Ezetimibe for the prevention of cardiovascular disease and all-cause mortality events

Zhan, Shipeng; Tang, Min; Liu, Fang; Xia, Peiyuan; Maoqin, Shu; Wu, Xiaojiao

doi:10.1002/14651858.cd012502.pub2

Cited by 64 publications

(54 citation statements)

References 181 publications

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“…Additional treatments of dyslipidemia include ezetimibe (second-line) and fenofibrate (third-line). Ezetimibe, in combination with statin therapy, lowers LDL-C by an additional 20% or so [39] and significantly reduces the risk of major adverse CV events, non-fatal myocardial infarction, and non-fatal stroke compared with statins alone, with less or no effect on fatal endpoints [40]. A simulation based on adding ezetimibe in a huge statin-treated cohort suggests that the percentage of patients with LDL-C > 1.8 mmol/l and >2.4 mmol/l would fall from 65% to 38% and from 25% to 12%, respectively [41].…”

Section: Plos Medicinementioning

confidence: 99%

Efficacy and safety of bempedoic acid for the treatment of hypercholesterolemia: A systematic review and meta-analysis

et al. 2020

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Background Bempedoic acid is a first-in-class lipid-lowering drug recommended by guidelines for the treatment of hypercholesterolemia. Our objective was to estimate its average effect on plasma lipids in humans and its safety profile. Methods and findings We carried out a systematic review and meta-analysis of phase II and III randomized controlled trials on bempedoic acid (PROSPERO: CRD42019129687). PubMed (Medline), Scopus, Google Scholar, and Web of Science databases were searched, with no language restriction, from inception to 5 August 2019. We included 10 RCTs (n = 3,788) comprising 26 arms (active arm [n = 2,460]; control arm [n = 1,328]). Effect sizes for changes in lipids and high-sensitivity C-reactive protein (hsCRP) serum concentration were expressed as mean differences (MDs) and 95% confidence intervals (CIs). For safety analyses, odds ratios (ORs) and 95% CIs were calculated using the Mantel-Haenszel method. Bempedoic acid significantly reduced total cholesterol (MD −14.94%; 95% CI −17.31%, −12.57%; p < 0.001), non-high-density lipoprotein cholesterol (MD −18.17%; 95% CI −21.14%, −15.19%; p < 0.001), low-density lipoprotein cholesterol (MD −22.94%; 95% CI −26.63%, −19.25%; p < 0.001), low-density lipoprotein particle number (MD −20.67%; 95% CI −23.84%, −17.48%; p < 0.001), apolipoprotein B (MD −15.18%; 95% CI −17.41%, −12.95%; p < 0.001), highdensity lipoprotein cholesterol (MD −5.83%; 95% CI −6.14%, −5.52%; p < 0.001), high-density lipoprotein particle number (MD −3.21%; 95% CI −6.40%, −0.02%; p = 0.049), and hsCRP (MD −27.03%; 95% CI −31.42%, −22.64%; p < 0.001). Bempedoic acid did not

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Section: Plos Medicinementioning

confidence: 99%

Efficacy and safety of bempedoic acid for the treatment of hypercholesterolemia: A systematic review and meta-analysis

et al. 2020

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“…Dyslipidemia is a major risk factor for cardiovascular disease (CVD), which remains the leading cause of mortality worldwide. Lipid-lowering drugs, like statins, are the medication most widely prescribed to reduce plasma cholesterol levels (Chou et al, 2016;Zhan et al, 2018). With common and long-term use of such medications, a number of adverse effects have been reported.…”

Section: Introductionmentioning

confidence: 99%

Statin Use Associates With Risk of Type 2 Diabetes via Epigenetic Patterns at ABCG1

Liu¹,

Shen²,

Guo³

et al. 2020

Front. Genet.

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Statin is the medication most widely prescribed to reduce plasma cholesterol levels. Yet, how the medication contributes to diabetes risk and impaired glucose metabolism is not clear. This study aims to examine the epigenetic mechanisms of ABCG1 through which statin use associates with risk of type 2 diabetes. We determined the association between the statin use, DNA methylation at ABCG1 and type 2 diabetes/glycemic traits in the Framingham Heart Study Offspring (FHS, n = 2741), with validation in the Women's Health Initiative Study (WHI, n = 2020). The causal effect of statin use on the risk of type 2 diabetes was examined using a two-step Mendelian randomization approach. Next, based on transcriptome analysis, we determined the links between the medicationassociated epigenetic status of ABCG1 and biological pathways on the pathogenesis of type 2 diabetes. Our results showed that DNA methylation levels at cg06500161 of ABCG1 were positively associated with the use of statin, type 2 diabetes and related traits (fasting glucose and insulin) in FHS and WHI. Two-step Mendelian randomization suggested a causal effect of statin use on type 2 diabetes and related traits through epigenetic mechanisms, specifically, DNA methylation at cg06500161. Our results highlighted that gene expression of ABCG1, ABCA1 and ACSL3, involved in both cholesterol metabolism and glycemic pathways, was inversely associated with statin use, CpG methylation, and diabetic signatures. We concluded that DNA methylation site cg06500161 at ABCG1 is a mediator of the association between statins and risk of type 2 diabetes.

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“… 47 It is unclear if ezetimibe works as monotherapy. 48 The main adverse effects of ezetimibe include myalgias, headaches and hepatitis.…”

Section: Cholesterol Managementmentioning

confidence: 99%

Drugs in secondary stroke prevention

Tremonti¹,

Thieben²

2021

Aust Prescr

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After an ischaemic stroke or transient ischaemic attack, patients have a high risk of having another stroke. Secondary stroke prevention includes antiplatelet therapy, statins and antihypertensives.Aspirin, clopidogrel, or a combination of aspirin with dipyridamole are first-line options for secondary stroke prevention in the absence of atrial fibrillation.Dual antiplatelet therapy has a benefit in the first three weeks after stroke, but patients should change to a single antiplatelet drug after this time.Anticoagulants are indicated if the patient has atrial fibrillation. Avoid combinations of anticoagulants and antiplatelet drugs.Patients should be started on statins after an ischaemic stroke. High doses are recommended even if cholesterol concentrations are normal.Antihypertensive drugs are recommended for all patients with systolic blood pressures greater than 140/90 mmHg. ACE inhibitors, calcium channel blockers and diuretics are first-line options. Drugs in secondary stroke preventionthere was an increased risk of bleeding with the increased dose range, so typically doses of 75-150 mg are used. The benefit of aspirin has been shown to be even more marked for secondary stroke prevention in the first six weeks post stroke. 5 Aspirin/dipyridamoleDipyridamole should not be used alone in stroke prevention. In trials it was combined with aspirin, typically as aspirin 25 mg and dipyridamole 200 mg. This is an acceptable antiplatelet combination for patients with non-cardioembolic ischaemic stroke or transient ischaemic attack.The 2006 ESPRIT trial found that the combination of aspirin and dipyridamole had a benefit over aspirin alone with regard to secondary stroke risk, and nonfatal bleeding. 8 It is worth noting however that the majority of patients were randomised after more than one month, and so it is unclear if aspirin/dipyridamole has benefit over aspirin immediately after a stroke.Dipyridamole has a vasodilatory action and headache is a common adverse effect which may lower adherence to treatment. 9 Dipyridamole's vasodilatory effect also means care should be used in patients with unstable angina or aortic stenosis.

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Ezetimibe for the prevention of cardiovascular disease and all-cause mortality events

Abstract: Analysis 1.13. Comparison 1 Ezetimibe plus other lipid-modifying drugs vs other lipid-modifying drugs alone or plus placebo, Outcome 13 Myocardial infarction (sensitivity analysis: excluding the studies compared ezetimibe plus statins versus double-dose statins alone

Cited by 64 publications

References 181 publications

Efficacy and safety of bempedoic acid for the treatment of hypercholesterolemia: A systematic review and meta-analysis

Efficacy and safety of bempedoic acid for the treatment of hypercholesterolemia: A systematic review and meta-analysis

Statin Use Associates With Risk of Type 2 Diabetes via Epigenetic Patterns at ABCG1

Drugs in secondary stroke prevention

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