md-medicaldata


Go to content

Main menu:

 

 

 

 

 

 

 


SIGNIFICANT REDUCTION OF RESIDUAL CARDIOVASCULAR RISK WITH COMBINATION THERAPY WITH STATIN AND FIBRATE /

ZNAČAJNA REDUKCIJA REZIDUALNOG KARDIOVASKULARNOG RIZIKA KOMBINOVANOM TERAPIJOM STATINOM I FIBRATOM

Authors

 

Milena Pandrc 1, Vanja Kostovski 2 , Nenad Zornić 3

1Klinika za urgentnu internu medicinu; Vojnomedicinska akademija; Univerzitet odbrane, Beograd, Srbija / Clinic for urgent internal medicine; Military Medical Academy; University of Defence, Belgrade, Serbia
2Klinika za grudnu i kardiohirurgiju; Vojnomedicinska akademija; Univerzitet odbrane, Beograd, Srbija / Clinic for cardiothoracic surgery; Military Medical Academy; University of Defence, Belgrade, Serbia
3Odeljenje anesteziologije, Medicinski fakultet, Univerzitet u Kragujevcu / Department of Anestesiology, Medical Faculty, University of Kragujevac

 

UDK: 615.272.03
616-008.9:577.125


The paper was received / Rad primljen: 31.07.2021.

Accepted / Rad prihvaćen: 30.08.2021.

 


Correseponding to:


Milena S. Pandrc, MD,
Military Medical Academy Department of Cardiology
Crnotravska 17, 11000 Belgrade, Serbia;
phone number: +381-64-291-6310
e-mail: pandrcmilena@yahoo.com

 

 

Abstract

 

 

Despite achieving the desired LDL cholesterol values, patients remain at high residual risk of major macrovascular events. High TG and low HDL cholesterol are strong independent predictors of adverse cardiovascular events, regardless of LDL cholesterol levels, elevated TG and low HDL cholesterol. Patients with increased TG and decreased HDL-c benefit from a combination of statin and fibrate therapy. It is necessary to underline the fact that high doses of statins can further worsen, ie. reduce the HDL fraction (so-called "good cholesterol"), and that fenofibrates are the ones that can raise HDL concentrations. Also, fenofibrate is crucial for lowering triglyceride concentration, statins have very little effect in this regard. So, if the patient is indicated to introduce both drugs, our choice is always on a fixed combination because of all the advantages of taking one tablet. Therapy should be continuous, because we stabilize fatty plaques in the walls of blood vessels continuously, so that physiological concentrations of lipids in the circulation are not an indication for discontinuation of the drug, because there is a repeated disturbance of lipid status and a pronounced "rebound" phenomenon.

 

Keywords:

residual cardiovascular risk, combination with  statins and fibrates

 

 

 

Sažetak

Uprkos postizanju željenih vrednosti LDL holesterola, pacijenati ostaju izloženi visokom preostalom riziku od velikih makrovaskularnih događaja.Visoki TG i nizak nivo HDL holesterola su snažni neuzavisni prediktori neželjenih kardiovaskularnih događaja, nezavisno od nivoa LDL holesterola.Terapija samo statinima nije dovoljna da bi pokrila vaskularni rizik pripisan  povišenim TG i niskom HDL holesterolu. Pacijenti sa povećanim TG i smanjenim HDL-c imaju korist od  kombinovane terapije statinom  i fibratom. Potrebno je podvući i činjenicu da visoke doze statina mogu dodatno da pogoršaju tj.  smanje HDL frakciju ( tzv. ,,dobri holesterol “), a da su fenofibrati ti koji mogu da podignu koncentracije  HDL. Takođe, fenofibrat je ključan za snižavanje koncentracije triglicerida,  statini imaju jako mali efekat u tom smislu. Dakle, ako je indikovan pacijentu uvesti oba leka, naš  izbor je uvek na fiksnoj kombinaciji zbog svih prednosti uzmanja jedne tablete. Terapija treba da bude kontinuirana, jer stabilizujemo masne plakove u zidovima krvnih sudova kontinuirano, tado da fiziološke koncentracije lipida u cirkulaciji nisu indikacija za ukidanje leka, jer dolazi do ponovnog poremećaja lipidnog statusa i izraženog tzv "rebound" fenomena.

 


Ključne reči:

rezidualni kardiocaskularni rizik,  kombinovana terapija hiperlipoproteinemija

 

 

 

 

References:

  1. Semova I, Levenson AE, Krawczyk J, Bullock K, Williams KA, Wadwa RP, et al. Markers of cholesterol synthesis are elevated in adolescents and young adults with type 2 diabetes. Pediatr Diabetes. 2020 ;21(7):1126-1131. doi: 10.1111/pedi.13097. PMID:32738021.
  2. Aghajani H, Moradi R, Alizadeh S, Salekani B, Garousi B, Rezaei Z, et al. A retrospective cohort of coronary artery disease development after at least two angiograms in patients with normal coronary angiograms or mild coronary artery disease. Caspian J Intern Med. 2021 Winter;12(1):84-90. doi: 10.22088/cjim.12.1.84. PMID: 33680403.
  3. https://www.eas-society.org/page/dyslipidaemia_guidelines_2019_comment
  4. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) . European Heart Journal. 2020; 41 (1) : 111–188. DOI: 10.1093/eurheartj/ehz455. PMID: 31504418
  5. Hinton W, McGovern A, Coyle R,  Han TS, Sharma P, Correaetn A et  al. Incidence and prevalence of cardiovascular disease in English primary care: a cross-sectional and follow-up study of the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). BMJ Open 2018;8:e020282. doi: 10.1136/bmjopen-2017-020282. PMID: 30127048.
  6. Alaofè H, Asaolu I, Ehiri J, Moretz H, Asuzu C, Balogun M, et al. Community Health Workers in Diabetes Prevention and Management in Developing Countries. Ann Glob Health. 2017;83(3-4):661-675. doi: 10.1016/j.aogh.2017.10.009.  PMID:29221543.
  7. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD).  European Heart Journal. 2020; 41( 2):255–323. doi: 10.1093/eurheartj/ehz486. PMID: 31497854.
  8. Charlton-Menys V, Betteridge DJ, Colhoun H, Fuller J, France M, Hitman GA, et al. . Targets of statin therapy: LDL cholesterol, non-HDL cholesterol, and apolipoprotein B in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS). Clin Chem 2009; 55: 473–480. doi: 10.1373/clinchem.2008.111401. PMID: 19147732.
  9. Toth PP, Granowitz C, Hull M, Liassou D, Anderson A, Philip S. High Triglycerides Are Associated With Increased Cardiovascular Events, Medical Costs, and Resource Use: A Real-World Administrative Claims Analysis of Statin-Treated Patients With High Residual Cardiovascular Risk. J Am Heart Assoc. 2018;7(15):e008740. doi: 10.1161/JAHA.118.008740. PMID: 30371242.
  10. Schwartz GG, Abt M, Bao W, DeMicco D, Kallend D, Miller M et al. Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins.  J Am Coll Cardiol. 2015;65(21):2267-2275. doi:10.1016/j.jacc.2015.03.544. PMID: 26022813.
  11. Grupo de trabajo de Dislipemia Aterogénica de la Sociedad Española de Arteriosclerosis y Grupo Europeo de Expertos. Practical recommendations for the management of cardiovascular risk associated with atherogenic dyslipidemia, with special attention to residual risk. Spanish adaptation of a European Consensus of Experts. Clin Investig Arterioscler. 2017 ;29(4):168-177. doi: 10.1016/j.arteri.2016.12.001. PMID: 28433209.
  12. Austin MA, King MC, Vranizan KM, Krauss RM. Atherogenic lipoprotein phenotype. A proposed genetic marker for coronary heart disease risk. Circulation. 1990;82(2):495-506. doi: 10.1161/01.cir.82.2.495. PMID: 2372896.
  13. Ninomiya JK, L'Italien G, Criqui MH, Whyte JL, Gamst A, Chen RS. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2004;109(1):42-46. doi: 10.1161/01.CIR.0000108926.04022.0C. PMID: 14676144.
  14. Gitt AK, Drexel H, Feely J, Ferrières J, Gonzalez-Juanatey JR, Thomsen KK, et al. Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada. Eur J Prev Cardiol. 2012;19(2):221-230. doi: 10.1177/1741826711400545. PMID: 21450578.
  15. Leiter LA, Lundman P, da Silva PM,  Drexel H, C Jünger C,  Gitt  AK et al. Persistent lipid abnormalities in statin-treated patients with diabetes mellitus in Europe and Canada: results of the Dyslipidaemia International Study. Diabet Med. 2011;28(11):1343-1351. doi: 10.1111/j.1464-5491.2011.03360.x. PMID: 21679231
  16. Pedro-Botet J, Flores-Le Roux JA. Estudios de eficacia [Efficacy studies]. Clin Investig Arterioscler. 2014;26 Suppl 1:17-19. doi: 10.1016/S0214-9168(14)70021-X. PMID: 25043542.
  17. Ray KK, Cannon CP, Cairns R, Morrow DA, Ridker PM, Braunwald E. Prognostic utility of apoB/AI, total cholesterol/HDL, non-HDL cholesterol, or hs-CRP as predictors of clinical risk in patients receiving statin therapy after acute coronary syndromes: results from PROVE IT-TIMI 22. Arterioscler Thromb Vasc Biol. 2009;29(3):424-430.
  18. Miller M, Cannon CP, Murphy SA,  Qin J , Ray KK , Braunwald E, et al. Impact of triglyceride levels beyond low-density lipoprotein cholesterol after acute coronary syndrome in the PROVE IT-TIMI 22 trial. J Am Coll Cardiol. 2008;51(7):724-730.
  19. ACCORD Study Group, Buse JB, Bigger JT,  Byington RP , Cooper LS , Cushman WC,  et al. Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol. 2007;99(12A):21i-33i.
  20. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L,  Emberson J, Holland LE,  Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670-1681.
  21. Pedersen TR, Faergeman O, Kastelein JJ,  Olsson AG,  Tikkanen MJ, Holme I et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA. 2005;294(19):2437-2445. 
  22. Byun YS, Lee JH, Arsenault BJ, Yang  X, Bao W, DeMicco D, et al. Relationship of oxidized phospholipids on apolipoprotein B-100 to cardiovascular outcomes in patients treated with intensive versus moderate atorvastatin therapy: the TNT trial. J Am Coll Cardiol. 2015;65(13):1286-1295.
  23. Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy MS, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007;357(13):1301-1310. doi: 10.1056/NEJMoa064278. PMID: 17898099.
  24. Elam MB, Ginsberg HN, Lovato LC, Corson M, Largay J, ; ACCORDION Study Investigators. Association of Fenofibrate Therapy With Long-term Cardiovascular Risk in Statin-Treated Patients With Type 2 Diabetes. JAMA Cardiol. 2017;2(4):370-380. doi: 10.1001/jamacardio.2016.4828. PMID: 28030716.
  25. Sažetak karakteristika leka Treakol, Predstavništvo BGP Products Switzerland GmbH Beograd – Novi Beograd, februar 2018.
  26. Gouni-Berthold I. The efficacy of anti-PCSK9 antibodies: Results from recent trials. Atheroscler Suppl. 2017 ;30:9-18. doi: 10.1016/j.atherosclerosissup.2017.05.030. PMID: 29096867.

PDF: 01-MD-Vol 13 No 3-4 Sept-Dec 2021_Pandrc et al.pdf

 

 

Naslovna | Revija | Galerija | Dešavanja | Instrukcije | Redakcija | Izdavač | Prijatelji sajta | Saradnja | Kontakt | Site Map


Back to content | Back to main menu