Simvastatin triglycerides

LC is a 51 -year-old female with a history of CHD (stent placement in the left anterior descending coronary artery 3 years prior) and type 2 diabetes who is referred to you for follow-up of her cholesterol. She is taking simvastatin 20 mg once daily in the evening for her cholesterol, and metformin 2000 mg once daily in the evening and piogliti-zone 15 mg once daily for diabetes. Her diabetes is well controlled. Her laboratory test results are within normal limits, except for her fasting lipid profile total cholesterol 215 mg/dL (5.57 mmol/L), triglycerides 135 mg/dL (1.53 mmol/L), HDL cholesterol 51 mg/dL (1.32 mmol/L), and LDL cholesterol 137 mg/dL (3.55 mmol/L). 

Simvastatin has been shown to reduce both normal and elevated low-density lipoprotein (LDL) cholesterol concentrations. Apolipoprotein B, VLDL cholesterol and plasma triglycerides also reduce and can produce increase in HDL cholesterol. 

Simvastatin reduces total cholesterol, LDL cholesterol and triglycerides by 25%, 35%, and 10% respectively. The increase in HDL is upto 12%. 

Atorvastatin, simvastatin, rosuvastatin Inhibit HMG-CoA reductase Reduce cholesterol synthesis and up-regulate low-density lipoprotein (LDL) receptors on hepatocytes modest reduction in triglycerides Atherosclerotic vascular disease (primary and secondary prevention) t acute coronary syndromes Oral duration 12-24 h Toxicity Myopathy, hepatic dysfunction Interactions CYP-dependent metabolism (3A4, 2C9) interacts with CYP inhibitors... 

The HMG-CoA reductase inhibitors (Statins like simvastatin, lovastatin, pravastatin, fluvastatin, etc.) inhibit the enzyme and thereby decrease the hepatic cholesterol synthesis and increase the synthesis of LDL receptors causing increased clearance of LDL and a reduced concentration of LDL cholesterol in plasma. HMG-CoA reductase inhibitors are used to treat elevated LDL which also causes a small reduction in plasma triglycerides and an increase in HDL cholesterol. 

The administration of medium-chain triglycerides has a positive influence on the malabsorption of fat when accompanied by an adequate intake of proteins. Pancreas enzymes may be helpful. Simvastatin or bezafi-brate can be successfully used in the treatment of hyper-cholesterinaemia. (154, 155, 172, 245) The deficiency of... 

GR is a 55-year-old HIV positive man currently receiving ritonavir/lopinavir, nevirapine, and lamivudine. You would like to start simvastatin to decrease his triglycerides. Which of his ARVs will interact with simvastatin ... 

Simvastatin 27 HMG-GoA Reductase (inhibitor) Methylated analog of lovastatin Fungal metabolite (lovastatin) First pass (issues still linger) Lower cholesterol and triglycerides Gl-tract... 

Atorvastatin, rosuvastatin, and simvastatin appear to have some effects beyond those seen with the other HMGRIs. These compounds have been shown to decrease plasma LDL levels in patients with homozygous familial hypercholesterolemia, an effect that is proposed to result from their ability to produce a more significant decrease in the hepatic production of LDL cholesterol. Additionally, atorvastatin and rosuvastatin can produce a significant lowering in plasma triglycerides. In the case of atorvastatin, this effect has been attributed to its ability to produce an enhanced removal of triglyceride-rich VLDL (15,36,37). 

Simvastatin therapy led to a 35% reduction in LDL-cholesterol, an 8% increase in HDL-cholesterol and a 10% reduction in triglycerides compared with the placebo group. After a mean follow-up of 5.4 years, there were 182 deaths in the simvastatin group compared with 256 deaths in the placebo group, a 30% reduction in overall mortality (HR 0.7 95% Cl 0.59-0.85 p < 0.0003). In addition, there were significant reductions in all coronary events. 

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