Evolving Role of Non‐Statin Therapy for the Management of Dyslipidemia and Cardiovascular Risk Reduction: Past, Present, and Future

Sisson, Evan M.; Pamulapati, Lauren G.; Bucheit, John D.; Kelly, Michael S.

doi:10.1002/phar.2074

Cited by 6 publications

(4 citation statements)

References 37 publications

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“…Nowadays, with the emergence of new preparations and therapeutics, as well as the appearance of some adverse reactions and tolerance phenomenon of statins in their applications, the statin monotherapies have been questioned [1,2,5]. Nonstatin therapy has gradually entered the field of vision [6]. However, in the clinical practice, evidence such as RCTs, guidelines, and recommendations for these nonstatin therapies are very limited, which provides little evidencebased efficacy support for clinicians to use only nonstatin therapies in the treatment of dyslipidemia.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials

Zhang

Lü

Jia

et al. 2020

Cardiovascular Therapeutics

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Objective. The drug efficacy may differ among different statins, and evidence from head-to-head comparisons is sparse and inconsistent. The study is aimed at comparing the lipid-lowering/increasing effects of 7 different statins in patients with dyslipidemia, cardiovascular diseases, or diabetes mellitus by conducting systematic review and network meta-analyses (NMA) of the lipid changes after certain statins’ use. Methods. In this study, we searched four electronic databases for randomized controlled trials (RCTs) published through February 25, 2020, comparing the lipid-lowering efficacy of no less than two of the included statins (or statin vs. placebo). Three reviewers independently extracted data in duplicate. Firstly, mixed treatment overall comparison analyses, in the form of frequentist NMAs, were conducted using STATA 15.0 software. Then, subgroup analyses were conducted according to different baseline diseases. At last, sensitivity analyses were conducted according to age and follow-up duration. The trial was registered with PROSPERO (number CRD42018108799). Results. As a result, seven statin monotherapy treatments in 50 studies (51956 participants) were used for the analyses. The statins included simvastatin (SIM), fluvastatin (FLU), atorvastatin (ATO), rosuvastatin (ROS), lovastatin (LOV), pravastatin (PRA), and pitavastatin (PIT). In terms of LDL-C lowering, rosuvastatin ranked 1st with a surface under cumulated ranking (SUCRA) value of 93.1%. The comparative treatment efficacy for LDL-C lowering was ROS>ATO>PIT>SIM>PRA>FLU>LOV>PLA. All of the other ranking and NMA results were reported in SUCRA plots and league tables. Conclusions. According to the NMAs, it can be concluded that rosuvastatin ranked 1st in LDL-C, ApoB-lowering efficacy and ApoA1-increasing efficacy. Lovastatin ranked 1st in TC- and TG-lowering efficacy, and fluvastatin ranked 1st in HDL-C-increasing efficacy. The results should be interpreted with caution due to some limitations in our review. However, they can provide references and evidence-based foundation for drug selection in both statin monotherapies and statin combination therapies.

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Section: Introductionmentioning

confidence: 99%

“…Therefore, at present, statins are still one of the main drugs for the treatment of hyperlipidemia, especially in combination with other drugs. Absolute nonstatin therapies should only be considered in high-risk patients who have a suboptimal response to statins and/or are intolerant to statin therapy [6].…”

Section: Introductionmentioning

confidence: 99%

Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials

Zhang

Lü

Jia

et al. 2020

Cardiovascular Therapeutics

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“…Because the timeframe of 1 January–31 December 2013 is the newly released 2013 ACC/AHA cholesterol treatment guide, there was no buffer period. 13 …”

Section: Discussionmentioning

confidence: 99%

“…The lack of definitive cardiovascular benefit had previously limited the widespread adoption of ezetimibe. 13 However, patients with genetic mutations such as Niemann-Pick C1 like 1 (NPC1L1) and HMGCR are especially affected by ezetimibe use in terms of LDL-C and cardiovascular risk reduction. As a considerable proportion of the Taiwanese population carry these mutations, ezetimibe is likely to be of use in this region.…”

Section: Discussionmentioning

confidence: 99%

Consumption and market share of cholesterol-lowering drugs in high-risk patients before and after the release of the 2013 ACC/AHA cholesterol guidelines: a retrospective observational study

2020

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ObjectiveWe examined the use of cholesterol-lowering drugs in Taiwan in high-risk patients before and after the release of the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) cholesterol guidelines.DesignRetrospective observational study.SettingKaohsiung Chang Gung Memorial Hospital database, Kaohsiung City, Taiwan.ParticipantsOutpatients aged ≥20 years with atherosclerosis cardiovascular disease, familial hypercholesterolaemia and diabetes.Primary and secondary outcome measuresData on brand and generic names, use and dosage of cholesterol-lowering drugs in 2012 and 2015 were compiled and the total amount used was calculated. Differences in usage and market share were compared. Usage rates of single and fixed-dose combination (FDC) products were compared.ResultsThe number of patients receiving ambulatory care increased from 36 367 in 2012 to 41 807 in 2015. Single (3 679 979–4 568 086 tablets) and FDC (540 522–572 954 tablets) product use increased from 2012 to 2015, respectively. Statins were the most commonly prescribed medications in 2012 (71.14%) and 2015 (72.91%). The average monthly consumption of statin among high-risk patients in 2012 was 269 948.8 tablets, and it increased significantly to 343 975.3 tablets in 2015. The average monthly consumption of pitavastatin was 34 113.4 tablets in 2015, which was significantly higher than 0 in 2012. Conversely, the highest decline was observed for fluvastatin use, with the average monthly consumption being 38 754.3 tablets in 2015, which was significantly lower than 45 929.8 tablets consumed in 2012. Regarding FDC therapy for cholesterol-lowering drugs, Vytorin (ezetimibe 10 mg + simvastatin 20 mg) use was the highest among all FDCs in 2015.ConclusionsThe 2013 ACC/AHA cholesterol guidelines likely promoted the use of fixed-dose, high-intensity and moderate-intensity monotherapy and FDC therapy statins in high-risk groups, and this was consistent with the use of high-intensity or moderate-intensity statins in the present study. Furthermore, these changes were associated with increased effectiveness and reduced adverse effects.

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Recent Updates on the Use of PCSK9 Inhibitors in Patients with Atherosclerotic Cardiovascular Disease

Pamulapati

Bucheit

Sisson

et al. 2019

Curr Atheroscler Rep

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Evolving Role of Non‐Statin Therapy for the Management of Dyslipidemia and Cardiovascular Risk Reduction: Past, Present, and Future

Cited by 6 publications

References 37 publications

Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials

Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials

Consumption and market share of cholesterol-lowering drugs in high-risk patients before and after the release of the 2013 ACC/AHA cholesterol guidelines: a retrospective observational study

Recent Updates on the Use of PCSK9 Inhibitors in Patients with Atherosclerotic Cardiovascular Disease

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