Hypercholesterolemia: Difference between revisions
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imported>Robert Badgett |
imported>Robert Badgett (→Treatment: Started combo rx treatment sections) |
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<!-- see http://www.nytimes.com/2008/01/29/health/29well.html --> | <!-- see http://www.nytimes.com/2008/01/29/health/29well.html --> | ||
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).<ref name="pmid17130382">{{cite journal |author=Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK |title=Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials |journal=Arch. Intern. Med. |volume=166 |issue=21 |pages=2307–13 |year=2006 |pmid=17130382 |doi=10.1001/archinte.166.21.2307}}</ref> | 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).<ref name="pmid17130382">{{cite journal |author=Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK |title=Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials |journal=Arch. Intern. Med. |volume=166 |issue=21 |pages=2307–13 |year=2006 |pmid=17130382 |doi=10.1001/archinte.166.21.2307}}</ref> | ||
;Combination treatment | |||
If treatment with a [[hydroxymethylglutaryl-coenzyme A reductase inhibitor]] does not achieve a desirable cholesterol, other drugs that have been studied include [wiki?title=Eicosapentaenoic_acid&action=edit&redlink=1 ]eicosapentaenoic acideicosapentaenoic acid which is a metabolite of [[fish oil]].<ref name="pmid17398308">{{cite journal |author=Yokoyama M, Origasa H, Matsuzaki M, ''et al'' |title=Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis |journal=Lancet |volume=369 |issue=9567 |pages=1090–8 |year=2007 |month=March |pmid=17398308 |doi=10.1016/S0140-6736(07)60527-3 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(07)60527-3 |issn=}}</ref> [[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>. | |||
===Secondary prevention=== | ===Secondary prevention=== | ||
[[Clinical practice guideline]]s 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).<ref name="pmid">{{cite journal |author=Cooper A, O'Flynn N |title=Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance |journal=BMJ |volume= |issue= |pages= |year=2008 |pmid=18511800 |pmc=2405875 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18511800 |issn=}}</ref><ref name="urlNICE guidance by type">{{cite web |url=http://www.nice.org.uk/guidance/index.jsp?action=byID |title=Lipid modification |author=Anonymous |authorlink= |coauthors= |date=2008 |format= |work= |publisher=National Institute for Health and Clinical Excellence |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=2008-08-26}}</ref> | [[Clinical practice guideline]]s 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).<ref name="pmid">{{cite journal |author=Cooper A, O'Flynn N |title=Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance |journal=BMJ |volume= |issue= |pages= |year=2008 |pmid=18511800 |pmc=2405875 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18511800 |issn=}}</ref><ref name="urlNICE guidance by type">{{cite web |url=http://www.nice.org.uk/guidance/index.jsp?action=byID |title=Lipid modification |author=Anonymous |authorlink= |coauthors= |date=2008 |format= |work= |publisher=National Institute for Health and Clinical Excellence |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=2008-08-26}}</ref> | ||
;Combination treatment | |||
If treatment with a [[hydroxymethylglutaryl-coenzyme A reductase inhibitor]] does not achieve a desirable cholesterol, other drugs that have been studied include [[fish oil]].<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> [[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 14:14, 22 January 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]
Ezetimibe is one drug that can reduce cholesterol. However, a recent randomized controlled trial found it did not reduce atherosclerosis in the carotid artery.[4]
Primary prevention
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).[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 [wiki?title=Eicosapentaenoic_acid&action=edit&redlink=1 ]eicosapentaenoic acideicosapentaenoic 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[4].
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 have been studied include fish oil.[8] 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[4].
Diabetic patients
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).[9]
Treating to a goal of LDL-C < 70 mg/dl and systolic blood pressure to < 115 mm Hg may cause regression of carotid intial media thickness in a randomized controlled trial.[10]
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.
- ↑ 4.0 4.1 4.2 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.