Treatment goals for the management of lipids and inflammation for patients with coronary artery disease.
ABSTRACT Appropriate management of lipids is a central component of risk reduction in patients with coronary artery disease (CAD). According to the most recent guidelines, low-density lipoprotein cholesterol (LDLC) is the principal target of lipid-lowering therapy and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the mainstay of this therapy. The actual target level of LDL lowering is being reassessed in light of recent clinical trials. Once appropriate LDL lowering has been achieved, treatment of other targets such as high-density lipoprotein cholesterol (HDLC), triglycerides, and non-HDLC should be considered. In addition to dyslipidemia, multiple observational studies suggest that inflammatory markers such as C-reactive protein (CRP) are associated with risk of cardiovascular events and that treatment with statins may lower CRP levels. However, there are insufficient data at this time supporting treatment of CRP as a principal target in CAD.
- Circulation 06/2006; 113(17):2128-34; discussion 2151. · 15.20 Impact Factor
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ABSTRACT: The purpose of this study was to assess the efficacy and safety of ezetimibe administered with simvastatin in patients with primary hypercholesterolemia. Despite the availability of statins, many patients do not achieve lipid targets. Combination therapy with lipid-lowering agents that act via a complementary pathway may allow additional patients to achieve recommended cholesterol goals. After dietary stabilization, a 2- to 12-week washout period, and a 4-week, single-blind, placebo lead-in period, patients with baseline low-density lipoprotein cholesterol (LDL-C) > or =145 mg/dl to < or =250 mg/dl and triglycerides (TG) < or =350 mg/dl were randomized to one of the following 10 groups administered daily for 12 consecutive weeks: ezetimibe 10 mg; simvastatin 10, 20, 40, or 80 mg; ezetimibe 10 mg plus simvastatin 10, 20, 40, or 80 mg; or placebo. The primary efficacy variable was percentage reduction from baseline to end point in direct LDL-C for the pooled ezetimibe plus simvastatin groups versus pooled simvastatin groups. Ezetimibe plus simvastatin significantly improved LDL-C (p < 0.01), high-density lipoprotein cholesterol (HDL-C) (p = 0.03), and TG (p < 0.01) compared with simvastatin alone. Ezetimibe plus simvastatin (pooled doses) provided an incremental 13.8% LDL-C reduction, 2.4% HDL-C increase, and 7.5% TG reduction compared with pooled simvastatin alone. Coadministration of ezetimibe and simvastatin provided LDL-C reductions of 44% to 57%, TG reductions of 20% to 28%, and HDL-C increases of 8% to 11%, depending on the simvastatin dose. Ezetimibe 10 mg plus simvastatin 10 mg and simvastatin 80 mg alone each provided a 44% LDL-C reduction. The coadministration of ezetimibe with simvastatin was well tolerated, with a safety profile similar to those of simvastatin and of placebo. When coadministered with simvastatin, ezetimibe provided significant incremental reductions in LDL-C and TG, as well as increases in HDL-C. Coadministration of ezetimibe with simvastatin was well tolerated and comparable to statin alone.Journal of the American College of Cardiology 12/2002; 40(12):2125-34. · 14.09 Impact Factor
- The American Journal of Cardiology 08/2002; 90(2):139-43. · 3.21 Impact Factor