Low-Dose Combined Therapy with Fluvastatin and Cholestyramine in Hyperlipidemic Patients

Sprecher, Dennis L.; Abrams, Jonathan; Allen, John; Keane, William F.; Chrysant, Steven G.; Ginsberg, Henry N.; Fischer, Jerome J.; Johnson, Brian F. G.; Théroux, Pierre; Jokubaitis, Leonard

doi:10.7326/0003-4819-120-7-199404010-00002

Cited by 50 publications

(21 citation statements)

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“…For instance, when combined with cholestyramine (CME) at a daily dose of 24 g, pravastatin (10 mg/d) reduced LDL by 56%, whereas a higher daily dose of pravastatin (40 mg) monotherapy elicited only a 35% decline [52]. Conversely, similar LDL-lowering effects were observed when fluvastatin (10 to 20 mg/d) was combined with either a low, more tolerable CME dose (8 g/d) or CME at a higher doses (16 g/d) [49].…”

Section: Statin-resin/ternary-drug Combination Regimenssupporting

confidence: 42%

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Combination lipid-altering therapy: An emerging treatment paradigm for the 21st century

Jacobson

2001

Curr Atheroscler Rep

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For the care of an expanding segment of the US population with multiple coronary risk factors, combination lipid-altering therapy is emerging as a treatment imperative. The most recent National Cholesterol Education Program's consensus guidelines emphasize long-term global coronary heart disease (CHD) risk status, designate patients with CHD risk equivalents (eg, diabetes, peripheral arterial disease, 20% or more 10-year absolute CHD risk) for aggressive lipid-altering therapy, and deem the metabolic syndrome (eg, obesity, insulin resistance, hypertension, elevated triglycerides, low levels of high-density lipoprotein cholesterol, small dense low-density lipoprotein particles) as a secondary target for intervention. With the advancing age of the US population and the high prevalence of diabetes, the metabolic syndrome, and CHD, increasing numbers of patients will require a more balanced metabolic attack attainable only through combination lipid-altering regimens. Many of these patients, as well as persons at heightened risk for cardiovascular disease because of a range of heritable conditions (eg, familial hypercholesterolemia, familial combined hyperlipidemia), will undoubtedly require binary or ternary regimens involving statins in concert with niacin, fibric-acid derivatives, or bile acid resins. Such approaches enable the clinician to exploit the complementary effects of these agents, allowing them to be administered at low, optimally tolerable doses that are consistent with superior efficacy and a lower risk of adverse events as compared with escalating doses of monotherapy.

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Section: Statin-resin/ternary-drug Combination Regimenssupporting

confidence: 42%

“…As shown in Table 3, binary statin-BAR regimens induce profound declines in LDL (up to 70%) [47][48][49][50][51]. Combination statin-BAR therapy has mutual dose-sparing effects.…”

Section: Statin-resin/ternary-drug Combination Regimensmentioning

confidence: 96%

Combination lipid-altering therapy: An emerging treatment paradigm for the 21st century

Jacobson

2001

Curr Atheroscler Rep

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“…21,35,36,[45][46][47][48][49][50][51]63,73,78,88,91,[94][95][96][97][98] For example, 20 mg of fluvastatin provides an approximate 20% LDL reduction as monotherapy. 36,[45][46][47][48][49][50][51][52][53][54][55] Niacin, 3 g, provides an approximate 21% LDL reduction as monotherapy. 19,51,76 When these drugs are administered as combination therapy, this combination provides approximately a 41% LDL reduction.…”

Section: Resultsmentioning

confidence: 99%

Forecasting Patient Outcomes in the Management of Hyperlipidemia

Brier

Tornow²,

Ries

et al. 1999

Arch Intern Med

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“…Despite this, the limitations of statin therapy in patients with severe hypercholesterolemia in whom a minimum of 50% LDL-C lowering was needed, were soon appreciated. Several studies were published in the early 1990s demonstrating the value of add-on cholestyramine or colestipol to treatment with, pravastatin, 15 fl uvastatin 16 and lovastatin, 17 in which approximately 50% lowering of LDL-C and up to 40% lowering of apo B 18 was achieved. Furthermore combination of these agents with non-statin drugs such as niacin 19 or fi brates 20 provided added LDL-C-lowering capability to triglyceride-lowering or HDL-C-raising agents, without the safety concerns that had been raised by combined use of these drugs with statins.…”

Section: Initial Use Of Bile Acid Sequestrants As Ldl-c-lowering Agentsmentioning

confidence: 99%

Improving glycemic and cholesterol control through an integrated approach incorporating colesevelam – a clinical perspective

Goldberg¹

2009

DMSO

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Bile sequestrants have been used for almost 50 years to lower low density lipoprotein cholesterol (LDL-C). The advent of colesevelam in 2000 provided a more tolerable add-on LDL-C-lowering agent with an excellent safety record and with likely benefi t for coronary heart disease events. Colesevelam lowers LDL-C approximately 15%, and has an additive effect when combined with statin or non-statin lipid-modifying agents. It also tends to increase triglyceride levels. The discovery that bile sequestrants also lower glucose levels led to defi nitive large-scale clinical trials testing the effect of colesevelam as a dual antihyperglycemic agent with LDL-Clowering properties in type 2 diabetic subjects on metformin-, sulfonylurea-or insulin-based therapy with inadequate glycemic control. Colesevelam was found to lower hemoglobin A1c (HbA1c) by approximately 0.5% compared to placebo over the 16-to 26-week period, and had similar effects on the lipid profi le in these diabetic subjects, as had previously been demonstrated in non-diabetic individuals. Colesevelam was well tolerated, with constipation being the most common adverse effect, and did not cause weight gain or excessive hypoglycemia. Colesevelam thus combines antihyperglycemic action with LDL-C-lowering properties, and should be useful in the management of type 2 diabetes.

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Low-Dose Combined Therapy with Fluvastatin and Cholestyramine in Hyperlipidemic Patients

Cited by 50 publications

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Combination lipid-altering therapy: An emerging treatment paradigm for the 21st century

Combination lipid-altering therapy: An emerging treatment paradigm for the 21st century

Forecasting Patient Outcomes in the Management of Hyperlipidemia

Improving glycemic and cholesterol control through an integrated approach incorporating colesevelam – a clinical perspective

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Low-Dose Combined Therapy with Fluvastatin and Cholestyramine in Hyperlipidemic Patients

Cited by 50 publications

References 0 publications

Combination lipid-altering therapy: An emerging treatment paradigm for the 21st century

Combination lipid-altering therapy: An emerging treatment paradigm for the 21st century

Forecasting Patient Outcomes in the Management of Hyperlipidemia

Improving glycemic and cholesterol control through an integrated approach incorporating colesevelam &ndash; a clinical perspective

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Product

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Improving glycemic and cholesterol control through an integrated approach incorporating colesevelam – a clinical perspective