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ALLEN R. LAST, MD, MPH, University of Wisconsin Fox Valley Family Medicine Residency Program, Appleton, Wisconsin, JONATHAN D. FERENCE, PharmD, Wilkes University Nesbitt College of Pharmacy and Nursing, Wilkes-Barre, Pennsylvania, JULIANNE FALLERONI, DO, MPH, University of Wisconsin Fox Valley Family Medicine Residency Program, Appleton, Wisconsin. 50. Lipid-lowering for peripheral arterial disease of the lower limb. Hayward RA, 52. Accessed September 13, 2010. Salen P, Chen Q, 1. All rights Reserved. Cholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER controversy: a critical reappraisal. 2010;152(2):69–77. Merz CN, Am J Cardiol. Zhao YT, Results of the Cholesterol and Recurrent Events (CARE) trial. In the meantime, statins and fibrates remain the major anti-hyperlipidemic agents for the treatment of elevated plasma cholesterol and triglycerides respectively, with the price of severe side effects on the muscles and the liver. Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Callahan A III, A second meta-analysis compared the effectiveness of high-dose statin therapy (80 mg of simvastatin daily) with lower-dose statin therapy (up to 20 mg of simvastatin daily) in patients with recent acute coronary syndrome or stable CHD.42 Higher-dose statin therapy reduced overall mortality (NNT = 91 for two years) in patients with acute coronary syndrome. Am Fam Physician. McKenney JM(1). Danielson E, 2009; 122(10):962.e1–8. The influence of statins on the expansion rate and rupture risk of abdominal aortic aneurysms. ; Benhamou, J. P.; Blei, A. T.; JürgReichen, J. and Mario Rizzetto, M, Jonas, A. Lipoprotein structure In: (Vance DE, Vance JE), Biochemistry of Lipids, Lipoproteins and Membranes, 4. Am Heart J. false (1:1 positive relationship between LDL and CVD; 2:1 negative relationship between HDL and CVD) HDLs <(#)mg/dL and/or LDLs > (#)mg/dL are risk factors for CVD. Erqou S, The ATP III recommendations are based on the assumption that achieving the mean LDL cholesterol level observed in clinical trials will produce similar results in practice, but no clinical trial has assessed a treat-to-target strategy. Cao, J.,Zhou, Y.,Peng, H.,Huang, X.,Stahler, S.,Suri, V.,Qadri, A.,Gareski, T.,Jones, J.,Hahm, S.,Perreault, M.,McKew, J.,Shi, M.,Xu, X.,Tobin, J. F., Gimeno, R. E. Targeting Acyl-CoA:diacylglycerolacyltransferase 1 (DGAT1) with small molecule inhibitors for the treatment of metabolic diseases. Chylomicrons (CM),verylow-densitylipoproteins (VLDL), low-density lipoproteins(LDL), intermediate-density lipoproteins (IDL) and high-densitylipoproteins (HDL) are the five classes of lipoproteins present in plasma.Theseclasses areheterogeneous;they have different composition, size, and density8. Lancet. et al. Pharmacol Ther. Want to use this article elsewhere? Cardiovascular disease (CVD) is the leading cause of mortality in the United States, accounting for 33.6 percent of all deaths in 2007.1 Hyperlipidemia is a common risk factor for CVD, with 53.4 percent of adults in the United States having abnormal cholesterol values and 32 percent having elevated low-density lipoprotein (LDL) cholesterol levels.1, Enlarge Genest J. 2003;57(2):193–200. It decreases total cholesterol, LDL cholesterol, triglycerides. Pharmacotherapy of Hyperlipidemia. Diabetes Intervention Study. As the triglyceride andcholesteryl ester contentsof the core increases the lipoprotein size increases,the densityof lipoproteins increasealso proportionally to their protein contents, andcontrariwise to their lipid contents9. This causes an increase in the clearance of cholesterol from the blood42. Burr ML, ; Limbird, L. E. and Gilman, A. G., Goodman & Gilman’s, The Pharmacological Basis of Therapeutics. Selective cholesterol absorption inhibitor (Ezetimibe). de Feyter P, BMJ. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Petersen LK, Statins may benefit patients with CHD independent of baseline cholesterol levels or age.37–40 The effectiveness of statin therapy on reducing mortality, myocardial infarction, and stroke does not appear to differ among atorvastatin (Lipitor), pravastatin (Pravachol), and simvastatin.41 No study has directly compared equivalent dosages of two different statins for secondary prevention. Introduction. T/F The Framingham study found definitive evidence that the positive relationship between LDL and CVD was greater than the negative relationship between HDL and CVD. Yes. Narrative review: statin-related myopathy. Morrissey RP, I. The evidence is strongest for statins. 2006;151(2):273–281. Patient information: See related handout on cholesterol-lowering medications, written by the authors of this article. 18. Lorberboym M, ; 27. WHO cooperative trial on primary prevention of ischaemic heart disease with clofibrate to lower serum cholesterol: final mortality follow-up. Foote C, et al. de Craen AJ, Evidence for treating these secondary lipid abnormalities with medications other than statins for primary prevention is not convincing. The most common side effects areintense cutaneous flush which affect more than three quarters of patients, itching, headache andsome patients experience nausea and abdominal discomfort. Drug treatment of lipid disorders. Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial. As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). Safeer, R. S., Lacivita, C.L. *—Intensity of drug therapy should be sufficient to achieve at least a 30 to 40 percent reduction in LDL cholesterol. Morantz C, Poulter C, HDL cholesterol level increases moderately. JAMA. Reprints are not available from the authors. ; et al. 2010;39(6):674–680. Home Books Pharmacotherapy: A Pathophysiologic Approach, 10e. 2005;165(7):725–730. Giral P. Choose a single article, issue, or full-access subscription. et al. 2009;151(9):622–630. Ferguson CD, Lipoprotein metabolism In: Rodés,J. 34. The liver usually uses these circulating fatty acids as a major precursor for triacylglycerol synthesis. Cholesterol and Recurrent Events Trial investigators. Alwaili K, et al. A more recent article on hyperlipidemia is available. McPherson R, In addition HL affects cellular lipid delivery by facilitating lipoprotein absorption by cell surface receptors and proteoglycans12. Lv J, 2002;106(25):3143–3421. Abramson J, et al. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. Optimizing statin treatment for primary prevention of coronary artery disease. corrected] Cigarette smoking; hypertension (systolic blood pressure ≥ 140 mm Hg or on antihypertensive therapy); low HDL cholesterol (< 40 mg per dL [1.04 mmol per L]); family history of premature CHD (male first-degree relative younger than 55 years, female first-degree relative younger than 65 years); age 45 years or older in men, age 55 years or older in women. Alrasadi K, A review of observational studies and RCTs on cholesterol and mortality in 80+-year olds. ; Zulman DM, J Clin Pharm Ther. Bax JJ, Acyl-CoA cholesterol acyl transferase (ACAT) is the enzyme that catalyzes the conversion of intracellular cholesterol into cholesteryl esters.

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