| Treating mixed hyperlipidemia and the atherogenic lipid phenotype for prevention of cardiovascular events. | |
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MedLine Citation:
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PMID: 20920687 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Statins reduce cardiovascular events and cardiovascular and total mortality in persons at risk for and with coronary disease, but there remains a significant residual event rate, particularly in those with the atherogenic lipid phenotype that is characterized by a low high-density lipoprotein (HDL) cholesterol and increase in non-HDL cholesterol. Large outcome trials designed to assess the value of combining statins with other agents to target HDL cholesterol and non-HDL cholesterol will not be completed for a few years, but there is ample evidence for the clinician to consider combination therapy. The choices for therapies to supplement statins include niacin, fibrates, and omega-3 fatty acids. We present the argument that after therapeutic lifestyle changes, the first priority should be the maximally tolerated effective dose of a potent statin. Evidence supports the addition of niacin as the second agent. In some situations, high-dose omega-3 fatty acid therapy could be the first agent added to statins. Although fibrate monotherapy alone or in combination with non-statin low-density lipoprotein cholesterol-lowering agents can be effective in mixed hyperlipidemia when statins are not tolerated, the combination of statin+fibrate should be considered second-line therapy until the efficacy and safety are established. |
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Authors:
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Melvyn Rubenfire; Robert D Brook; Robert S Rosenson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: The American journal of medicine Volume: 123 ISSN: 1555-7162 ISO Abbreviation: Am. J. Med. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-05 Completed Date: 2010-10-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 892-8 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Mich 48106, USA. mrubenfi@umich.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Atherosclerosis
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prevention & control* Cardiovascular Diseases / prevention & control Cholesterol, LDL / blood Clofibric Acid / therapeutic use Drug Therapy, Combination Fatty Acids, Omega-3 / therapeutic use Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use Hyperlipidemia, Familial Combined / drug therapy*, therapy Lipid Metabolism / drug effects, genetics Niacin / therapeutic use Phenotype Risk Factors Risk Reduction Behavior |
| Chemical | |
Reg. No./Substance:
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0/Cholesterol, LDL; 0/Fatty Acids, Omega-3; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 59-67-6/Niacin; 882-09-7/Clofibric Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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