DOCSLIB.ORG

Statins for the Primary Prevention of Cardiovascular Events

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Statins for the Primary Prevention of Cardiovascular Events KCE REPORT 306 STATINS FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR EVENTS 2019 www.kce.fgov.be KCE REPORT 306 HEALTH TECHNOLOGY ASSESSMENT STATINS FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR EVENTS AUDREY CORDON, CHRISTOPHE DE MEESTER, SOPHIE GERKENS, DOMINIQUE ROBERFROID, CHRIS DE LAET 2019 www.kce.fgov.be COLOPHON Title: Statins for the primary prevention of cardiovascular events Authors: Audrey Cordon (KCE), Christophe De Meester (KCE), Sophie Gerkens (KCE), Dominique Roberfroid (KCE), Chris De Laet (KCE) Information specialist: Nicolas Fairon (KCE) Project coordinator: Els Van Bruystegem (KCE) Senior supervisor: Dominique Roberfroid (KCE) Synthesis editor: Gudrun Briat (KCE), Karin Rondia (KCE) Reviewers: Dorien Dossche(KCE), Matthias Neyt (KCE) External experts: Michel Boutsen (Solidaris), Thierry Christiaens (Ugent, BCFI – CBIP), Johan De Sutter (Ugent), Nicolas Delvaux (Domus Medica), Olivier Descamps (Hôpital Jolimont), Griet Goesaert (BCFI – CBIP), Michel Hermans (Cliniques Universitaires Saint-Luc, Bruxelles), Mark Lamotte (IQVIA), Thomas Orban (SSMG - Société Scientifique de Médecine Générale), Thibault Richard (CHU Charleroi), Muriel Sprynger (ULG – Université de Liège), Guy Van Camp (UZ Brussel), Marc Van De Casteele (RIZIV – INAMI), Christiaan Van Haecht (Christelijke Mutualiteiten – Mutualités Chrétiennes), Thierry Van Hedent (RIZIV – INAMI ), Jacques Vanderstraeten (SSMG - Société Scientifique de Médecine Générale), Christiaan Vrints (UZA – Universitair Ziekenhuis Antwerpen) External validators: Guy De Backer (Ugent), Oscar Franco (University of Bern), Bert Vaes (KULeuven) Reported interests: All experts and stakeholders consulted within this report were selected because of their involvement in the topic of ‘Statins’. Therefore, by definition, each of them might have a certain degree of conflict of interest to the main topic of this report. Membership of a stakeholder group on which the results of this report could have an impact: Olivier Descamps (Belgian Society of Atherosclerosis). Fees or other compensation for writing a publication or participating in its development: Nicolas Delvaux (update Domus Medica guideline – cardiovasculair risk management (co-auteur)). Participation in scientific or experimental research as an initiator, principal investigator or researcher: Nicolas Delvaux (update Domus Medica guideline), Olivier Descamps (Amgen), Johan De Sutter (Emperor study: researcher, BEL CASCADE: researcher). Consultancy or employment for a company, an association or an organisation that may gain or lose financially due to the results of this report: Olivier Descamps (Amgen / MSD), Hermans Michel (MSD / Sanofi / Amgen). Payments to speak, training remuneration, subsidised travel or payment for participation at a conference: Olivier Descamps (Amgen / MSD), Michel Hermans (Astra-Zeneca / MSD / Mylan / Eurogenerics / Tilman). Presidency or accountable function within an institution, association, department or other entity on which the results of this report could have an impact: Olivier Descamps (President Belgian Atherosclerosis Society – BELCHOL association of Belgian patients with familial hypercholesterolemia), Thomas Orban (President SSMG). Layout: Ine Verhulst Disclaimer: • The external experts were consulted about a (preliminary) version of the scientific report. Their comments were discussed during meetings. They did not co-author the scientific report and did not necessarily agree with its content. • Subsequently, a (final) version was submitted to the validators. The validation of the report results from a consensus or a voting process between the validators. The validators did not co-author the scientific report and did not necessarily all three agree with its content. • Finally, this report has been approved by common assent by the Executive Board. • Only the KCE is responsible for errors or omissions that could persist. The policy recommendations are also under the full responsibility of the KCE. Publication date: 15 January 2019 Domain: Health Technology Assessment (HTA) MeSH: Hydroxymethylglutaryl-CoA Reductase Inhibitors; Cardiovascular Diseases; Primary prevention; Costs and Cost Analysis. NLM Classification: WG 120 Language: English Format: Adobe® PDF™ (A4) Legal depot: D/2019/10.273/07 ISSN: 2466-6459 Copyright: KCE reports are published under a “by/nc/nd” Creative Commons Licence http://kce.fgov.be/content/about-copyrights-for-kce-publications. How to refer to this document? Cordon A, De Meester C, Gerkens S, Roberfroid D, De Laet C. Statins for the primary prevention of cardiovascular events. Health Technology Assessment (HTA) Brussels: Belgian Health Care Knowledge Centre (KCE). 2019. KCE Reports 306. D/2019/10.273/07. This document is available on the website of the Belgian Health Care Knowledge Centre. Statins in primary prevention: confidential draft KCE Report 306 Statins in primary prevention 1 TABLE OF CONTENTS TABLE OF FIGURES .......................................................................................................................................... 6 TABLE OF TABLES ............................................................................................................................................ 8 LIST OF ABBREVIATIONS .............................................................................................................................. 12 SCIENTIFIC REPORT ......................................................................................................................... 16 1 BACKGROUND .................................................................................................................................. 16 2 OBJECTIVES ...................................................................................................................................... 18 3 HISTORICAL AND CURRENT STATIN USE IN BELGIUM .............................................................. 18 3.1 INTRODUCTION ................................................................................................................................. 18 3.2 METHODS ........................................................................................................................................... 19 3.2.1 Global data ............................................................................................................................ 19 3.2.2 Individual data ....................................................................................................................... 19 3.3 STATINS AVAILABLE ON THE BELGIAN MARKET ......................................................................... 21 3.3.1 Statins ................................................................................................................................... 21 3.3.2 Combination products containing a statin ............................................................................. 23 3.4 REIMBURSEMENT RULES FOR STATINS ....................................................................................... 24 3.4.1 Basic rules ............................................................................................................................. 24 3.4.2 Indications and indicators ...................................................................................................... 24 3.5 NUMBER OF STATIN USERS (GLOBAL DATA) ............................................................................... 25 3.6 VOLUMES OF PRESCRIBED STATINS (GLOBAL DATA) ................................................................ 26 3.6.1 Statins ................................................................................................................................... 26 3.6.2 Combination products containing a statin ............................................................................. 27 3.6.3 All products containing a statin ............................................................................................. 27 3.7 COST OF STATINS (GLOBAL DATA) ................................................................................................ 28 2 Statins in primary prevention KCE Report 306 3.7.1 Total cost ............................................................................................................................... 28 3.7.2 Reimbursements ................................................................................................................... 28 3.7.3 Patient contribution ............................................................................................................... 29 3.8 SUMMARY OF THE GLOBAL DATA .................................................................................................. 30 3.9 STATIN USERS (INDIVIDUAL DATA) ................................................................................................ 30 3.9.1 Users and New users ............................................................................................................ 30 3.9.2 Characteristics of users and new users of the last years of registration 2014-2015 ............ 32 3.10 PRIMARY VS. SECONDARY PREVENTION (INDIVIDUAL DATA) ................................................... 36 3.11 ADHERENCE (INDIVIDUAL DATA) .................................................................................................... 38 3.11.1 Regular and occasional users ............................................................................................... 38 3.11.2 Factors associated with poor adherence .............................................................................
Load more

Recommended publications
  • Roszet (Rosuvastatin/Ezetimibe) – New Drug Approval
    Roszet (rosuvastatin/ezetimibe) – New drug approval • On March 23, 2021, the FDA approved Althera Pharmaceuticals’ Roszet (rosuvastatin/ezetimibe), in adults: as an adjunct to diet in patients with primary non-familial hyperlipidemia to reduce low- density lipoprotein cholesterol (LDL-C) and alone or as an adjunct to other LDL-C-lowering therapies in patients with homozygous familial hypercholesterolemia (HoFH) to reduce LDL-C. • Roszet is a combination tablet containing rosuvastatin, an HMG CoA-reductase inhibitor (statin), and ezetimibe, a dietary cholesterol absorption inhibitor. Both components are available generically. • The approval of Roszet was based on previous efficacy data with rosuvastatin and ezetimibe. • Roszet is contraindicated in patients with: — Acute liver failure or decompensated cirrhosis — Hypersensitivity to rosuvastatin, ezetimibe, or any excipients in Roszet. Hypersensitivity reactions including anaphylaxis, angioedema, and erythema multiforme have been reported. • Warnings and precautions for Roszet include myopathy and rhabdomyolysis, immune-mediated necrotizing myopathy, hepatic dysfunction, proteinuria and hematuria, and HbA1c and glucose levels. • The most common adverse reactions (> 2% and greater than statin alone) with ezetimibe co- administered with a statin are nasopharyngitis, myalgia, upper respiratory tract infection, arthralgia, diarrhea, back pain, influenza, pain in extremity, and fatigue. • The recommended dosage range of Roszet is 5 mg/10 mg to 40 mg/10 mg once daily. — The recommended dose of Roszet depends on a patient’s indication for usage, LDL-C, and individual risk for cardiovascular events. — The starting dosage for patients switching to Roszet from co-administration of a statin and ezetimibe is based on an equivalent dose of rosuvastatin and 10 mg of ezetimibe.
    [Show full text]
  • Effects of Pitavastatin, Atorvastatin, and Rosuvastatin on the Risk Of
    biomedicines Article Effects of Pitavastatin, Atorvastatin, and Rosuvastatin on the Risk of New-Onset Diabetes Mellitus: A Single-Center Cohort Study Wei-Ting Liu 1, Chin Lin 2,3,4, Min-Chien Tsai 5, Cheng-Chung Cheng 6, Sy-Jou Chen 7,8, Jun-Ting Liou 6 , Wei-Shiang Lin 6, Shu-Meng Cheng 6, Chin-Sheng Lin 6,* and Tien-Ping Tsao 6,9,* 1 Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] 2 School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] 3 School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan 4 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan, 5 Department of Physiology and Biophysics, Graduate Institute of Physiology, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] 6 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] (C.-C.C.); [email protected] (J.-T.L.); [email protected] (W.-S.L.); [email protected] (S.-M.C.) 7 Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; [email protected] 8 Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei 11031, Taiwan 9 Division of Cardiology, Cheng Hsin General Hospital, Taipei 11220, Taiwan * Correspondence: [email protected] (C.-S.L.); [email protected] (T.-P.T.); Tel.: +886-2-6601-2656 (C.-S.L.); +886-2-2826-4400 (T.-P.T.) Received: 25 October 2020; Accepted: 11 November 2020; Published: 13 November 2020 Abstract: Statins constitute the mainstay treatment for atherosclerotic cardiovascular disease, which is associated with the risk of new-onset diabetes mellitus (NODM).
    [Show full text]
  • Ezetimibe: a Novel Selective Cholesterol Absorption Inhibitor by Michele Koder, Pharm.D
    OREGON DUR BOARD NEWSLETTER A N E VIDENCE B ASED D RUG T HERAPY R ESOURCE COPYRIGHT 2003 OREGON STATE UNIVERSITY. ALL RIGHTS RESERVED Volume 5, Issue 2 Also available on the web and via e-mail list-serve at February 2003 http://pharmacy.orst.edu/drug_policy/newsletter_email.html Ezetimibe: A novel selective cholesterol absorption inhibitor By Michele Koder, Pharm.D. , OSU College of Pharmacy Ezetimibe (Zetia) is a novel selective cholesterol absorption inhibitor that was approved by the FDA in October 2002. Unlike statins (HMG-CoA reductase inhibitors) and bile acid sequestrants, ezetimibe does not inhibit hepatic cholesterol synthesis or increase bile acid secretion. In contrast, ezetimibe selectively inhibits the uptake of dietary cholesterol from enterocytes in the brush border of the intestinal lumen resulting in a decrease in the delivery of dietary cholesterol to the liver and a subsequent decrease in hepatic cholesterol stores and increased cholesterol clearance from the blood.1 Ezetimibe’s unique action has generated interest in its use in combination with other cholesterol-lowering agents. It is indicated for the treatment of primary hypercholesterolemia as monotherapy and in combination with a statin. Ezetimibe is also approved for homozygous familial hypercholesterolemia and homozygous sitosterolemia. TABLE 1: EZETIMIBE CLINICAL TRIAL SUMMARY Study / Design Population Treatment % Change LDL % Change HDL % Change TG Bays et al3 N=432 EZ 5 mg -15.7 +2.9 MC, R, DB, PC LDL 130-250mg/dl EZ 10 mg -18.5 +3.5 NS 12 wk; Phase II TG
    [Show full text]
  • Nustendi, INN-Bempedoic Acid, Ezetimibe
    Summary of risk management plan for Nustendi (Bempedoic acid/Ezetimibe) This is a summary of the risk management plan (RMP) for Nustendi. The RMP details important risks of Nustendi, how these risks can be minimized, and how more information will be obtained about Nustendi's risks and uncertainties (missing information). Nustendi's summary of product characteristics (SmPC) and its package leaflet give essential information to healthcare professionals and patients on how Nustendi should be used. This summary of the RMP for Nustendi should be read in the context of all this information, including the assessment report of the evaluation and its plain-language summary, all which is part of the European Public Assessment Report (EPAR). Important new concerns or changes to the current ones will be included in updates of Nustendi's RMP. I. The Medicine and What It Is Used For Nustendi is authorized for treatment of primary hypercholesterolemia in adults, as an adjunct to diet (see SmPC for the full indication). It contains bempedoic acid as the active substance and it is given by mouth. Further information about the evaluation of Nustendi’s benefits can be found in Nustendi’s EPAR, including in its plain-language summary, available on the EMA website, under the medicine’s webpage https://www.ema.europa.eu/en/medicines/human/EPAR/nustendi II. Risks Associated With the Medicine and Activities to Minimize or Further Characterize the Risks Important risks of Nustendi, together with measures to minimize such risks and the proposed studies for learning
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2004/0224012 A1 Suvanprakorn Et Al
    US 2004O224012A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2004/0224012 A1 Suvanprakorn et al. (43) Pub. Date: Nov. 11, 2004 (54) TOPICAL APPLICATION AND METHODS Related U.S. Application Data FOR ADMINISTRATION OF ACTIVE AGENTS USING LIPOSOME MACRO-BEADS (63) Continuation-in-part of application No. 10/264,205, filed on Oct. 3, 2002. (76) Inventors: Pichit Suvanprakorn, Bangkok (TH); (60) Provisional application No. 60/327,643, filed on Oct. Tanusin Ploysangam, Bangkok (TH); 5, 2001. Lerson Tanasugarn, Bangkok (TH); Suwalee Chandrkrachang, Bangkok Publication Classification (TH); Nardo Zaias, Miami Beach, FL (US) (51) Int. CI.7. A61K 9/127; A61K 9/14 (52) U.S. Cl. ............................................ 424/450; 424/489 Correspondence Address: (57) ABSTRACT Eric G. Masamori 6520 Ridgewood Drive A topical application and methods for administration of Castro Valley, CA 94.552 (US) active agents encapsulated within non-permeable macro beads to enable a wider range of delivery vehicles, to provide longer product shelf-life, to allow multiple active (21) Appl. No.: 10/864,149 agents within the composition, to allow the controlled use of the active agents, to provide protected and designable release features and to provide visual inspection for damage (22) Filed: Jun. 9, 2004 and inconsistency. US 2004/0224012 A1 Nov. 11, 2004 TOPCAL APPLICATION AND METHODS FOR 0006 Various limitations on the shelf-life and use of ADMINISTRATION OF ACTIVE AGENTS USING liposome compounds exist due to the relatively fragile LPOSOME MACRO-BEADS nature of liposomes. Major problems encountered during liposome drug Storage in vesicular Suspension are the chemi CROSS REFERENCE TO OTHER cal alterations of the lipoSome compounds, Such as phos APPLICATIONS pholipids, cholesterols, ceramides, leading to potentially toxic degradation of the products, leakage of the drug from 0001) This application claims the benefit of U.S.
    [Show full text]
  • Fenofibrate Ezetimibe Studies
    FenofibrateFenofibrate EzetimibeEzetimibe SurrogateSurrogate TrialsTrials ThomasThomas Dayspring,Dayspring, MD,MD, FACPFACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry of New Jersey Attending in Medicine: St Joseph’s Hospital, Paterson, NJ Certified Menopause Practitioner: North American Menopause Society North Jersey Institute of Menopausal Lipidology PharmacokineticPharmacokinetic DataData FenofibrateFenofibrate –– EzetimibeEzetimibe PharmacodynamicPharmacodynamic andand PharmacokineticPharmacokinetic InteractionInteraction StudyStudy Placebo (n = 8) Ezetimibe 10 mg (n = 8) Patients have no physical 30 activity and are on a high Fenofibrate 200 mg (n = 8) carbohydrate low fat diet which lowers HDL-C 20 Fenofibrate 200mg + 10 Ezetimibe 10 mg (n = 8) 0 -10 -20 -30 Change from Baseline (%) -40 -50 TC LDL-C HDL-C TG Mean (SE) percentage change from baseline in serum lipids on day 14 following oral administration of fenofibrate monotherapy, ezetimibe monotherapy, fenofibrate-ezetimibe co- administration therapy or placebo once daily to 14 healthy subjects with hypercholesterolemia Kosoglou T et al. Curr Med Res & Opin 2004;20:1185-1195 FenofibrateFenofibrate –– EzetimibeEzetimibe PharmacodynamicPharmacodynamic andand PharmacokineticPharmacokinetic InteractionInteraction StudyStudy Placebo (n = 8) 30 Ezetimibe 10 mg (n = 8) Fenofibrate 200 mg (n = 8) Combination therapy 20 produced significantly Fenofibrate 200mg + 10 Ezetimibe 10 mg (n = 8) greater reductions in 0 LDL-C and in small LDL-III -10 Levels of
    [Show full text]
  • SUMMARY of the PRODUCT CHARACTERISTICS 1. NAME of the MEDICINAL PRODUCT <Invented Name> 10 Mg/10 Mg Film-Coated Tablets
    SUMMARY OF THE PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT <Invented name> 10 mg/10 mg film-coated tablets <Invented name> 20 mg/10 mg film-coated tablets <Invented name> 40 mg/10 mg film-coated tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION <Invented name> 10 mg/10 mg: Each film-coated tablet contains 10 mg of rosuvastatin (as rosuvastatin calcium) and 10 mg of ezetimibe. <Invented name> 20 mg/10 mg: Each film-coated tablet contains 20 mg of rosuvastatin (as rosuvastatin calcium) and 10 mg of ezetimibe. <Invented name> 40 mg/10 mg: Each film-coated tablet contains 40 mg of rosuvastatin (as rosuvastatin calcium) and 10 mg of ezetimibe. Excipient with known effect: <Invented name> 10 mg/10 mg: Each film-coated tablet contains 111.2 mg of lactose (as lactose monohydrate). <Invented name> 20 mg/10 mg: Each film-coated tablet contains 168.6 mg of lactose (as lactose monohydrate). <Invented name> 40 mg/10 mg: Each film-coated tablet contains 286.0 mg of lactose (as lactose monohydrate). For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Film-coated tablet (tablet) <Invented name> 10 mg/10 mg: white to off-white oblong film-coated tablets. <Invented name> 20 mg/10 mg: yellow to light yellow oblong film-coated tablets. <Invented name> 40 mg/10 mg: pink oblong film-coated tablets. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Primary Hypercholesterolaemia/Homozygous Familial Hypercholesterolaemia (HoFH) <Invented name> is indicated for substitution therapy in adult patients who are adequately controlled with rosuvastatin and ezetimibe given concurrently at the same dose level as in the fixed combination, but as separate products, as adjunct to diet for treatment of primary hypercholesterolaemia (heterozygous familial and non-familial) or homozygous familial hypercholesterolaemia.
    [Show full text]
  • HMG-Coa Reductase (HMGCR)
    HMG-CoA Reductase (HMGCR) HMG-CoA Reductase (HMGCR) is the rate-limiting enzyme for cholesterol synthesis in the conversion of HMG-CoA to mevalonate. HMGCR is found in eukaryotes and prokaryotes. The phylogenetic analysis has revealed two classes of HMG-CoA reductase, the Class I enzymes of eukaryotes and some archaea and the Class II enzymes of eubacteria and certain other archaea. Both in eukaryotes and in archaebacteria the enzyme HMGCR is known to catalyze an early reaction unique to isoprenoid biosynthesis. In humans, the HMG-CoA reductase reaction is rate-limiting for the biosynthesis of cholesterol and therefore constitutes a prime target of drugs that reduce serum cholesterol levels. www.MedChemExpress.com 1 HMG-CoA Reductase (HMGCR) Inhibitors (3R,5R)-Rosuvastatin (3R,5S)-Fluvastatin Cat. No.: HY-17504C ((3R,5S)-XU 62-320 free acid) Cat. No.: HY-14664B (3R,5R)-Rosuvastatin is the (3R,5R)-enantiomer of (3R,5S)-Fluvastatin is the Rosuvastatin. Rosuvastatin is a competitive 3R,5S-isomer Fluvastatin. Fluvastatin (XU HMG-CoA reductase inhibitor with an IC50 of 11 62-320 free acid) is a first fully synthetic, nM. Rosuvastatin potently blocks human competitive HMG-CoA reductase inhibitor with ether-a-go-go related gene (hERG) current with an an IC50 of 8 nM. IC50 of 195 nM. Purity: >98% Purity: >98% Clinical Data: No Development Reported Clinical Data: No Development Reported Size: 1 mg, 5 mg Size: 1 mg, 5 mg (3S,5R)-Fluvastatin D6 sodium (3S,5R)-Fluvastatin sodium ((3S,5R)-XU 62-320 D6) Cat. No.: HY-14664CS ((3S,5R)-XU 62-320) Cat.
    [Show full text]
  • Zetia® (Ezetimibe) Tablets
    29480958T REV 14 ZETIA® (EZETIMIBE) TABLETS DESCRIPTION ZETIA (ezetimibe) is in a class of lipid-lowering compounds that selectively inhibits the intestinal absorption of cholesterol and related phytosterols. The chemical name of ezetimibe is 1-(4-fluorophenyl)- 3(R)-[3-(4-fluorophenyl)-3(S)-hydroxypropyl]-4(S)-(4-hydroxyphenyl)-2-azetidinone. The empirical formula is C24H21F2NO3. Its molecular weight is 409.4 and its structural formula is: OH OH S SR N F F O Ezetimibe is a white, crystalline powder that is freely to very soluble in ethanol, methanol, and acetone and practically insoluble in water. Ezetimibe has a melting point of about 163°C and is stable at ambient temperature. ZETIA is available as a tablet for oral administration containing 10 mg of ezetimibe and the following inactive ingredients: croscarmellose sodium NF, lactose monohydrate NF, magnesium stearate NF, microcrystalline cellulose NF, povidone USP, and sodium lauryl sulfate NF. CLINICAL PHARMACOLOGY Background Clinical studies have demonstrated that elevated levels of total cholesterol (total-C), low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (Apo B), the major protein constituent of LDL, promote human atherosclerosis. In addition, decreased levels of high density lipoprotein cholesterol (HDL-C) are associated with the development of atherosclerosis. Epidemiologic studies have established that cardiovascular morbidity and mortality vary directly with the level of total-C and LDL-C and inversely with the level of HDL-C. Like LDL, cholesterol-enriched triglyceride-rich lipoproteins, including very-low- density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), and remnants, can also promote atherosclerosis. The independent effect of raising HDL-C or lowering triglycerides (TG) on the risk of coronary and cardiovascular morbidity and mortality has not been determined.
    [Show full text]
  • Bempedoic Acid) Tablets, for Oral Use Most Common (Incidence ≥ 2% and Greater Than Placebo) Adverse Reactions Initial U.S
    HIGHLIGHTS OF PRESCRIBING INFORMATION • Tendon Rupture: Tendon rupture has occurred. Discontinue NEXLETOL These highlights do not include all the information needed to use at the first sign of tendon rupture. Avoid NEXLETOL in patients who NEXLETOL™ safely and effectively. See full prescribing information have a history of tendon disorders or tendon rupture. (5.2) for NEXLETOL. --------------------------------ADVERSE REACTIONS----------------------------­ NEXLETOL (bempedoic acid) tablets, for oral use Most common (incidence ≥ 2% and greater than placebo) adverse reactions Initial U.S. Approval: 2020 are upper respiratory tract infection, muscle spasms, hyperuricemia, back pain, abdominal pain or discomfort, bronchitis, pain in extremity, anemia, ----------------------------INDICATIONS AND USAGE--------------------------­ and elevated liver enzymes. (6.1) NEXLETOL is an adenosine triphosphate-citrate lyase (ACL) inhibitor indicated as an adjunct to diet and maximally tolerated statin therapy for the To report SUSPECTED ADVERSE REACTIONS, contact Esperion at treatment of adults with heterozygous familial hypercholesterolemia or 833-377-7633 (833 ESPRMED) or FDA at 1-800-FDA-1088 or established atherosclerotic cardiovascular disease who require additional www.fda.gov/medwatch. lowering of LDL-C. (1) --------------------------------DRUG INTERACTIONS----------------------------­ Limitations of Use: The effect of NEXLETOL on cardiovascular morbidity • Simvastatin: Avoid concomitant use of NEXLETOL with simvastatin and mortality has not been
    [Show full text]
  • Statins: Mechanism of Action and Effects
    J.Cell.Mol.Med. Vol 5, No 4, 2001 pp. 378-387 Review Statins: mechanism of action and effects Camelia Stancu, Anca Sima * "Nicolae Simionescu" Institute of Cellular Biology and Pathology, Bucharest, Romania Received: November 12, 2001; Accepted: December 5, 2001 • Introduction • Effects on • Classification of statins - cholesterol esterification and - How they are obtained its accumulation in macrophages - Liver metabolism - endothelial cell function - Physico-chemical properties - inflammatory process - Specific activity - proliferation, migration and • Mechanisms for the action of statins apoptosis of arterial smooth muscle cells - Mechanisms involving lipids - stability of the atherosclerotic plaque - Mechanisms involving intracellular - platelets activation signaling pathways - coagulation process • Beneficial effects of statins • Adverse effects of statins therapy • Conclusions Abstract The beneficial effects of statins are the result of their capacity to reduce cholesterol biosyntesis, mainly in the liver, where they are selectively distributed, as well as to the modulation of lipid metabolism, derived from their effect of inhibition upon HMG-CoA reductase. Statins have antiatherosclerotic effects, that positively correlate with the percent decrease in LDL cholesterol. In addition, they can exert antiatherosclerotic effects independently of their hypolipidemic action. Because the mevalonate metabolism generates a series of isoprenoids vital for different cellular functions, from cholesterol synthesis to the control of cell growth and differentiation, HMG-CoA reductase inhibition has beneficial pleiotropic effects. Consequently, statins reduce significantly the incidence of coronary events, both in primary and secondary prevention, being the most efficient hypolipidemic compounds that have reduced the rate of mortality in coronary patients. Independent of their hypolipidemic properties, statins interfere with events involved in bone formation and impede tumor cell growth.
    [Show full text]
  • The Effectiveness of Statins for Primary Prevention: a Rapid Review
    The Effectiveness of Statins for Primary Prevention: A Rapid Review A Schaink February 2013 Effectiveness of Statins for Primary Prevention: A Rapid Review. February 2013; pp. 1–23. Suggested Citation This report should be cited as follows: Schaink A. The effectiveness of statins for primary prevention: a rapid review. Toronto, ON: Health Quality Ontario; 2013 Feb. 23 p. Available from: http://www.hqontario.ca/evidence/publications-and-ohtac- recommendations/rapid-reviews. Conflict of Interest Statement All reports prepared by the Division of Evidence Development and Standards at Health Quality Ontario are impartial. There are no competing interests or conflicts of interest to declare. Rapid Review Methodology Clinical questions are developed by the Division of Evidence Development and Standards at Health Quality Ontario in consultation with experts, end-users, and/or applicants in the topic area. A systematic literature search is then conducted to identify relevant systematic reviews, health technology assessments, and meta-analyses; if none are located, the search is expanded to include randomized controlled trials (RCTs), and guidelines. Systematic reviews are evaluated using a rating scale developed for this purpose. If the systematic review has evaluated the included primary studies using the GRADE Working Group criteria (http://www.gradeworkinggroup.org/index.htm), the results are reported and the rapid review process is complete. If the systematic review has not evaluated the primary studies using GRADE, the primary studies included in the systematic review are retrieved and a maximum of two outcomes are graded. If no well-conducted systematic reviews are available, RCTs and/or guidelines are evaluated. Because rapid reviews are completed in very short timeframes, other publication types are not included.
    [Show full text]