unblinded study. The lipidomic profiles (23 lipid classes) of five LDL subclasses fractionated from baseline and post-statin plasmas were determined by LC-MS. At baseline and on statin treatment, very small dense LDL (LDL5) was preferentially enriched (up to 3-fold) in specific lysophospholipids {LPC, lysophosphatidylinositol (LPI), lysoalkylphosphatidylcholine [LPC(O)]; 9, 0.2, and 0.14 mol per mole of apoB, respectively; all P < 0.001 vs. LDL1-4}, suggesting elevated inflammatory potential per particle. In contrast, lysophosphatidylethanolamine was uniformly distributed among LDL subclasses. Statin treatment markedly reduced absolute plasma concentrations of all LDL subclasses (up to 33.5%), including LPC, LPI, and LPC(O) contents (up to −52%), consistent with reduction in cardiovascular risk. Despite such reductions, lipotoxic ceramide load per particle in LDL1-5 (1.5–3 mol per mole of apoB; 3–7 mmol per mole of PC) was either conserved or elevated. Bioactive lipids may constitute biomarkers for the cardiometabolic risk associated with specific LDL subclasses in atherogenic dyslipidemia at baseline, and with residual risk on statin therapy.

Ezetimibe and fenofibrate combination therapy for mixed hyperlipidemia

2007 ◽  
Vol 43 (1) ◽  
pp. 35 ◽  
Author(s):  
Y.S.K. Moon ◽  
P. Chun ◽  
S. Chung
Keyword(s):  
Combination Therapy ◽  
Mixed Hyperlipidemia
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