-
1.
Current Drugs and Nutraceuticals for the Treatment of Patients with Dyslipidemias.
Scognamiglio, M, Costa, D, Sorriento, A, Napoli, C
Current pharmaceutical design. 2019;(1):85-95
Abstract
Coronary heart disease (CHD) remains the leading cause of disability and death in industrialized Countries. Among many conditions, which contribute to the etiology and progression of CHD, the presence of high low density lipoprotein-cholesterol (LDL-C) levels represents the major risk factor. Therefore, the reduction of LDL-C levels plays a key role in the management of patients with high or very high cardiovascular risk. Although statins represent the gold standard therapy for the reduction of cholesterol levels, these drugs do not allow to achieve target levels of LDL-C in all patients. Indeed, a significant number of patients resulted intolerants, especially when the dosage increased. The availability of new lipid-lowering drugs, such as ezetimibe and PCSK9 inhibitors, may represent an important alternative or complement to the conventional lipid-lowering therapies. However, long-term studies are still needed to define both efficacy and safety of use of these latter new drugs. Some nutraceuticals may become an adequate and effective support in the management of some patients. To date, several nutraceuticals with different mechanism of actions that provide a good tolerability are available as lipidlowering agents. In particular, the most investigated are red yeast rice, phytosterols, berberine, beta-glucans and soy. The aim of this review was to report recent data on the efficacy and safety of principle hypocholesterolemic drugs available and to evaluate the possible role of some nutraceuticals as support therapy in the management of patients with dyslipidemias.
-
2.
Lipotoxicity in Kidney, Heart, and Skeletal Muscle Dysfunction.
Nishi, H, Higashihara, T, Inagi, R
Nutrients. 2019;(7)
Abstract
Dyslipidemia is a common nutritional and metabolic disorder in patients with chronic kidney disease. Accumulating evidence supports the hypothesis that prolonged metabolic imbalance of lipids leads to ectopic fat distribution in the peripheral organs (lipotoxicity), including the kidney, heart, and skeletal muscle, which accelerates peripheral inflammation and afflictions. Thus, lipotoxicity may partly explain progression of renal dysfunction and even extrarenal complications, including renal anemia, heart failure, and sarcopenia. Additionally, endoplasmic reticulum stress activated by the unfolded protein response pathway plays a pivotal role in lipotoxicity by modulating the expression of key enzymes in lipid synthesis and oxidation. Here, we review the molecular mechanisms underlying lipid deposition and resultant tissue damage in the kidney, heart, and skeletal muscle, with the goal of illuminating the nutritional aspects of these pathologies.
-
3.
Efficacy and Safety of Triple Therapy With Telmisartan, Amlodipine, and Rosuvastatin in Patients With Dyslipidemia and Hypertension: The Jeil Telmisartan, Amlodipine, and Rosuvastatin Randomized Clinical Trial.
Hong, SJ, Jeong, HS, Cho, JM, Chang, K, Pyun, WB, Ahn, Y, Hyon, MS, Kang, WC, Lee, JH, Kim, HS
Clinical therapeutics. 2019;(2):233-248.e9
Abstract
PURPOSE Fixed-dose combination therapy with telmisartan, amlodipine, and rosuvastatin is needed in patients with hypertension and dyslipidemia for better adherence and cost-effectiveness than free-equivalent combination therapies. This study aimed to compare the efficacy and safety of combination therapy with telmisartan, amlodipine, and rosuvastatin versus telmisartan plus amlodipine or telmisartan plus rosuvastatin in patients with hypertension and dyslipidemia. METHODS The Jeil Telmisartan, Amlodipine, and Rosuvastatin Randomized Clinical Trial (J-TAROS-RCT) was an 8-week, multicenter, randomized, double-blind, parallel, Phase III clinical trial conducted at 9 hospitals in Korea. After a run-in period of >4 weeks, patients who fulfilled the criteria of the National Cholesterol Education Program Adult Treatment Panel III guidelines were eligible for randomization to receive 1 of 3 treatments for 8 weeks: (1) telmisartan/amlodipine 80 mg/10 mg plus rosuvastatin 20 mg, (2) telmisartan/amlodipine 80 mg/10 mg, or (3) telmisartan 80 mg plus rosuvastatin 20 mg. The primary end point was efficacy evaluation of combination therapy with telmisartan/amlodipine/rosuvastatin by comparing the change in mean sitting systolic blood pressure (msSBP) and mean percentage change in LDL-C from baseline after 8 weeks of treatment. Adverse events (AEs), clinical laboratory data, and vital signs were assessed in all patients. FINDINGS Among 148 patients, the changes in msSBP from baseline after 8 weeks of treatment were a mean (SD) of -24.41 (2.38) versus -9.31 (2.36) mm Hg in the telmisartan/amlodipine/rosuvastatin and telmisartan/rosuvastatin groups, respectively. Significantly more participants achieved the target BP at week 8 in the telmisartan/amlodipine/rosuvastatin group (41 patients [87.2%]) than in the telmisartan/rosuvastatin group (24 [50.0%], P < 0.001). The changes in mean (SD) LDL-C at 8 weeks compared with baseline values were -57.59% (11.59%) versus 6.08% (20.98%) in the telmisartan/amlodipine/rosuvastatin and telmisartan/amlodipine groups, respectively. The percentages of patients who achieved the target LDL-C according to their risk factors after 8 weeks of treatment were 97.87% vs 6.12% in the telmisartan/amlodipine/rosuvastatin and the telmisartan/amlodipine groups (P < 0.0001), respectively. No significant differences were found in the incidence of overall AEs and adverse drug reactions, and serious AEs were comparable among 3 groups. IMPLICATIONS Fixed-dose combinations of telmisartan, amlodipine, and rosuvastatin decreased BP and LDL-C in patients with hypertension and dyslipidemia. The safety and tolerability profiles of fixed-dose telmisartan, amlodipine, and rosuvastatin combination therapy were comparable with those of telmisartan plus amlodipine or telmisartan plus rosuvastatin. ClinicalTrials.gov identifier: NCT03088254.
-
4.
Current pharmacotherapeutic options for primary dyslipidemia in adults.
Cicero, AFG, Landolfo, M, Ventura, F, Borghi, C
Expert opinion on pharmacotherapy. 2019;(10):1277-1288
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (ASCVD) and its clinical manifestations, remain a leading cause of death and disability worldwide. One of the major risk factors of ASCVD is dyslipidemia and all the available guidelines suggest the importance of strategies for lipid control in a remarkable proportion of the general population. AREAS COVERED This review focuses on the therapeutic options available for the management of lipid disorders in adults. EXPERT OPINION A large body of evidence supports that statins are still the first-line option for the management of hypercholesterolemia in a large percentage of patients. Statins should be given at the appropriate dose and considering the differences in lipid-lowering potency across the different medications. The main current challenge in the treatment of lipid disorders is the need of improving patient adherence and persistence to lipid-lowering treatments beyond the drug choice and the target lipid component. To achieve this goal, the best strategy would be to treat the patients by using the appropriate drugs given at adequate doses to reach the treatment target. We should also avoid drug interactions, monitor possible untoward side effects and promote adherence to treatment by tailoring treatment strategies to each patient.
-
5.
Effect of purslane on blood lipids and glucose: A systematic review and meta-analysis of randomized controlled trials.
Hadi, A, Pourmasoumi, M, Najafgholizadeh, A, Kafeshani, M, Sahebkar, A
Phytotherapy research : PTR. 2019;(1):3-12
Abstract
Despite a history of purslane usage as a herbal treatment for dyslipidemia and hyperglycemia management, existing evidence from clinical trials is controversial. The aim for the current study was to evaluate the efficacy of purslane supplementation on lipid parameters and glycemic status in adult populations. A systematic review was conducted in PubMed, Scopus, ISI Web of Science, and Google Scholar up to January 15, 2018, searching for randomized controlled trials that assessed the impact of purslane on fasting blood glucose (FBG), triglycerides, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Based on the detected heterogeneity between studies, a random- or fixed-effect model was applied in the meta-analysis. The findings from six randomized controlled trials, comprising 352 participants, indicated that purslane can reduce FBG (-4.54 mg/dl, 95% CI [-7.54, -1.53]; I2 = 0.53%) and triglycerides (-19.16 mg/dl, 95% CI [-38.17, -0.15]; I2 = 0%) levels. Changes in TC, LDL-C, and HDL-C concentrations did not reach a statistically significant level. Subgroup analysis showed a favorable effects of purslane on FBG, triglycerides, TC, and LDL-C in a subset of studies in which purslane was administered >1.5 g/day. Categorization based on gender showed that purslane was more effective in improving FBG, TC and LDL-C in females compared with males. This systematic review and meta-analysis suggested that the purslane might be effective on the improvement of blood lipid and glucose levels. Further robust studies with sufficient durations and dosages of supplementation are needed to confirm these results.
-
6.
Can alternate-day Statin regimen minimize its adverse effects on muscle and tendon? A systematic review.
Muhammad, ZA, Ahmad, T, Baloch, N
JPMA. The Journal of the Pakistan Medical Association. 2019;(7):1006-1013
Abstract
OBJECTIVE To review evidence-based data with respect to safety and efficacy of alternate-day statin therapy in dyslipidaemia compared to the standard daily dose. METHODS The literature review was conducted at Aga Khan University Hospital, Karachi from July, 2016 to August, 2017. Electronic database search was carried out to compile available literature using PubMed, Excerpta Medica database and Google Scholar. The most relevant evidence-based research articles published over 10 years were selected. The latest search was dated August 03, 2017. RESULTS A total of 2,074 articles were initially located. Alternate day statin regimen was reported in 53% of articles. Adverse effects on muscle and tendon were reported in 69% of articles. After scrutiny, 19(0.9%) studies covering alternate-day statin-mediated muscle and tendon disorders and 9(0.4%) studies encompassing the potential pathophysiological mechanisms of statin-associated muscle and tendon injury were selected. Except pravastatin and lovastatin, alternate-day statin therapy was almost as effective in lowering total cholesterol, low-density lipoprotein cholesterol and triglycerides as the daily dosing with low incidence of muscle toxicity and tends in opathy. CONCLUSIONS Alternate-day statin regimen was found to be very well tolerated and might be an effective and safe remedy in clinical practice.
-
7.
Pemafibrate Tends to have Better Efficacy in Treating Dyslipidemia than Fenofibrate.
Wang, H, Li, H, Zhou, Y, Liu, J, Wang, F, Zhao, Q
Current pharmaceutical design. 2019;(44):4725-4734
Abstract
AIMS: To compare the efficacy of pemafibrate (PF) and fenofibrate (FF) in treating dyslipidemia. METHODS A comprehensive search was performed on the public database to identify relevant randomized controlled trials (RCTs), which compared the effects of PF and FF treatment in lipid parameters among patients with dyslipidemia. Mean difference (MD) and 95% confidence intervals (CI) were pooled for continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated for dichotomous outcomes. RESULTS Three RCTs were included with a total of 744 patients (PF=547 and FF=197). Compared with the FF group (100mg/day), PF group (0.05 to 0.4mg/day) had a better effect on reducing triglycerides (TGs) (MD, -8.66; 95%CI, -10.91 to -6.41), very low-density lipoprotein cholesterol (VLDL-C, MD, -12.19; 95%CI, -15.37 to - 9.01), remnant lipoprotein cholesterol (MD, -13.16; 95%CI, -17.62 to -8.69), apolipoprotein-B48 (ApoB48, MD, -12.74; 95%CI, -17.71 to -7.76) and ApoCIII (MD, -6.25; 95%CI, -11.85 to -0.64). Although a slightly LDL-Cincreasing effect was found in PF-treated group (MD, 3.10; 95%CI, -0.12 to 6.09), the levels of HDL-C (MD, 3.59; 95%CI, 1.65 to 5.53) and ApoAI (MD, 1.60; 95%CI, 0.38 to 2.82) were significantly increased in the PF group. However, no significant difference was found in the level of total cholesterol (MD, 0.01; 95%CI, -1.37 to - 1.39), non-HDL-C (MD, -0.06; 95%CI, -1.75 to 1.63), ApoB (MD, 0.39; 95%CI, -1.37 to 2.15) and ApoAII (MD, 3.31; 95%CI, -1.66 to 8.29) between the two groups. In addition, the incidence of total adverse events (OR, 0.68; 95%CI, 0.53 to 0.86) and adverse drug reactions (OR, 0.36; 95%CI, 0.24 to 0.54) was lower in the PF group than that in the FF group. CONCLUSIONS Pemafibrate tends to have better efficacy in treating dyslipidemia than fenofibrate.
-
8.
Statins an oft-prescribed drug is implicated in peripheral neuropathy: The time to know more.
Al-Kuraishy, HM, Al-Gareeb, AI, Hussien, NR, Al-Naimi, MS, Rasheed, HA
JPMA. The Journal of the Pakistan Medical Association. 2019;(8):S108-S112
Abstract
Statins are hydroxymethylglutaryl-coenzyme A reductase inhibitors inhibit denovo cholesterol synthesis leading to reduction of serum cholesterol and low density lipoprotein as well as elevation of high density lipoprotein level. Statins are used in the treatment of dyslipidaemia, prevention of major cardiovascular events and complications. The potential role of statins in the induction of peripheral neuropathy has not been verified as most of statins induced-peripheral neuropathy had been reported as case reports. Also, statins therapy leads to noteworthy reduction of Coenzyme Q10, causing impairment of neuronal energy. The incidence of polyneuropathy was high with atorvastatin (65%) which is lipophilic, and relatively less with fluvastatin (54%) which is hydrophilic. Long-term statins therapy, mainly with atorvastatin and simvastatin, is linked with thedevelopment of peripheral neuropathy.
-
9.
Three-arm, placebo-controlled, randomized clinical trial evaluating the metabolic effect of a combined nutraceutical containing a bergamot standardized flavonoid extract in dyslipidemic overweight subjects.
Cicero, AFG, Fogacci, F, Bove, M, Giovannini, M, Borghi, C
Phytotherapy research : PTR. 2019;(8):2094-2101
Abstract
Our double-blind, placebo-controlled, parallel-group, dose-escalation, clinical trial aimed to test the effect of a combined nutraceutical containing bergamot extract (120-mg flavonoids), phytosterols, vitamin C, and chlorogenic acid from dry artichoke extract on 90 overweight dyslipidemic subjects. Participants were randomly allocated to treatment with two pills of either active treatment or placebo, or a combination of both (a pill per treatment). After 8 weeks, all active-treated groups experienced a significant improvement in triglycerides (TG) versus placebo and in low-density lipoprotein cholesterol (LDL-C) versus baseline and placebo treatments. In the high-dose-treated group, also total cholesterol (TC), nonhigh-density lipoprotein cholesterol (non-HDL-C), γ-glutamil transpeptidasi, high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) significantly decreased. At 24-week follow-up, TG levels maintained lower than baseline in all groups. All patients allocated to either low-dose or high-dose active treatment experienced a significant decrease in TG, LDL-C, and homeostatin model assessment of insulin resistance. In subjects taking high-dose active treatment, adiponectin significantly increased, whereas TC, non-HDL-C, insulin (fasting plasma insulin), leptin, leptin/adiponectin ratio, hs-CRP, and TNF-α were significantly reduced. The tested nutraceutical showed to improve lipid and glucose metabolism, adipokines pattern, and systemic inflammation in dyslipidemic overweight subjects.
-
10.
Prevalence of dyslipidemia among the diabetic patients in southern Bangladesh: A cross-sectional study.
Das, H, Banik, S
Diabetes & metabolic syndrome. 2019;(1):252-257
Abstract
AIM: Diabetic dyslipidemia is one of the major risk factors for cardiovascular disease which has a vast mortality rate throughout the world. Early detection and treatment of dyslipidemia can avoid risk for cardiovascular disorder in diabetic patients. This study was conducted to determine the prevalence of and pattern of dyslipidemia in diabetic patients. MATERIALS AND METHODS This cross sectional study was performed in several specialized diabetic hospital of Noakhali, a southern district of Bangladesh. All known cases of diabetes mellitus were evaluated for their lipid profile. A total number of 1008 patients were included in the study having 683 (67.8%) female and 325 (32.2%) male subjects. RESULTS The prevalence of dyslipidemia among the male subjects was 73% while among female subjects 71%. Among diabetic males the percentage of high serum Cholesterol, high serum TG (Triglyceride), low HDL (High density cholesterol) and high LDL (Low density cholesterol) was 35.69%, 44.31%, 50.15% and 72.92% respectively, whereas the female had the percentage at 35.29%, 40.85%, 49.49% and 70.57% respectively. CONCLUSION Majority portion of the study subjects were dyslipidemic. The most prevalent pattern among both male and female was high level of LDL and low level of HDL. The prevalence of dyslipidemia in Bangladesh is significantly high, which indicates the urgency of lifestyle intervention strategies to prevent and manage this important health problem and risk factor.