Medication for dyslipidemia in cardiovascular disease prevention

Authors

  • Surachet Loetthiraphan

Keywords:

cholesterol, medication, statins, cardiovascular disease

Abstract

บทคัดย่อ
ภาวะไขมันในเลือดผิดปกติเป็นปัจจัยเสี่ยงสำคัญที่ทำให้เกิดโรคหลอดเลือดหัวใจ ควรเเนะนำการปรับเปลี่ยนพฤติกรรมสุขภาพทั้งเรื่องของอาหารที่รับประทาน การควบคุมน้ำหนัก และการออกกำลังกายโดยต้องคำนึงถึงปริมาณเเคลอรี่ที่เหมาะสม ในผู้ป่วยบางรายมีความจำเป็นต้องใช้ยากลุ่มสแตติน ยานี้เป็นยาที่มีบทบาทที่สำคัญในการรักษา นอกจากนี้ ยังมียากลุ่มอื่นที่ไม่ใช่กลุ่มสแตติน เช่น Ezetimibe, PCSK9minhibitors ใช้ในการรักษาทดแทนหรือเพิ่มเติมร่วมกับยากลุ่มสแตตินด้วย บทความนี้อธิบายถึงบทบาทของยาเเต่ละกลุ่มที่สำคัญ รวมถึงยาใหม่ด้วย เช่น Inclisiran, Bempedoic acid การรักษาภาวะไขมันในเลือดผิดปกติสามารถรักษาด้วยยาได้ผล และยาบางกลุ่ม เช่น ยากลุ่มสเเตตินยังสามารถป้องกันการเกิดโรคหลอดเลือดหัวใจลดปัญหาเรื่องหลอดเลือดและหัวใจ และการเสียชีวิตได้ด้วย

Abstract
Dyslipidemia is one of the most important risk factor of coronary artery disease. Lifestyle management is recommended including diet composition, weight control and physical activity,and calorie requirement should be adjusted. In some cases, lipid lowering drugs are needed,Statins are the cornerstone of therapy. Moreover, non-statin agents such as Ezetimibe, PCSK9 inhibitors can substitute or add on to Statins. This review article explained role of each medication including new medications such as Inclisiran and Bempedoic acid. Dyslipidemia can be treated with many medications, and some medications such as Statins can also prevent progression of coronary artery disease, decrease cardiovascular events and death.

 

Downloads

Download data is not yet available.

References

1. Eckel RH, Jakicic JM, Ard JD, et al.2013 AHA/ACC Guideline on lifestyle management to reduce cardiovascular risk, a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation 2014;129(25 suppl2):S76-9.
2. Collins R, Reith C, Emberson J, et al.Interpretation of the evidence for the efficacy and safety of statin therapy.Lancet 2016;388(10059):2532-61.
3. Cholesterol Treatment Trialists’ (CTT)Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol:a meta-analysis of data from 170,000 participants in 26 randomized trials.Lancet 2010;376(9753):1670-81.
4. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4,444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344(8934):1383-9.
5. Schwartz GG, Olsson AG, Ezekowitz MD,et al. Effect of atorvastatin on early recurrent ischemic events in acute coronary syndromes. J Am Med Assoc 2001;285(13):1711-8.
6. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350(15):1495-504.
7. Cholesterol Treatment Trialists’Collaboration. Efficacy and safety of statin therapy in older people: a metaanalysis of individual participant data from 28 randomized controlled trials. Lancet 2019;393(10170):407-15.
8. Cholesterol Treatment Trialists’Collaboration. Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a metaanalysis of individual participant data from 28 randomized trials. Lancet Diabetes Endocrinol 2016;4(10):829-39.
9. Sever PS, Poulter NR, Dahlöf B, et al.Reduction in Cardiovascular Events with Atorvastatin in 2,532 Patients With Type 2 Diabetes: Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA). Diabetes Care 2005;28(5):1151-7.
10. Shepherd J, Cobbe SM, Ford I,et al. Prevention of coronary heart disease with pravastatin in men with158 J Med Health Sci Vol.27 No.1 April 2020 hypercholesterolemia. Atheroscler Suppl. 2004;5(3):91-7.
11. Ridker PM, Danielson E, Fonseca FA, et al.Rosuvastatin to prevent vascular events in men and women with elevated C-reactiveprotein. N Engl J Med 2008;359(21): 2195-
207.
12. Newman CB, Preiss D, Tobert JA, et al.Statin safety and associated adverse events, a scientific statement from the American Heart Association. Arterioscler Throm Vasc Biol 2019;39(2):e38-e81. DOI:10.1161/ATV.0000000000000073.
13. Wiggins BS, Saseen JJ, Page RL, et al.Recommendation for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: A scientific statement from the American Heart Association. Circulation 2016;134(21):e468-95. DOI: 10.1161/CIR.0000000000000456.
14. Opie LH, Gersh BJ. Drugs for the heart, 8th ed. Philadelphia: Elsevier Saunders; 2013.
15. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015;372(25):2387-97.
16. Lavie CJ, Milani RV, Mehra MR, et al.Omega-3 polyunsaturated fatty acids and cardiovascular diseases. J Am Coll Cardiol 2009;54(7):585-94.
17. Bhatt DL, Steg PG, Miller M, et al.Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia.N Engl J Med 2019;380(1):11-22.
18. Manson JE, Cook NR, Lee IM, et al. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med 2019;380(1):23-32.
19. A S C E N D S t u d y C o l l a b o r a t i v e Group, Bowman L, Mafham M, et al. Effects of n-3 fatty acid supplements in diabetes mellitus. N Engl J Med 2018;379(16):1540-50.
20. Nissen S, Lincoff M, Nicholls S, et al. Outcomes study to assess statin residual risk reduction with EpaNova in high CV risk patients with hypertriglyceridemia. astrazeneca.com. [published online 2020 Jan 13].
21. Wang Y, Liu ZP. PCSK9 Inhibitors: Noveltherapeutic strategies for lowering LDL cholesterol. Mini Rev Med Chem 2019;19(2):165-76.
22. Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017;376(18):1713-22.
23. Schwartz GG, Steg PG, Szarek M, et al.Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med 2018;379(22):2097-107.
24. Ray KK, Landmesser U, Leiter LA, et al.Inclisiran in patients at high cardiovascular risk with elevated LDL cholesterol. N Engl J Med 2017;376(15):1430-40.
25. Staels B, Dallongeville J, Auwerx J, et al. Mechanism of action of fibrates on lipid and lipoprotein metabolism. Circulation 1998;98(19):2088-93.J Med Health Sci Vol.27 No.1 April 2020 159
26. Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment,changes in risk factors, and incidence of coronary heart disease. N Engl J Med 1987;317(20):1237-45.
27. Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999;341(6):410-8.
28. Elam M, Lovato L, Ginsberg H. The ACCORD-Lipid study: implications for treatment of dyslipidemia in Type 2 diabetes Mellitus. J Clin Lipidol 2011;6(1):9-20.
29. Keech A, Simes RJ, Barter P, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD trial): randomized controlled trial. Lancet 2005;366(9500):1849-61.
30. Laufs U, Banach M, Mancini GBJ, et al.Efficacy and safety of bempedoic acid in patients with hypercholesterolemia and statin intolerance. J Am Heart Assoc 2019;8(7):e011662. DOI: 10.1161/JAHA. 118.011662.
31. Ray KK, Bays HE, Catapano AL, et al.Safety and efficacy of bempedoic acid to reduce LDL cholesterol. N Engl J Med2019;380(11):1022-32.
32. Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACPVR/AAPA/ABC/ACPM/ ADA/AGS/ APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;73(24):3168-209.
33. Arnett DK, Blumenthal RS, Albert MA,et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;140(11):e596-e646.

Published

2020-04-29

Issue

Section

Review Article (บทความวิชาการ)