Hypercholesterolemia: Difference between revisions
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If treatment with a [[hydroxymethylglutaryl-coenzyme A reductase inhibitor]] does not achieve a desirable cholesterol, other drugs that may be added for additional benefit include [[niacin]]<ref name="pmid11757504">{{cite journal |author=Brown BG, Zhao XQ, Chait A, ''et al.'' |title=Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease |journal=N. Engl. J. Med. |volume=345 |issue=22 |pages=1583–92 |year=2001 |month=November |pmid=11757504 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11757504&promo=ONFLNS19 |issn=}}</ref> | If treatment with a [[hydroxymethylglutaryl-coenzyme A reductase inhibitor]] does not achieve a desirable cholesterol, other drugs that may be added for additional benefit include [[niacin]]<ref name="pmid11757504">{{cite journal |author=Brown BG, Zhao XQ, Chait A, ''et al.'' |title=Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease |journal=N. Engl. J. Med. |volume=345 |issue=22 |pages=1583–92 |year=2001 |month=November |pmid=11757504 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11757504&promo=ONFLNS19 |issn=}}</ref><ref name="pmid15537681">{{cite journal |author=Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA |title=Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins |journal=Circulation |volume=110 |issue=23 |pages=3512–7 |year=2004 |month=December |pmid=15537681 |doi=10.1161/01.CIR.0000148955.19792.8D |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15537681 |issn=}}</ref> and [[fish oil]]. [[Ezetimibe]], a cholesterol-absorption inhibitor, was not clearly beneficial in a study of [[diabetes mellitus type 2]]<ref name="pmid18398080">{{cite journal |author=Howard BV, Roman MJ, Devereux RB, ''et al'' |title=Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial |journal=JAMA |volume=299 |issue=14 |pages=1678–89 |year=2008 |month=April |pmid=18398080 |doi=10.1001/jama.299.14.1678 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18398080 |issn=}}</ref> and a study of mixed [[primary prevention]] and [[secondary prevention]]<ref name="pmid18376000">{{cite journal |author=Kastelein JJ, Akdim F, Stroes ES, ''et al'' |title=Simvastatin with or without ezetimibe in familial hypercholesterolemia |journal=N. Engl. J. Med. |volume=358 |issue=14 |pages=1431–43 |year=2008 |month=April |pmid=18376000 |doi=10.1056/NEJMoa0800742 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18376000&promo=ONFLNS19 |issn=}}</ref>. | ||
===Diabetic patients=== | ===Diabetic patients=== | ||
Revision as of 08:59, 24 July 2009
Hypercolesterolemia is "a condition with abnormally high levels of cholesterol in the blood. It is defined as a cholesterol value exceeding the 95th percentile for the population."[1]
Treatment
Clinical practice guidelines by the National Institute for Health and Clinical Excellence recommend treatment if the estimated 10 year risk of cardiovascular disease is at least 20%.[2][3]
Primary prevention
One meta-analysis found that overall mortality is insignificantly reduced from 6.6% over 4.3 years to 6.1% in patients without prior cardiovascular disease (Number needed to treat, although statistically insignificant, is estimated to be 200).[4]
A second meta-analysis reported that statins can significantly help in the primary prevention of coronary heart disease among patients at risk.[5]
- Combination treatment
If treatment with a hydroxymethylglutaryl-coenzyme A reductase inhibitor does not achieve a desirable cholesterol, other drugs that have been studied include eicosapentaenoic acid which is a metabolite of fish oil.[6] Ezetimibe, a cholesterol-absorption inhibitor, was not clearly beneficial in a study of diabetes mellitus type 2[7] and a study of mixed primary prevention and secondary prevention[8]. Niacin has been studied with improvements in the LDL and HDL[9] with uncertain effects on carotid intima-media thickness [10].
Secondary prevention
Clinical practice guidelines by the National Institute for Health and Clinical Excellence recommend treatment goal of <4 mmol/l (77 mg/dl)or a low density lipoprotein cholesterol concentration of <2 mmol/l (154 mg/dl).[2][3]
- Combination treatment
If treatment with a hydroxymethylglutaryl-coenzyme A reductase inhibitor does not achieve a desirable cholesterol, other drugs that may be added for additional benefit include niacin[11][10] and fish oil. Ezetimibe, a cholesterol-absorption inhibitor, was not clearly beneficial in a study of diabetes mellitus type 2[7] and a study of mixed primary prevention and secondary prevention[8].
Diabetic patients
Whether diabetes is an equivalent risk factor to having an existing myocardial infarction is debated.[12]
Statin therapy prevents major vascular events in about 1 of every 24 patients with diabetes who use the treatment for 5 years if they are similar to the patients in the meta-analysis by Kearney et al (Number needed to treat is 24).[13]
Treating to a goal of LDL-C < 70 mg/dl and systolic blood pressure to < 115 mm Hg may cause regression of carotid intima-media thickness in a randomized controlled trial.[14]
References
- ↑ Anonymous. Hypercholesterolemia. National Library of Medicine. Retrieved on 2008-01-18.
- ↑ 2.0 2.1 Cooper A, O'Flynn N (2008). "Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance". BMJ. PMID 18511800. PMC 2405875. [e]
- ↑ 3.0 3.1 Anonymous (2008). Lipid modification. National Institute for Health and Clinical Excellence. Retrieved on 2008-08-26.
- ↑ Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK (2006). "Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials". Arch. Intern. Med. 166 (21): 2307–13. DOI:10.1001/archinte.166.21.2307. PMID 17130382. Research Blogging.
- ↑ Brugts JJ, Yetgin T, Hoeks SE, et al. (2009). "The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials". BMJ 338: b2376. PMID 19567909. [e]
- ↑ Yokoyama M, Origasa H, Matsuzaki M, et al (March 2007). "Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis". Lancet 369 (9567): 1090–8. DOI:10.1016/S0140-6736(07)60527-3. PMID 17398308. Research Blogging.
- ↑ 7.0 7.1 Howard BV, Roman MJ, Devereux RB, et al (April 2008). "Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial". JAMA 299 (14): 1678–89. DOI:10.1001/jama.299.14.1678. PMID 18398080. Research Blogging.
- ↑ 8.0 8.1 Kastelein JJ, Akdim F, Stroes ES, et al (April 2008). "Simvastatin with or without ezetimibe in familial hypercholesterolemia". N. Engl. J. Med. 358 (14): 1431–43. DOI:10.1056/NEJMoa0800742. PMID 18376000. Research Blogging.
- ↑ McKenney JM, Jones PH, Bays HE, et al (June 2007). "Comparative effects on lipid levels of combination therapy with a statin and extended-release niacin or ezetimibe versus a statin alone (the COMPELL study)". Atherosclerosis 192 (2): 432–7. DOI:10.1016/j.atherosclerosis.2006.11.037. PMID 17239888. Research Blogging.
- ↑ 10.0 10.1 Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA (December 2004). "Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins". Circulation 110 (23): 3512–7. DOI:10.1161/01.CIR.0000148955.19792.8D. PMID 15537681. Research Blogging.
- ↑ Brown BG, Zhao XQ, Chait A, et al. (November 2001). "Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease". N. Engl. J. Med. 345 (22): 1583–92. PMID 11757504. [e]
- ↑ Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I (February 2009). "Is diabetes a coronary risk equivalent? Systematic review and meta-analysis". Diabet. Med. 26 (2): 142–8. DOI:10.1111/j.1464-5491.2008.02640.x. PMID 19236616. Research Blogging.
- ↑ Kearney PM, Blackwell L, Collins R, et al (2008). "Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis". Lancet 371 (9607): 117–25. DOI:10.1016/S0140-6736(08)60104-X. PMID 18191683. Research Blogging.
- ↑ Howard, B. V., Roman, M. J., Devereux, R. B., Fleg, J. L., Galloway, J. M., Henderson, J. A., et al. (2008). Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes: The SANDS Randomized Trial. JAMA, 299(14), 1678-1689. DOI:10.1001/jama.299.14.1678.