Moderate Dose, Three-Drug Therapy With Niacin, Lovastatin, and Colestipol to Reduce Low-Density Lipoprotein Cholesterol &lt;100 mg/dl in Patients With Hyperlipidemia and Coronary Artery Disease

Brown, B. Greg; Bardsley, Joanna; Poulin, Drew; Hillger, Lynn A.; Dowdy, Alice; Maher, Vincent; Zhao, Xue Qiao; Albers, John J.; Knopp, Robert H.

doi:10.1016/s0002-9149(97)00303-2

Cited by 92 publications

(85 citation statements)

References 21 publications

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“…Several teams of investigators, including Brown et al, have begun to examine this hypothesis. [14][15][16][17] Their work will continue to provide interesting insight into this engaging field.…”

Section: Resultsmentioning

confidence: 99%

“…15,16 In one follow-up investigation to the FATS trial, the efficacy, tolerability, and side effect profiles of regular and sustained-release niacin were compared, as was compliance. 15 After 8 months of treatment, 83% of patients achieved a target LDL-C ≤ 100 mg/dl with sustained-release niacin as opposed to 52% with regular niacin (p<0.01). The side effect profiles and toxicity of the two forms of niacin did not differ significantly.…”

Section: Impact Of Niacin Plus Statin Therapy On Coronary Heart Diseamentioning

confidence: 99%

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Combination niacin and statin therapy in primary and secondary prevention of cardiovascular disease

Levy

M.D.

2005

Clinical Cardiology

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Summary: Statin monotherapy may not be sufficient to reach serum lipid goals in many patients, especially in those with combined lipid abnormalities. Statins cause only a modest increase in high-density lipoprotein cholesterol (HDL)-an established independent protective factor for coronary heart disease (CHD)-and a modest decrease in triglycerides (TG). Niacin is an effective pharmacologic agent for increasing HDL, as well as lowering TG. Used in combination with a statin, niacin provides an option to help patients attain their low-density lipoprotein cholesterol (LDL-C) goals, non-HDL goals, and HDL goals. Based on the National Health and Nutrition Examination Survey, 1999 to 2000, only 12% of the surveyed adult population were under treatment for diagnosed hypercholesterolemia. Furthermore, only 5.4% of the surveyed population had attained goal total cholesterol levels of < 5.2 mmol/l (< 200 mg/dl). Combination therapy offers a means to get more people to goal. This paper reviews the impact of lipid-modifying combination therapy with niacin plus a statin on lipid profile outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Impact Of Niacin Plus Statin Therapy On Coronary Heart Diseamentioning

confidence: 99%

Combination niacin and statin therapy in primary and secondary prevention of cardiovascular disease

Levy

M.D.

2005

Clinical Cardiology

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“…In a meta-analysis 74 of HDL-C-raising therapies involving more than 4000 patients using immediate-release niacin (n=3062), 75-83 sustained-release niacin (n=536), 66,67,77,[84][85][86] or extended-release niacin (n=648), [68][69][70][71]87,88 some of the results of which are summarized in eTable 1, most patients (70%) receiving niacin experienced flushing (vs 4% with placebo; P<.001). This proportion included 85% of patients receiving immediate-release niacin, 66% receiving extended-release niacin, and 26% receiving sustained-release niacin.…”

Section: Clinical Trials Of Niacin Monotherapy: 1985-1999mentioning

confidence: 99%

A “Hot” Topic in Dyslipidemia Management—“How to Beat a Flush”: Optimizing Niacin Tolerability to Promote Long-term Treatment Adherence and Coronary Disease Prevention

Jacobson

2010

Mayo Clinic Proceedings

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Niacin is the most effective lipid-modifying agent for raising highdensity lipoprotein cholesterol levels, but it also causes cutaneous vasodilation with flushing. To determine the frequency of flushing in clinical trials, as well as to delineate counseling and treatment approaches to prevent or manage flushing, a MEDLINE search was conducted of English-language literature from January 1, 19851, , through April 7, 2009. This search used the title keywords niacin or nicotinic acid crossed with the Medical Subject Headings adverse effects and human. Niacin flushing is a receptormediated, mainly prostaglandin D 2 -driven phenomenon, the frequency, onset, and duration of which are largely determined by the distinct pharmacological and metabolic profiles of different niacin formulations. Subjective assessments include ratings of redness, warmth, itching, and tingling. In clinical trials, most (>60%) niacin users experienced mild or moderate flushing, which tended to decrease in frequency and severity with continued niacin treatment, even with advancing doses. Approximately 5% to 20% of patients discontinued treatment because of flushing. Flushing may be minimized by taking niacin with meals (or at bedtime with a low-fat snack), avoiding exacerbating factors (alcohol or hot beverages), and taking 325 mg of aspirin 30 minutes before niacin dosing. The current review advocates an initially slow niacin dose escalation from 0.5 to 1.0 g/d during 8 weeks and then from 1.0 to 2.0 g in a single titration step (if tolerated). Through effective counseling, treatment prophylaxis with aspirin, and careful dose escalation, adherence to niacin treatment can be improved significantly. Wider implementation of these measures should enable higher proportions of patients to reach sufficient niacin doses over time to prevent cardiovascular events. Proc. 2010;85(4):365-379 GPR = G i protein-coupled receptor; HDL-C = high-density lipoprotein cholesterol; NSAID = nonsteroidal anti-inflammatory drug; PG = prostaglandin; RCT = randomized controlled trial R educing low-density lipoprotein cholesterol levels is the primary treatment for preventing cardiovascular disease, largely because of robust evidence from randomized controlled trials (RCTs) involving statins. Mayo Clin

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“…Nos pacientes com LDL-colesterol ≥ 100 mg/dl em tratamento, a dose da medicação deve ser aumentada e, se necessário, uma combinação de medicamentos deve ser utilizada -grau de recomendação I, nível de evidência A. Nos pacientes com 284 . Os únicos dados com relação ao uso de hipolipemiantes na fase aguda do IAM vêm do registro sueco, que mostrou redução de 25% na mortalidade em um ano pós-IAM nos pacientes que iniciaram terapia precocemente 285 .…”

Section: -Agentes Hipolipemiantesunclassified

Diretrizes

2009

Arq. Bras. Cardiol.

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-Atendimento pré-hospitalarO interesse no atendimento pré-hospitalar do infarto agudo do miocárdio (IAM) teve início na década de 1960, devido ao grande número de óbitos que ocorriam antes que os paciente chegassem ao hospital.A maioria das mortes por IAM ocorre nas primeiras horas de manifestação da doença, sendo 40%-65% dos casos na primeira hora e, aproximadamente, 80% nas primeiras 24 horas [1][2][3] . Assim, a maior parte das mortes por IAM acontece fora do ambiente hospitalar, geralmente desassistidas pelos médicos 4 . A modalidade mais frequente de parada cardiorrespiratória nas primeiras horas do IAM é a fibrilação ventricular 3 . -Período pré-hospitalar.O período pré-hospitalar compreende dois momentos: a) do início dos sintomas (geralmente dor torácica aguda) até a decisão de procurar atendimento; b) da decisão de procurar atendimento até a chegada ao hospital.No infarto agudo do miocárdio com elevação do segmento ST (IAMCST), o tempo desde o início dos sintomas (oclusão da artéria coronária) até a instituição do tratamento (reperfusão química ou mecânica) é diretamente proporcional à ocorrência de eventos clinicamente relevantes. Esse tempo é fator fundamental para o benefício do tratamento, tanto imediato quanto tardio 5 .No entanto, sabe-se que a fase pré-hospitalar (em ambos os momentos descritos) é caracterizada por ser demorada, especialmente em pacientes idosos, do sexo feminino e com baixa condição socioeconômica 4 . Alguns fatores estão relacionados ao aumento desse tempo tão precioso (Quadro 1.1.1.1) 6 . O componente pré-hospitalar no atraso do atendimento ao paciente com dor torácica é de tal magnitude que, na prática clínica, apenas cerca de 20% destes pacientes chegam ao setor de emergência com até duas horas após o início dos sintomas 7 . -Medidas na fase pré-hospitalarApesar da significativa redução da mortalidade hospitalar do IAM nas últimas décadas 8,9 , houve pouco avanço no conhecimento sobre a epidemiologia e o tratamento na fase pré-hospitalar. É notória a necessidade de mudanças nesse cenário, embora poucas sejam as evidências geradas para este fim.A abordagem do paciente com suspeita de síndrome coronária aguda em ambiente extra-hospitalar deve, idealmente, ser feita por profissional de saúde, com realização de uma história clínica direcionada, investigando as características dos sintomas atuais (momento do início, tempo de duração, qualidade, intensidade, relação com o esforço e repouso) e a presença de doença coronária estabelecida (angina prévia). Algumas características são reconhecidamente determinantes para a manifestação atípica de um evento coronariano e devem ser lembradas quando um indivíduo for abordado na fase pré-hospitalar, por mascararem o quadro de IAM (Tabela 1.1.2.1) [10][11][12] .O eletrocardiograma executado no local de atendimento e interpretado por um médico habilitado (na ambulância ou em local remoto) mostrou ser um método que reduz em 34% o tempo porta-agulha e em 18% o tempo porta-balão, além de proporcionar maiores taxas de tempo porta-balão ideal (men...

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Moderate Dose, Three-Drug Therapy With Niacin, Lovastatin, and Colestipol to Reduce Low-Density Lipoprotein Cholesterol <100 mg/dl in Patients With Hyperlipidemia and Coronary Artery Disease

Cited by 92 publications

References 21 publications

Combination niacin and statin therapy in primary and secondary prevention of cardiovascular disease

Combination niacin and statin therapy in primary and secondary prevention of cardiovascular disease

A “Hot” Topic in Dyslipidemia Management—“How to Beat a Flush”: Optimizing Niacin Tolerability to Promote Long-term Treatment Adherence and Coronary Disease Prevention

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