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Current Atherosclerosis Reports Mar 2018We provide an overview of our current understanding of combination lipid-lowering therapies intended for dyslipidemia treatment and cardiovascular disease prevention.... (Review)
Review
PURPOSE OF REVIEW
We provide an overview of our current understanding of combination lipid-lowering therapies intended for dyslipidemia treatment and cardiovascular disease prevention. First, we analyze recent statin and non-statin combination therapy guidelines and clinical studies since the publication of 2013 American College of Cardiology Cholesterol Guidelines. Second, we examine the clinical utility of non-statin agents alone and in combination in terms of LDL-C lowering and ASCVD risk reduction.
RECENT FINDINGS
Medical societies, including the American College of Cardiology (ACC), National Lipid Association (NLA), and American Association of Clinical Endocrinologists (AACE), have released guidelines to address the appropriate use of non-statin therapies. The guidelines incorporated new evidence, including the IMPROVE-IT and FOURIER clinical trials, which demonstrate that the combination of statin therapy with other non-statin agents such as ezetimibe and PCSK9 inhibitors has a significant clinical benefit. Increasing evidence that aggressive low-density lipoprotein cholesterol (LDL-C) lowering leads to lower cardiovascular disease risk supports the need for continued exploration of the role of combination lipid-lowering therapies. A review of guidelines and clinical trials evaluating non-statin agents illuminates the growing base of evidence and expert opinion supporting the use of combination lipid-lowering therapies. While the majority of clinical trial data utilizes dyslipidemia monotherapy, especially statins, combination therapies represent an opportunity for individualized, patient-centered approach to LDL-C lowering and atherosclerotic cardiovascular disease (ASCVD) risk reduction. The overview provides a perspective on lipid management intended for clinicians who seek additional information and guidance on the use of combination therapies.
Topics: Anticholesteremic Agents; Cardiovascular Diseases; Dyslipidemias; Ezetimibe; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypolipidemic Agents; PCSK9 Inhibitors
PubMed: 29516190
DOI: 10.1007/s11883-018-0721-2 -
Anesthesia and Analgesia Apr 2016
Topics: Anesthetics, Inhalation; Animals; Antimetabolites; Deoxyglucose; Humans
PubMed: 26991630
DOI: 10.1213/ANE.0000000000001177 -
Nihon Rinsho. Japanese Journal of... Feb 2015
Topics: Antimetabolites, Antineoplastic; Biological Transport; Cytarabine; Drug Administration Schedule; Hematologic Neoplasms; Humans
PubMed: 25831835
DOI: No ID Found -
The New England Journal of Medicine Apr 2023
Topics: Humans; Cardiovascular Diseases; Dicarboxylic Acids; Fatty Acids; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypolipidemic Agents
PubMed: 36876758
DOI: 10.1056/NEJMe2300793 -
Future Cardiology Sep 2020Bempedoic acid (ETC-1002) is a novel, first-in-class, oral, small molecule that inhibits cholesterol biosynthesis in the same pathway as statins, thereby lowering... (Review)
Review
Bempedoic acid (ETC-1002) is a novel, first-in-class, oral, small molecule that inhibits cholesterol biosynthesis in the same pathway as statins, thereby lowering low-density lipoprotein cholesterol (LDL-C) by upregulating LDL receptors. Preclinical and completed Phase II and III clinical trials have demonstrated promising results regarding its safety and efficacy across a variety of patient characteristics including statin intolerance and on a background of lipid-lowering therapy. Bempedoic acid is currently being evaluated in a cardiovascular outcomes trial to evaluate its effect on major cardiovascular events in patients with or at high risk for cardiovascular disease and with statin intolerance. In this review, we will discuss the history and development of bempedoic acid, relevant clinical trials, and its potential role as a lipid-lowering medication in the context of other currently available lipid-lowering therapies.
Topics: Anticholesteremic Agents; Cholesterol, LDL; Dicarboxylic Acids; Fatty Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors
PubMed: 32463301
DOI: 10.2217/fca-2020-0016 -
Nature Reviews. Cardiology Jun 2022
Topics: Antibodies, Monoclonal, Humanized; Anticholesteremic Agents; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Plaque, Atherosclerotic
PubMed: 35422520
DOI: 10.1038/s41569-022-00706-9 -
Clinical Pharmacology and Therapeutics Oct 2022Fluoropyrimidines (FP; 5-fluorouracil, capecitabine, and tegafur) are a commonly prescribed class of antimetabolite chemotherapies, used for various solid organ... (Review)
Review
Fluoropyrimidines (FP; 5-fluorouracil, capecitabine, and tegafur) are a commonly prescribed class of antimetabolite chemotherapies, used for various solid organ malignancies in over 2 million patients globally per annum. Dihydropyrimidine dehydrogenase (DPD), encoded by the DPYD gene, is the critical enzyme implicated in FP metabolism. DPYD variant genotypes can result in decreased DPD production, leading to the development of severe toxicities resulting in hospitalization, intensive care admission, and even death. Management of toxicity incurs financial burden on both patients and healthcare systems alike. Upfront DPYD genotyping to identify variant carriers allows an opportunity to identify patients who are at high risk to suffer from serious toxicities and allow prospective dose adjustment of FP treatment. This approach has been shown to reduce patient morbidity, as well as improve the cost-effectiveness of managing FP treatment. Upfront DPYD genotyping has been recently endorsed by several countries in Europe and the United Kingdom. This review summarizes current knowledge about DPD deficiency and upfront DPYD genotyping, including clinical and cost-effectiveness outcomes, with the intent of supporting implementation of an upfront DPYD genotyping service with individualized dose-personalization.
Topics: Antimetabolites, Antineoplastic; Dihydropyrimidine Dehydrogenase Deficiency; Dihydrouracil Dehydrogenase (NADP); Fluorouracil; Genotype; Humans; Prospective Studies
PubMed: 35607723
DOI: 10.1002/cpt.2667 -
Facial Plastic Surgery Clinics of North... Feb 2017Scarring of the neck affects millions of people every year. The appearance of neck scarring can be disturbing both physically and psychologically. Scarring of the neck... (Review)
Review
Scarring of the neck affects millions of people every year. The appearance of neck scarring can be disturbing both physically and psychologically. Scarring of the neck can be accompanied by morbidities because of the limitation of functional motion of the neck. Treatment options and modalities for reduction and prevention of scar formation include topical steroids, intralesional steroids, interferon, 5-fluorouracil, silicone gel, radiation, laser therapy, and surgeries. There is no general consensus in the literature as to the optimal treatment of neck scarring. Patients should understand that the scar is likely to be improved but not eliminated by treatment.
Topics: Anti-Inflammatory Agents; Antimetabolites; Catheter Ablation; Cicatrix; Combined Modality Therapy; Female; Humans; Laser Therapy; Middle Aged; Neck; Neck Injuries; Postoperative Complications; Plastic Surgery Procedures
PubMed: 27888898
DOI: 10.1016/j.fsc.2016.08.009 -
Medical Oncology (Northwood, London,... Dec 2022Cancer is one of the most challenging diseases to manage. A sizeable number of researches are done each year to find better diagnostic and therapeutic strategies. At the... (Review)
Review
Cancer is one of the most challenging diseases to manage. A sizeable number of researches are done each year to find better diagnostic and therapeutic strategies. At the present time, a package of chemotherapy, targeted therapy, radiotherapy, and immunotherapy is available to cope with cancer cells. Regarding chemo-radiation therapy, low effectiveness and normal tissue toxicity are like barriers against optimal response. To remedy the situation, some agents have been proposed as adjuvants to improve tumor responses. Statins, the known substances for reducing lipid, have shown a considerable capability for cancer treatment. Among them, atorvastatin as a reductase (HMG-CoA) inhibitor might affect proliferation, migration, and survival of cancer cells. Since finding an appropriate adjutant is of great importance, numerous studies have been conducted to precisely unveil antitumor effects of atorvastatin and its associated pathways. In this review, we aim to comprehensively review the most highlighted studies which focus on the use of atorvastatin in cancer therapy.
Topics: Humans; Atorvastatin; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Immunotherapy; Radiation Oncology; Adjuvants, Immunologic; Neoplasms
PubMed: 36459301
DOI: 10.1007/s12032-022-01892-9 -
European Journal of Internal Medicine Jun 2023The relative risk reduction of cardiovascular events is proportional to the absolute reduction in LDL-C levels, the primary target of therapy, no matter the way of... (Review)
Review
The relative risk reduction of cardiovascular events is proportional to the absolute reduction in LDL-C levels, the primary target of therapy, no matter the way of reduction. During the last decades, the therapeutic regimens for reducing the LDL-C levels have been immerged and improved, with favorable effects on the atherosclerotic process and clinical benefits of various cardiovascular outcomes. From a practical view of point, this review is focusing only on the current available lipid lowering agents: statins, ezetimibe, anti PCSK9 monoclonal antibodies, the small interfering RNA (siRNA) agent, Inclisiran, and Bempedoic acid. The recent changes in lipid lowering regimens, including the early combination of lipid lowering agents and "Low LDL-C" levels <30 mg/dL for high/very high cardiovascular risk patients will also be discussed.
Topics: Humans; Cholesterol, LDL; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Cholesterol; Ezetimibe; Drug Therapy, Combination; Anticholesteremic Agents; Proprotein Convertase 9
PubMed: 36813611
DOI: 10.1016/j.ejim.2023.02.010