Dyslipidemia: Management Using Optimal Lipid-Lowering Therapy

College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, OR.
Annals of Pharmacotherapy (Impact Factor: 2.06). 10/2012; 46(10):1368-81. DOI: 10.1345/aph.1R127
Source: PubMed


To evaluate current approaches and explore emerging research related to dyslipidemia management.
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.
English-language articles on large multicenter trials were evaluated.
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. Statin 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.
Intensifying lifestyle changes and statin dose should be utilized first in patients not achieving their LDL-C and non-HDL-C goals.

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    • ". In addition, it has been suggested that high dose levels of statins and combination therapies could be used more widely to achieve LDL-C targets in high-risk patients [37] [38]. For example, the Austrian Cholesterol screening and Treatment (ACT) II study evaluated the effect of lipid-lowering therapies in high-risk, statin-treated patients with elevated LDL-C levels. "
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    ABSTRACT: Background and objective: The Baltic nations (Estonia, Latvia, and Lithuania) are profoundly affected by cardiovascular disease (CVD). Studies have indicated that patients may experience persistent dyslipidemia despite chronic statin treatment. Therefore, the aim of this study was to analyze the risk factors for dyslipidemia despite statin-treatment in a large dataset from the Baltic nations. Material and methods: Patients in primary care centers across the Baltic nations were enrolled into the cross-sectional, observational Dyslipidemia International Study (DYSIS). Patients were ≥ 45 years old and had been treated with statins for at least three months. Patient characteristics and lipid measurements were used to determine variables contributing to dyslipidemia (abnormal low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], or total triglyceride [TG] values). Results: We enrolled 1797 patients with a mean age of 66.1 years and 59.1% being female. Overall 63.4% had cardiovascular disease, 30.1% were diabetic and 77.8% at high risk for cardiovascular complications. LDL-C was not at target level for 80.7%; low HDL-C levels were observed for 26.0%, and elevated TG levels were found in 35.0% of all patients. Multivariate analyses indicated that a BMI ≥ 30 kg/m(2) (OR, 2.12; 95% CI, 1.45-3.08) and hypertension (OR, 2.43; 95% CI, 1.1 6-5.10) were strongly associated with dyslipidemia (involving all three lipids) during statin therapy while age ≥ 70 years (OR, 0.63; 95% CI, 0.42-0.94) and female gender (OR, 0.48; 95% CI, 0.33-0.68) conferred reduced risk. Conclusions: Our findings indicate many statin-treated patients in Estonia, Latvia, and Lithuania did not meet target lipid levels and had a very high risk of CVD. Combating other well-known CVD risk factors such as obesity and hypertension is vital to reduce the exceptionally high risk for CVD mortality seen in the Baltic nations.
    Full-text · Article · Dec 2014 · Medicina (Kaunas, Lithuania)
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    • "Statins, for most patients, are the first-line cholesterol-lowering agents (Armitage, 2007; Ito, 2012), acting as inhibitors of 3-hydroxy 3-methylglutaryl coenzyme A reductase (Istvan, 2002), which catalyzes the rate-limiting step in cholesterol biosynthesis. Meta-analysis has shown strong evidence of statins in prevention from CAD, CVA, and mortality rate of all causes, and in reduction of total cholesterol and low-density-lipoprotein cholesterol levels (Taylor et al., 2013). "
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    ABSTRACT: Hyperlipidemia is associated with increased risk of coronary artery disease and stroke, both of which, in turn, are risk factors of old-age depression. Statins are extensively used for decreasing cholesterol levels. Clinical investigations revealed that long-term use of statins appeared to be associated with a lower risk of anxiety and depression. However, the antidepressant property of statins has not been well examined. This study aimed at examining the antidepressant-like effects of statins in rats exposed to chronic mild stress (CMS). We found that animals exposed to CMS for 4 weeks developed depressive-like state, shown by forced swim test and sucrose preference test. However, these CMS-induced behavioral changes were reversed by simvastatin (5 or 10 mg/kg/day) for 14 days, comparable to imipramine (10 mg/kg/day) treatment. Locomotor activity and anxiety-like behaviors were not altered by CMS or these treatments. These results demonstrated antidepressant-like effects of statin in CMS model of rats and suggested the potential that statins could be used to facilitate antidepressant treatment in clinical setting.
    Full-text · Article · Sep 2014 · Pharmacology Biochemistry and Behavior
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    • "In this context, atherogenic dyslipidemia is an integral component of MetS and a major contributor to the cardiovascular risks in patients [1]. Orthodox medicine offered different pharmacotherapeutic programs like common statin monotherapy to control and/or combat various features of dyslipidemia [2] [3], however adverse effects of modern pharmacotherapeutic agents encouraged patients, pharmaceutical companies and researchers to seek more healthier drugs or alternative therapeutic programs. Non-drug approach to treating dyslipidemia suggests that canonical medicine still has many remedies and putative phytomedicines that need to be shortlisted. "
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    Full-text · Article · Jan 2013 · Journal of Applied Biological Sciences
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