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Dual Inhibiton: New Strategy for Lowering Cholesterol
Intro
Cardiovascular disease (CVD) has risen world consent about it. Since cardiovascular disease is the leading cause of death worldwide. According to WHO data, it's estimated about 17.5 millions people die from CVD annually.
The pathogenesis of CVD has been welll-known as the process that involving progressive cholesterol deposits in vessels that causing decreased in vessels lumen diameters. Disruption in developed cholesterol plaque may promotes thrombosis events that lead to distal perfused organ damaged, for example heart attack, stroke and perifer arterial disease.
The process and progressivity of atherosclerosis is depend on several risk factors, includes high level of low-density Lipoprotein cholesterol as demonstrated in many trials.
Comprehensive management of CVD involves combined intervention of lifestyle and medication therapy.
Many studies have demonstrated association between LDL-C and progression of CVD, and those findings are positive linear correlation between LDL-C and CVD. Thus, implicate in treatment of CVD patient.
"Increasing number of age is impossible to avoid, but perhaps we can slow or retard the degenerative process." This has become major treatment goals and motivation for scientists to look any other possibilities in treatment.
Cholesterol lowering therapy
Cholesterol control, especially LDL-C control has become popular in medical field. And becoming one of treatment modalities for CVD.
Lowering serum cholesterol levels reduces the risk of coronary heart disease (CHD)-related events.
National and international guideline for the prevention of CHD recommend the modification of lipid profiles and particularly LDL-C. Several clinical trials indicated an added benefit from aggressive lipid lowering LDL-C levels. Based on these findings NCEP ATP III revised the LDL-C target from <100 mg/dl to 70 mg/dl for very high risk patients. Unfortunately, result from REALITY-Asia study. for across all cardiovascular risk categories, only 48% of patients attained ATP III targets for LDL-C.
Statins are commonly prescribed as first line treatment but many patients at high-risk for CHD still fail to reach their cholesterol or low density lipoprotein (LDL-C) goals with statin monotherapy.
For patients who fail to achieve their LDL-C target, inhibiting two main sources of cholesterol synthesis and uptake -- can produce more effective lipid lowering, allowing more patients to reach their LDL-C goal. Ezetimibe is a highly-selective inhibitor of cholesterol absorption and simvastatin is an evidence based inhibitor of cholesterol synthesis.
The 23% additional reduction in LDL-cholesterol seen with ezetimibe added to ongoing statin monotherapy compares favorably with the 6% to 8% reduction usually seen when the dose of the original statin is doubled, Dr. Pearson commented. The results of EASE study suggest that the addition of ezetimibe to statin therapy should be considered in patients who have not achieved their NCEP ATP III goal on statin therapy alone.
Recently, SEAS trial has reported that the combination of ezetimibe/simvastatin was associated with a significantly increased risk of cancer compare to placebo, causing widespread public concern. But based on post marketing analysis by dr. Alawi et al, that adverse event in SEAS trial doesn't support that ezetimibe alone or in combination with simvastatin increase the risk of cancer.
I think based on those trials, dual therapy on cholesterol lowering should be applicated in medical practice. Ezetimibe (absorption inhibitor) and Statin (production inhibitor) are promising combination in cholesterol control.
Cardiovascular disease (CVD) has risen world consent about it. Since cardiovascular disease is the leading cause of death worldwide. According to WHO data, it's estimated about 17.5 millions people die from CVD annually.
The pathogenesis of CVD has been welll-known as the process that involving progressive cholesterol deposits in vessels that causing decreased in vessels lumen diameters. Disruption in developed cholesterol plaque may promotes thrombosis events that lead to distal perfused organ damaged, for example heart attack, stroke and perifer arterial disease.
adopted from http://www.gbscorp.com
Comprehensive management of CVD involves combined intervention of lifestyle and medication therapy.
Many studies have demonstrated association between LDL-C and progression of CVD, and those findings are positive linear correlation between LDL-C and CVD. Thus, implicate in treatment of CVD patient.
"Increasing number of age is impossible to avoid, but perhaps we can slow or retard the degenerative process." This has become major treatment goals and motivation for scientists to look any other possibilities in treatment.
Cholesterol lowering therapy
Cholesterol control, especially LDL-C control has become popular in medical field. And becoming one of treatment modalities for CVD.
Lowering serum cholesterol levels reduces the risk of coronary heart disease (CHD)-related events.
adopted from http://www.glasbergen.com
National and international guideline for the prevention of CHD recommend the modification of lipid profiles and particularly LDL-C. Several clinical trials indicated an added benefit from aggressive lipid lowering LDL-C levels. Based on these findings NCEP ATP III revised the LDL-C target from <100 mg/dl to 70 mg/dl for very high risk patients. Unfortunately, result from REALITY-Asia study. for across all cardiovascular risk categories, only 48% of patients attained ATP III targets for LDL-C.
Statins are commonly prescribed as first line treatment but many patients at high-risk for CHD still fail to reach their cholesterol or low density lipoprotein (LDL-C) goals with statin monotherapy.
For patients who fail to achieve their LDL-C target, inhibiting two main sources of cholesterol synthesis and uptake -- can produce more effective lipid lowering, allowing more patients to reach their LDL-C goal. Ezetimibe is a highly-selective inhibitor of cholesterol absorption and simvastatin is an evidence based inhibitor of cholesterol synthesis.
The 23% additional reduction in LDL-cholesterol seen with ezetimibe added to ongoing statin monotherapy compares favorably with the 6% to 8% reduction usually seen when the dose of the original statin is doubled, Dr. Pearson commented. The results of EASE study suggest that the addition of ezetimibe to statin therapy should be considered in patients who have not achieved their NCEP ATP III goal on statin therapy alone.
adopted from http://www.diabetesmonitor.com
Recently, SEAS trial has reported that the combination of ezetimibe/simvastatin was associated with a significantly increased risk of cancer compare to placebo, causing widespread public concern. But based on post marketing analysis by dr. Alawi et al, that adverse event in SEAS trial doesn't support that ezetimibe alone or in combination with simvastatin increase the risk of cancer.
I think based on those trials, dual therapy on cholesterol lowering should be applicated in medical practice. Ezetimibe (absorption inhibitor) and Statin (production inhibitor) are promising combination in cholesterol control.
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But another good article, well illustrated.
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I agree with you. Medications will not give good effects if the lifestyle isn't modified.