Limitations of statin monotherapy for the treatment of dyslipidemia: a projection based on the Canadian lipid study – observational

Sénécal, Martin; Fodor, George; Gagné, Claude; Genest, Jacques; Lavoie, Marc-André; McPherson, Ruth; Marentette, Michael; Sebaldt, Rolf J.

doi:10.1185/03007990802575734

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…Also, changing guideline targets such as the recent changes made to the Canadian Lipid Guidelines in 2006, which decreased the target LDL level from 2.5 mmol/L to the more stringent 2.0 mmol/L may have also impacted the rates [51]. Furthermore, some experts have suggested that the choice of medication and a lack of dose titration are two potential reasons for poor LDL control rates [52], while a recent study suggested that 38% of high risk patients would be unable to reach an LDL target of <2.0 mmol/L even when using a maximum dose statin monotherapy [53]. As well, this difficulty in management could potentially be due in part to clinical inertia - resistance of a health care provider to intensify therapy when indicated – as there could be a need to change drug therapies, doses or initiate counselling to change lifestyle habits (e.g., diet, exercise, etc.).…”

Section: Discussionmentioning

confidence: 99%

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Liddy

Singh

Hogg

et al. 2012

BMC Cardiovasc Disord

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BackgroundPrimary care plays a key role in the prevention and management of cardiovascular disease (CVD). We examined primary care practice adherence to recommended care guidelines associated with the prevention and management of CVD for high risk patients.MethodsWe conducted a secondary analysis of cross-sectional baseline data collected from 84 primary care practices participating in a large quality improvement initiative in Eastern Ontario from 2008 to 2010. We collected medical chart data from 4,931 patients who either had, or were at high risk of developing CVD to study adherence rates to recommended guidelines for CVD care and to examine the proportion of patients at target for clinical markers such as blood pressure, lipid levels and hemoglobin A1c.ResultsAdherence to preventive care recommendations was poor. Less than 10% of high risk patients received a waistline measurement, half of the smokers received cessation advice, and 7.7% were referred to a smoking cessation program. Gaps in care exist for diabetes and kidney disease as 54.9% of patients with diabetes received recommended hemoglobin-A1c screenings, and only 55.8% received an albumin excretion test. Adherence rates to recommended guidelines for coronary artery disease, hypertension, and dyslipidemia were high (>75%); however <50% of patients were at target for blood pressure or LDL-cholesterol levels (37.1% and 49.7% respectively), and only 59.3% of patients with diabetes were at target for hemoglobin-A1c.ConclusionsThere remain significant opportunities for primary care providers to engage high risk patients in prevention activities such as weight management and smoking cessation. Despite high adherence rates for hypertension, dyslipidemia, and coronary artery disease, a significant proportion of patients failed to meet treatment targets, highlighting the complexity of caring for people with multiple chronic conditions.Trial RegistrationNCT00574808

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Section: Discussionmentioning

confidence: 99%

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Liddy

Singh

Hogg

et al. 2012

BMC Cardiovasc Disord

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“…Several guidelines and studies recommend high-intensity statins for patients who are incapable of attaining the target lipid levels [2]. However, an increase in the dose of statins alone does not achieve the recommended target low-density lipoprotein cholesterol (LDL-C) levels [3], as only a 6% reduction in LDL-C can be achieved by doubling the statin dose [4]. Thus, the addition of other LDL-C lowering agents is useful for further LDL-C level reduction [5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Combination Therapy with Ezetimibe and Statins versus Statin Monotherapy on Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Kwon,

Cho,

Park

et al. 2023

Medicina

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Background and Objectives: Lipid-lowering agents such as ezetimibe are recommended in uncontrolled hyperlipidemia for primary and secondary prevention of cardiovascular disease. Carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis and a predictor of cardiovascular and cerebral events. The effects of ezetimibe on CIMT have been inconsistently reported. The aim of this meta-analysis is to compare the effects of ezetimibe/statin and statin alone therapies on CIMT reduction. Materials and Methods: The PubMed, Embase, and Cochrane library databases were searched for randomized controlled trials (RCTs) published prior to 26 January 2023 with the MeSH keywords ‘Ezetimibe’ and ‘Carotid Intima-Media Thickness’. The results were presented as standard mean difference (SMD) with 95% confidence intervals using the random-effect model method, and heterogeneity was assessed. Subgroup, meta-regression, and sensitivity analyses were conducted. Results: Five RCTs with 642 participants were included. CIMT reduction was not significantly different between the ezetimibe/statin and statin alone groups. However, in subgroup analyses, CIMT in the ezetimibe/statin group was significantly reduced in patients with non-familial hypercholesterolemia (SMD: −0.34 mm and p = 0.002) and in patients with secondary prevention (SMD: −0.38 mm and p = 0.002). The low-density lipoprotein cholesterol level was significantly reduced in the ezetimibe/statin group (SMD: −0.58 mg/dL and p < 0.001). Conclusions: The effect of ezetimibe on CIMT reduction was shown in non-familial hypercholesterolemia and secondary prevention. These results suggest that the efficacy of ezetimibe may vary with potential CIMT reduction benefits in certain subpopulations.

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Functional nano-vector boost anti-atherosclerosis efficacy of berberine in Apoe() mice

Zhang

Luo

et al. 2020

Acta Pharmaceutica Sinica B

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Atherosclerosis (AS) is the leading cause of heart attacks, stroke, and peripheral vascular disease. Berberine (BBR), a botanical medicine, has diversified anti-atherosclerotic effects but with poor absorption. The aim of this study was to develop an effective BBR-entrapped nano-system for treating AS in high-fat diet (HFD)-fed Apoe (−/−) mice, and also explore the possible underlying mechanisms involved. Three d - α -tocopherol polyethylene glycol (PEG) succinate (TPGS) analogues with different PEG chain lengths were synthesized to formulate BBR-entrapped micelles. HFD-fed Apoe (−/−) mice were administered with optimized formula (BBR, 100 mg/kg/day) orally for 5 months. The artery plaque onset and related metabolic disorders were evaluated, and the underlying mechanisms were studied. Our data showed that, BT 1500 M increased BBR deposition in liver and adipose by 107.6% and 172.3%, respectively. In the Apoe (−/−) mice, BT 1500 M ameliorated HFD-induced hyperlipidemia and lipid accumulation in liver and adipose. BT 1500 M also suppressed HFD-induced chronic inflammation as evidenced by the reduced liver and adipose levels of interleukin-6 (IL-6), tumor necrosis factor- α (TNF- α ) and interleukin-1 β ( IL-1 β ); and decreased plasma level of TNF- α , IL-6, IL-1 β , interferon- γ ( IFN- γ ), monocyte chemotactic protein (MCP), and macrophage inflammatory factor (MIP). The mechanism study showed that BT 1500 M changed Ampk and Nf-κb gene expression, and interrupted a crosstalk process between adipocytes and macrophages. Further investigation proved that BT 1500 M decreased endothelial lesion and subsequent macrophage activation, cytokines release, as well as cholesteryl ester gathering in the aortic arch, resulting in ameliorated artery plaque build-up. Our results provide a practical strategy for treating AS using a BBR-entrapped nano-system.

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Limitations of statin monotherapy for the treatment of dyslipidemia: a projection based on the Canadian lipid study – observational

Cited by 7 publications

References 23 publications

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Effect of Combination Therapy with Ezetimibe and Statins versus Statin Monotherapy on Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Functional nano-vector boost anti-atherosclerosis efficacy of berberine in Apoe() mice

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