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Statin intolerance

Peter P Toth, Alberico L Catapano, Michel Farnier, Joanne Foody, Joanne E Tomassini, Erin Jensen, Adam B Polis, Mary E Hanson, Thomas A Musliner, Andrew M Tershakovec
Statin therapy is associated with a slightly increased risk of developing diabetes mellitus and insulin resistance in patients without diabetes. Ezetimibe combined with statins may be considered for high-risk patients who do not achieve optimal low-density lipoprotein cholesterol lowering on statin monotherapy or who are statin intolerant. Changes in fasting serum glucose (FSG) levels during ezetimibe, ezetimibe/statin, and statin treatments were assessed using data pooled from clinical trials in hypercholesterolemic and heterozygous familial hypercholesterolemic patients, who were or were not receiving statin therapy...
September 13, 2016: American Journal of Cardiology
Kathy L Schulman, Lois E Lamerato, Mehul R Dalal, Jennifer Sung, Mehul Jhaveri, Andrew Koren, Usha G Mallya, JoAnne M Foody
OBJECTIVES: To develop and validate algorithms to define statin intolerance (SI) in an administrative database using electronic medical records (EMRs) as the reference comparison. METHODS: One thousand adults with one or more qualifying changes in statin therapy and one or more previous diagnoses of hyperlipidemia, hypercholesterolemia, or mixed dyslipidemia were identified from the Henry Ford Health System administrative database. Data regarding statin utilization, comorbidities, and adverse effects were extracted from the administrative database and corresponding EMR...
September 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Karen M Goldstein, Leah L Zullig, Lori A Bastian, Hayden B Bosworth
PURPOSE OF REVIEW: Cardiovascular disease (CVD) continues to be the leading cause of death for men and women in the USA. Statins have contributed significantly to noted declines in cardiovascular-related mortality in the last decade; however, the benefit of statins is inequitable across genders. Women continue to be less likely to take statins and to meet target LDL goals than men. As a possible contributing factor to this disparity, we explore the evidence for gender-based differences in provision of, and adherence to statins...
November 2016: Current Atherosclerosis Reports
Thomas Knickelbine, Matthew Lui, Ross Garberich, Michael D Miedema, Craig Strauss, Jeffrey J VanWormer
BACKGROUND: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disease resulting in elevated serum low-density lipoprotein cholesterol (LDL-C) levels. Patients with FH have a very high lifetime risk of cardiovascular disease, but FH often goes unrecognized in clinical care. New treatments including PCSK9 inhibitors are now available for this population, and the use of the electronic record may be able to help identify potential patients for therapy. OBJECTIVES: The goal of this study was to determine the period prevalence of FH in a large ambulatory care population, including the homozygous form...
September 2016: Journal of Clinical Lipidology
Ozlem Bilen, Christie M Ballantyne
Bempedoic acid (ETC-1002), a novel therapeutic approach for low-density lipoprotein cholesterol (LDL-C) lowering, inhibits ATP citrate lyase (ACL), an enzyme involved in fatty acid and cholesterol synthesis. Although rodent studies suggested potential effects of ACL inhibition on both fatty acid and cholesterol synthesis, studies in humans show an effect only on cholesterol synthesis. In phase 2 studies, ETC-1002 reduced LDL-C as monotherapy, combined with ezetimibe, and added to statin therapy, with LDL-C lowering most pronounced when ETC-1002 was combined with ezetimibe in patients who cannot tolerate statins...
October 2016: Current Atherosclerosis Reports
Alon Eisen, Robert P Giugliano
PURPOSE OF REVIEW: Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors are promising therapies that inhibit the degradation of low-density lipoprotein (LDL) receptors in the hepatocyte and thus increase LDL cholesterol (LDL-C) uptake from the blood. This review summarizes main findings in the field of PCSK9 inhibitors, from basic mechanism to clinical studies, and aims to provide a contemporary and practical overview of the clinical implication and future directions with PCSK9 inhibitors...
November 2016: Current Opinion in Cardiology
Alessandro Colletti, Giuseppe Derosa, Arrigo Fg Cicero
Hypercholesterolemia is one of the main risk factors for atherosclerosis and cardiovascular diseases. The treatment is based on the modification of the diet and lifestyle and if necessary on a pharmacological therapy. The most widely used drugs are the inhibitors of 3-hydroxy-3-methyl-glutaryl coenzyme A reductase (statins); nevertheless, many patients do not reach optimal levels of low-density lipoprotein-cholesterol (LDL-C) even with maximal dosage of statins (eventually associated to ezetimibe) or present side effects, which do not allow them to continue the treatment...
2016: Therapeutics and Clinical Risk Management
Engi Abdel-Hady Algharably, Iris Filler, Stephanie Rosenfeld, Katja Grabowski, Reinhold Kreutz
Introduction Statin therapy is the backbone of pharmacologic therapy for low-density lipoproteins cholesterol lowering and plays a pivotal role in cardiovascular disease prevention. Statin intolerance is understood as the inability to continue using a statin to reduce individual cardiovascular risk sufficiently, due to the development of symptoms or laboratory abnormalities attributable to the initiation or dose escalation of a statin. Muscle symptoms are the most common side effects observed. Areas covered The main aim of this article is to present a review on published definitions of statin intolerance...
September 19, 2016: Expert Opinion on Drug Safety
Evaggelia Papadopoulou, Maria Meidani, Maria Boutsikou, Pinelopi Papaspiropoulou, Theodosia Kelaiditou, Afedia Koukouzli, Anastasia Tapola, Ioanna Voudoufianaki, Sophie Mavrogeni, Niki Katsiki, Genovefa Kolovou, Ioannis Lekakis
AIMS: Specialized nurses estimated the HeartScore in an urban Greek population by recognizing cardiovascular disease (CVD) risk factors in the setting of the Onassis Cardiovascular Prevention Program (OCPP). They also provided nursing consultation and assessed the clinical and biochemical characteristics of the studied population. METHODS AND RESULTS: Individuals were recruited through TV announcements and via the website of the Onassis Cardiac Surgery Centre. All participants visited the Onassis Cardiac Centre from 20 September to 30 October 2011...
September 14, 2016: Current Vascular Pharmacology
Michael D Miedema, Salim S Virani
Despite significant progress in pharmacologic treatment aimed at lowering low-density lipoprotein cholesterol to reduce cardiovascular disease risk, a number of patient groups that often prove difficult to treat remain. Patients with familial hypercholesterolemia may go undiagnosed and untreated or, despite treatment, have persistently elevated lipid levels that confer a high cardiovascular disease risk. Although the true prevalence is unknown, statin intolerance is a common clinical presentation that is difficult to assess and frequently leads to suboptimal lipid treatment...
September 15, 2016: American Journal of Cardiology
Wanda C Lakey, Nicole G Greyshock, Carly E Kelley, Mohammad A Siddiqui, Umar Ahmad, Yuliya V Lokhnygina, John R Guyton
BACKGROUND: Statins effectively prevent atherosclerotic cardiovascular disease, but rates of statin discontinuation after adverse events are high. OBJECTIVE: Describe the range and relative frequencies of adverse events potentially attributable to statins in lipid referral practice and assess statin rechallenge outcomes. METHODS: Retrospective cohort study of 642 patients with statin-associated adverse events evaluated in a referral lipid clinic between January 1, 2004 and January 27, 2011...
July 2016: Journal of Clinical Lipidology
Jonathan A Tobert, Connie B Newman
The nocebo effect, the inverse of the placebo effect, is a well-established phenomenon that is under-appreciated in cardiovascular medicine. It refers to adverse events, usually purely subjective, that result from expectations of harm from a drug, placebo, other therapeutic intervention or a nonmedical situation. These expectations can be driven by many factors including the informed consent form in a clinical trial, warnings about adverse effects communicated by clinicians when prescribing a drug, and information in the media about the dangers of certain treatments...
July 2016: Journal of Clinical Lipidology
Enrico Agabiti Rosei, Massimo Salvetti
Control of lipid levels is one of the most effective strategies for cardiovascular (CV) event prevention. In fact, many clinical trials have clearly demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering, primarily with statins, reduces major CV events and mortality. The evidence from these trials has been useful in designing the cholesterol treatment guidelines, which are mainly aimed at preventing and managing cardiovascular disease (CVD). However, available data indicate that a large proportion of patients fail to achieve lipid goals, and this is particularly frequent in patients at high or very high CV risk...
September 2016: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
Eliano P Navarese, Michalina Kołodziejczak, Dimitrios Dimitroulis, Georg Wolff, Hans L Busch, Fiorella Devito, Alessandro Sionis, Marco Matteo Ciccone
Statins are recommended as first-line therapy for patients with hypercholesterolaemia. A sizable proportion of patients, however, does not reach therapeutic goals, is statin intolerant, or, despite optimal statin therapy, is at high risk of ischaemic events. Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a major role in lipid metabolism and several comorbidities. Monoclonal antibodies targeting PCSK9 are a new lipid-lowering approach with the potential to improve clinical outcomes in patients with dyslipidaemia...
January 2016: European Heart Journal. Cardiovascular Pharmacotherapy
Paul M Ridker, Pierre Amarenco, Robert Brunell, Robert J Glynn, J Wouter Jukema, John J P Kastelein, Wolfgang Koenig, Steven Nissen, James Revkin, Raul D Santos, Pamela F Schwartz, Carla Yunis, Jean-Claude Tardif
BACKGROUND: Although statins significantly reduce vascular event rates, residual cholesterol risk remains high in many patient groups, including those with known vascular disease as well as in the setting of high-risk primary prevention. Bococizumab is a humanized monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9), prolongs the half-life of hepatic low-density lipoprotein (LDL) receptors, and reduces circulating atherogenic cholesterol levels. DESIGN: The SPIRE program comprises 6 lipid-lowering studies and 2 cardiovascular outcomes trials, each comparing bococizumab (150 mg subcutaneously every 2 weeks) to matching placebo...
August 2016: American Heart Journal
David R Saxon, Robert H Eckel
Statin intolerance is a commonly encountered clinical problem for which useful management strategies exist. Although many patients report statin-related muscle symptoms, studies indicate that the majority of these patients can tolerate a statin upon re-challenge. Alternative statin dosing strategies are an effective way to modify and reintroduce statin therapy for patients reporting adverse symptoms. Correction of vitamin D deficiency and hypothyroidism may improve statin tolerability in some patients. CoQ10 supplementation has been found to be of no benefit for statin-related muscle symptoms in most recent clinical trials...
September 2016: Progress in Cardiovascular Diseases
H Qu, M Guo, N Kou, H-T Wu, Y Zhang, Z-Y Gao, D-Z Shi
WHAT IS KNOWN AND OBJECTIVES: Choosing an alternative statin is recommended when managing statin-associated muscle symptoms (SAMS) and new hydrophilic statins are often suggested. We report on a case of statin-associated muscle damage that was successfully managed by simplifying the patient's combination therapy with simvastatin-ezetimibe to simvastatin alone. CASE SUMMARY: The patient experienced SAMS when he was successively treated with atorvastatin, rosuvastatin, Xuezhikang capsule and combined simvastatin/ezetimibe therapy...
October 2016: Journal of Clinical Pharmacy and Therapeutics
Marc S Sabatine, James A Underberg, Michael Koren, Seth J Baum
Elevation of low-density lipoprotein cholesterol (LDL-C) is an important cause of atherosclerotic cardiovascular disease (ASCVD). Over the years, clinical outcome studies with LDL-C lowering agents have revealed that reducing LCL-C levels is effective in reducing rates of major ASCVD events. Although secondary factors play a role in clinical expression, severe lipid disorders often have a strong genetic component. Genetic revelations have provided novel targets for improving LDL-C management in high-risk individuals...
October 2016: Postgraduate Medicine
Om P Ganda
Persuasive data from many randomized controlled trials and large, long-term observational studies indicate a modestly increased risk for the emergence of new diabetes after statin initiation. Several meta-analyses of many statin trials as well as longitudinal population-based studies suggest that the risk factors for diabetes in statin-treated persons include underlying risk for diabetes at baseline (specifically features of metabolic syndrome), the intensity of statin therapy, certain genetic traits independent of diabetes risk, and adherence to lifestyle factors...
2016: F1000Research
Konstantinos Koskinas, Matthias Wilhelm, Stephan Windecker
Statins are the cornerstone of the management of dyslipidaemias and prevention of cardiovascular disease. Although statins are, overall, safe and well tolerated, adverse events can occur and constitute an important barrier to maintaining long-term adherence to statin treatment. In patients who cannot tolerate statins, alternative treatments include switch to another statin, intermittent-dosage regimens and non-statin lipid-lowering medications. Nonetheless, a high proportion of statin-intolerant patients are unable to achieve recommended low-density lipoprotein (LDL) cholesterol goals, thereby resulting in substantial residual cardiovascular risk...
2016: Swiss Medical Weekly
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