Effectiveness and safety of combinational therapy compared with intensified statin monotherapy in patients with coronary heart disease

Abstract

Reducing the plasma levels of low-density lipoprotein-cholesterol (LDL-C) is critical for patients with coronary heart disease (CHD). Conventional treatment with statins alone may not achieve the goal of lowering LDL-C due to drug intolerance or resistance. The present study evaluated the effectiveness and safety of combining statin with another lipid-lowering agent in the management of dyslipidemia in CHD patients. A total of 180 patients with CHD were divided into three therapeutic groups (n=60 in each): Statin/colesevelam group (20 mg atorvastatin and 10 mg colesevelam daily), statin/ezetimibe group (20 mg atorvastatin and 10 mg ezetimibe daily) and high-intensity statin monotherapy group (30 mg atorvastatin daily). The baseline plasma lipid levels were measured. The duration of the treatment was eight weeks and the side effects were noted at one year's follow-up. After eight weeks' treatment, the mean plasma level of LDL-C was reduced by 45.2, 44.8 and 30.0% in the statin/colesevelam, statin/ezetimibe and statin monotherapy group, respectively. The reduction of LDL-C in the combinational therapy groups was greater than that in the statin monotherapy group (P<0.05). The proportion of patients achieving the goal of lowering LDL-C in the combinational therapy groups was higher than that in the statin monotherapy group. The effectiveness of reducing lipids was similar in the two combinational statin/colesevelam and statin/ezetimibe groups. Rates of adverse events were not significantly different among the three groups. In conclusion, statins combined with colesevelam or ezetimibe were more effective in reducing plasma LDL-C levels than high-intensity statin monotherapy. This combinational therapeutic strategy may be an alternative for patients that are resistant or intolerant to statins.

Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol (LDL-C) Goal Achievement in High-Cardiovascular-Risk Patients in Fuzhou, China

“…6 Thus, the combination of statin and other lipidlowering drugs has been extensively studied, from which they found that combination therapy is not only safer but also more effective. [41][42][43][44] Studies have confirmed that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can be used as a new lipid-lowering drug when statin alone is ineffective for lipid lowering. 45,46 Therefore, more and more evidence show that the combination of statin and nonstatin drugs will be the key of lipid control.…”

Dyslipidemia: A Trigger for Coronary Heart Disease in Romanian Patients with Diabetes

“…A key contributor in the development of CHD is dyslipidemia [7]. Dyslipidemia is characterized by high plasma levels of triglycerides (TG), low HDL-cholesterol (HDLc) concentrations and increased concentrations of small dense LDL-cholesterol (LDLc) particles [5].…”

Efficient production of an ezetimibe intermediate using carbonyl reductase coupled with glucose dehydrogenase

“…Ezetimibe is a top selling hypolipidemic drug for the treatment of cardiovascular disease which acts as a novel selective cholesterol absorption inhibitor to prevent intestinal intake of cholesterol from the diet without affecting the synthesis of cholesterol by the body itself. [1][2][3][4][5] Therefore, the synthesis of ezetimibe has important com- 75 C), which results in low overall yield, high production cost, poor security, and contaminant discharge. 6,7 To explore for the synthesis approaches which meet the concepts of green chemistry is of great value.…”

“…Ezetimibe is a top selling hypolipidemic drug for the treatment of cardiovascular disease which acts as a novel selective cholesterol absorption inhibitor to prevent intestinal intake of cholesterol from the diet without affecting the synthesis of cholesterol by the body itself 1‐5 . Therefore, the synthesis of ezetimibe has important commercial value and development prospects.…”

“…Ezetimibe is a top selling hypolipidemic drug for the treatment of cardiovascular disease which acts as a novel selective cholesterol absorption inhibitor to prevent intestinal intake of cholesterol from the diet without affecting the synthesis of cholesterol by the body itself. [1][2][3][4][5] Therefore, the synthesis of ezetimibe has important commercial value and development prospects. The construction of the chiral amino group of the intermediate, (S)-ET-5 from (4S)-3-[5-(4fluorophenyl)-1,5-dioxopentyl]-4-phenyl-2-oxazolidinone (ET-4) was considered as the key step to produce ezetimibe.…”