Cholesterol combination therapy

Doxorubicin Mycet Egg PC, cholesterol Combinational therapy of recurrent breast cancer Zeneus... 

Resins are moderately effective in lowering LDL cholesterol but do not lower triglycerides (Table 9-8). Moreover, in patients with elevated triglycerides, the use of a resin may worsen the condition. This may be due to a compensatory increase in HMG-CoA reductase activity and results in an increase in assembly and secretion of VLDL. The increase in HMG-CoA reductase activity can be blocked with a statin, resulting in enhanced reductions in serum lipids (see section on combination therapy). Resins reduce LDL cholesterol from 15% to 30%, with a modest increase in HDL cholesterol (3% to 5%) (Table 9-8). Resins are most often used as adjuncts to statins in patients who require additional lowering of LDL cholesterol. Since these drugs are not absorbed, adverse effects are limited to the gastrointestinal tract (Table 9-9). About 20%... 

Fibrates are the most effective triglyceride-lowering agents and also raise HDL cholesterol levels. Combination therapy with a fibrate, particularly gemfibrozil, and a statin has been found to increase the risk for myopathy. Of the 31 rhabdomyolysis deaths reported with cerivastatin use, 12 involved concomitant gemfibrozil.25 Therefore, more frequent monitoring, thorough patient education, and consideration of factors that increase the risk as reviewed previously should be considered. 

Combination therapy with a statin and BAR is rational because numbers of LDL-Rs are increased, leadingto greater degradation of LDL cholesterol intracellular synthesis of cholesterol is inhibited and enterohepatic recycling of bile acids is interrupted. 

Combination therapy with a statin and ezetimibe is also rational because ezetimibe inhibits cholesterol absorption across the gut border and adds 12% to 20% further reduction when combined with a statin or other drugs. 

The combination of amprenavir and low-dose ritonavir has been associated with elevations of cholesterol and triglycerides, AST, and ALT in some patients. Consider appropriate laboratory testing prior to initiating combination therapy with amprenavir and ritonavir and at periodic intervals, or if any clinical signs or symptoms of hyperlipidemia or elevated liver function tests occur during therapy. 

Ezetimibe is a newer dmg that inhibits cholesterol absorption by the G1 tract it reduces LDLc modestly as monotherapy and is used in combination therapy with simvastatin (marketed as Vytorin) to achieve good cholesterol lowering and minimizing... 

Drugs such as ezetimibe which inhibit the absorption of cholesterol in the intestine are effective in lowering cholesterol levels. This drug is often given in combination with a statin and this combination therapy is very effective in lowering cholesterol levels. 

Combination therapy with niacin and a statin has also been shown to produce clinical and angiographic benefits. Brown et al. (56) evaluated the effects of simvastatin in combination with niacin on patients with documented coronary disease in the HATS trial and demonstrated a significant reduction in nonfatal MI or death from cardiovascular causes compared to placebo, albeit with a relatively small number of patients. In the treatment arm, HDL cholesterol increased by 26% over the three years of treatment and was also associated with a slight regression (0.4%) in coronary mean percent stenosis in the proximal arteries by invasive arteriography the placebo arm experienced a 3.9% increase in stenoses. 

A 1-year randomized double-blind study in 639 type 2 diabetic patients [13] showed clinically equivalent improvements in glycaemic control for the combination therapy of metformin and SU (HbAlc decrease 1.36%) or pioglitazone and SU (HbAlc decrease 1.20%). Pioglitazone addition to SU significantly reduced triglycerides (-16% vs. -9% p = 0.008) and increased HDL-cholesterol (14% vs. 8% p < 0.001) compared with metformin... 

Combination studies Triple combination therapy with a statin + ezetimibe + extended-release niacin (ER niacin) is being considered for patients who require intensive lowering of LDL cholesterol. In a 64-week study in 942 patients with hypercholesterolemia, with or without triglyceri-demia, combinations of up to 2 g of ER niacin, together with 20 mg/day simvastatin and 10 mg/day ezetimibe, were well tolerated, except for flushing due to niacin [35 ]. However, in others ER niacin was associated with rises in blood glucose concentrations, albeit slightly, and rises in liver enzymes, as reported in a 28-week study in which ER niacin up to 2g/day was... 

Pasternak RC, Brown LE, Stone PH, et al. Effect of combination therapy with lipid-reducing drugs in patients with coronary heart disease and normal cholesterol eye s. Arm Inter Med 1996 125 259-540. 

Okada K, Fukui K, Himeno H, Endo T, Shimizu M, Kobayashi S, Shigemasa T, Morita Y, Wada A, Shimizu T, Mochida Y, Sawada R, Ishigami T, Uchino K, Iwahashi N, Kimura K, Umemura S. Long-term effect of ezetimibe-statin combination therapy on low-density lipoprotein cholesterol lowering in patents with coronary artery disease focus on cholesterol absorption and synthesis. J. Am. Coll. Cardiol. 2011 57(14 Suppl S) E524. 

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

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