Hypercholesterolemia therapy

Denke, M. A., 1995. Lack of efficacy of low-dose sitostanol therapy as an adjunct to a cholesterol-lowering diet in men widi moderate hypercholesterolemia. American Journal of Clinical Nutrition 61 392—396. 

The bile acid sequestrants are used as adjunctive therapy for the reduction of elevated serum cholesterol in patients with hypercholesterolemia who do not have an... 

Patients receiving LT4 therapy who are not maintained in a euthyroid state are at risk for long-term adverse sequelae. In general, overtreatment and a suppressed TSH is more common than undertreatment27 with an elevated TSH. Patients with long-term overtreatment may be at higher risk for atrial fibrillation and other cardiovascular morbidities, depression, and post-menopausal osteoporosis. Patients who are undertreated are at higher risk for hypercholesterolemia and other cardiovascular problems, depression, and obstetric complications. 

The principal use of niacin is for mixed hyperlipidemia or as a second-line agent in combination therapy for hypercholesterolemia. It is a first-line agent or alternative for the treatment of hypertriglyceridemia and diabetic dyslipidemia. 

Anderson, J. W., Allgood, L. D., Laurence, A., Altringer, L. A., Jerdack, G. R., Hengehold, D. A., and Morel, J. G. (2000a). Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia Metaanalysis of 8 controlled trials. Am. J. Clin. Nutr. 71, 472 79. 

Currently, there is stUl a gap for the potential of gene therapy to be fulfilled. Gene therapy clinical trials have been conducted for diseases such as severe combined immunodeficiency disease (SCID, bubble baby syndrome), sickle cell anemia, cystic fibrosis, familial hypercholesterolemia, and Gaucher disease. 

Hypercholesterolemia Serum cholesterol may be altered during therapy. 

Heterozygous familial hypercholesterolemia in pediatric patients 10 to 17 years of age - Recommended starting dose is 10 mg/day the maximum recommended dose is 20 mg/day. Individualize doses according to recommended goal of therapy. Make adjustments at intervals of 4 weeks or more. 

Hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson type I la and lib) - The dose range for rosuvastatin is 5 to 40 mg once daily. Individualize rosuvastatin therapy according to goal of therapy and response. The usual recommended starting dose of rosuvastatin... 

Diet Before instituting therapy, attempt to control hypercholesterolemia with diet, exercise, and weight reduction in obese patients. 

Hypercholesterolemia Adjunctive therapy to diet for the reduction of LDL-C, total-C, triglycerides, and apolipoprotein B (apo B) and to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia (Fredrickson Types lla and Mb). 

Monotherapy - Administered alone as adjunctive therapy to diet for the reduction of elevated total cholesterol (total-C), low density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo B) in patients with primary (heterozygous familial and nonfamilial) hypercholesterolemia. 

Primary hypercholesterolemia Adjunctive therapy to diet for reducing elevated total-C, LDL-C, Apo B, TG, and non-HDL-C, and increasing HDL-C in patients with... 

Treatment Plan Based upon the criteria for initiating drug therapy of hypercholesterolemia, the physician... 

For ethical reasons, children enrolled in these clinical trials have also received standard therapy of enzyme infusions, so the results of these studies have been difficult to interpret and are controversial. Nevertheless, there is some evidence that the ex vivo gene transfer approach may evoke a biological response relevant to the treatment of ADA deficiency. Such interpretations have stimulated efforts to use the ex vivo strategy for other monogenic disorders, such as familial hypercholesterolemia, hemophilia B, and Gaucher s disease. 

PO026 Smith, M. A., and A. A. Aso. Comparison of psyllium hydrophilic mucilloid and bile salt binding resin therapy for hypercholesterolemia. Abstr Endocrine Society 144 Annual Meeting June 1992 62. 

Hepatocyte transplantation is being explored as an alternative to whole-organ transplantation. In addition, gene transfer therapy is being developed for familial hypercholesterolemia. A non-invasive method to serially assess the metabolic status and proliferation of hepa-tocytes transferred as treatment for end-stage liver disease or genetic... 

Dietary measures are initiated first—unless the patient has evident coronary or peripheral vascular disease—and may obviate the need for drugs. Patients with familial hypercholesterolemia or familial combined hyperlipidemia always require drug therapy. Cholesterol and saturated and trans-fats are the principal factors that increase LDL, whereas total fat, alcohol, and excess calories increase triglycerides. 

Combined drug therapy is useful (1) when VLDL levels are significantly increased during treatment of hypercholesterolemia with a resin (2) when LDL and VLDL levels are both elevated initially (3) when LDL or VLDL levels are not normalized with a single agent, or (4) when an elevated level of Lp(a) or an HDL deficiency coexists with other hyperlipidemias. 

This combination effectively controls VLDL levels during resin therapy of familial combined hyperlipoproteinemia or other disorders involving both increased VLDL and LDL levels. When VLDL and LDL levels are both initially increased, doses of niacin as low as 1-3 g/d may be sufficient in combination with a resin. The niacin-resin combination is effective for treating heterozygous familial hypercholesterolemia. 

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