2012 Update of the Canadian Cardiovascular Society Guidelines for the Diagnosis and Treatment of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult

Anderson, Todd J.; Grégoire, Jean; Hegele, Robert A.; Couture, Patrick; Mancini, G.B. John; McPherson, Ruth; Francis, Gordon A.; Poirier, Paul; Lau, David C.W.; Grover, Steven A.; Genest, Jacques; Carpentier, André C.; Dufour, Robert; Gupta, Milan; Ward, Richard A.; Leiter, Lawrence A.; Lonn, Eva; Ng, Dominic S.; Pearson, Glen J.; Yates, Gillian; Stone, James A.; Ur, Ehud

doi:10.1016/j.cjca.2012.11.032

Cited by 677 publications

(483 citation statements)

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“…To assess the response to lipid‐lowering therapy, LDL‐P targets have been proposed, based on population equivalent levels for LDL‐C targets (<20th percentile for high‐ and very high‐risk patients). It should be noted that while treatment targets for LDL‐C, non–HDL‐C, and apoB have been recommended in various national dyslipidemia guidelines, LDL‐P targets have not been endorsed 1, 7, 12, 15. Achievement of LDL‐P targets that are equivalent to LDL‐C and non–HDL‐C targets based on population percentiles have been shown to require intensive therapy 44.…”

Section: Discussionmentioning

confidence: 99%

“…This residual risk may be attributed in part to atherogenic dyslipidemia, characterized by high levels of triglycerides, low levels of high‐density lipoprotein (HDL) cholesterol (HDL‐C), and high LDL‐particle (LDL‐P) numbers in these patients 1. In addition to LDL‐C lowering, non–HDL‐C and apolipoprotein B (apoB) have been recommended as treatment targets for assessment of individuals with diabetic dyslipidemia 1, 7, 12, 13, 14, 15…”

Section: Introductionmentioning

confidence: 99%

“…Several international guidelines endorse statin uptitration, switching to a more‐potent statin therapy, and/or combination therapy for high‐risk individuals in need of additional cholesterol lowering 7, 12, 13, 14, 15. US guidelines recommend using the maximum tolerated statin dose with consideration given to the addition of a nonstatin cholesterol‐lowering drug if the clinical benefit outweighs the safety risk in these patients 16.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid‐Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease

Tomassini

Tershakovec

et al. 2015

JAHA

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BackgroundPatients with diabetes mellitus and cardiovascular disease may not achieve adequate low‐density lipoprotein cholesterol (LDL‐C) lowering on statin monotherapy, attributed partly to atherogenic dyslipidemia. More intensive LDL‐C–lowering therapy can be considered for these patients. A previous randomized, controlled study demonstrated greater LDL‐C lowering in diabetic patients with symptomatic cardiovascular disease who switched from simvastatin 20 mg (S20) or atorvastatin 10 mg (A10) to combination ezetimibe/simvastatin 10/20 mg (ES10/20) therapy, compared with statin dose‐doubling (to S40 or A20) or switching to rosuvastatin 10 mg (R10). The effect of these regimens on novel biomarkers of atherogenic dyslipidemia (low‐ and high‐density lipoprotein particle number and lipoprotein‐associated phospholipase A2 [Lp‐PLA2]) was assessed.Methods and ResultsTreatment effects on low‐ and high‐density lipoprotein particle number (by NMR) and Lp‐PLA2 (by ELISA) were evaluated using plasma samples available from 358 subjects in the study. Switching to ES10/20 reduced low‐density lipoprotein‐particle number numerically more than did statin dose‐doubling and was comparable with R10 (−133.3, −94.4, and −56.3 nmol/L, respectively; P>0.05). Increases in high‐density lipoprotein particle number were significantly greater with switches to ES10/20 versus statin dose‐doubling (1.5 and −0.5 μmol/L; P<0.05) and comparable with R10 (0.7 μmol/L; P>0.05). Percentages of patients attaining low‐density lipoprotein particle number levels <990 nmol/L were 62.4% for ES10/20, 54.1% for statin dose‐doubling, and 57.0% for R10. Switching to ES10/20 reduced Lp‐PLA2 activity significantly more than did statin dose‐doubling (−28.0 versus −3.8 nmol/min per mL, P<0.05) and was comparable with R10 (−28.0 versus −18.6 nmol/min per mL; P>0.05); effects on Lp‐PLA2 concentration were modest.ConclusionsIn diabetic patients with dyslipidemia, switching from statins to combination ES10/20 therapy generally improved lipoprotein subclass profile and Lp‐PLA2 activity more than did statin dose‐doubling and was comparable with R10, consistent with its lipid effects.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00862251.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid‐Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease

Tomassini

Tershakovec

et al. 2015

JAHA

View full text Add to dashboard Cite

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“…Dietary and lifestyle changes remain the cornerstone of heart disease prevention 1, 2. It has been estimated that >80% of cardiovascular events can be prevented with dietary and lifestyle modifications 3.…”

mentioning

confidence: 99%

“…Vegetarian diets are one approach to achieving a heart healthy dietary pattern, low in saturated and trans‐fats and high in fiber and antioxidants. While other heart healthy dietary strategies such as low‐ carbohydrate, low‐glycaemic index and Mediterranean diets have been shown to reduce incidence of cardiovascular disease, recent meta‐analyses have found that these diets do not consistently reduce low density lipoprotein‐cholesterol (LDL‐C),4 a major therapeutic blood lipid target to improve cardiovascular health 1, 2. This lack of consistent effect represents a possible major barrier to recommending these diets to dyslipidemic individuals.…”

mentioning

confidence: 99%