Controlling Plasma Cholesterol

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Controlling plasma cholesterol is one of the major ways to reduce the risk of developing cardiovascular diseases (CVD). Total body cholesterol includes different components such as low-density lipoprotein (LDL) and triglyceride (TG), the “bad cholesterols”, and high-density lipoprotein (HDL) or “good cholesterol”. The Adult Treatment Panel III (ATP III) guideline recommends monotherapy with statins as the primary drug therapy for dyslipidemia by lowering LDL cholesterol. However, statins do not prevent all cardiovascular (CV) events and residual risk remains. Fenofibrates, by decreasing the level of TG and increasing HDL are considered adjunctive therapy in reducing the risk of CVD.1 Several studies investigated the benefits of adding fenofibrates to statins in increasing HDL level and thus decreasing CV events. HD Shah, KH Parikh, MC Chag, et al, compared the benefit of combination therapy of statin and fenofibrate versus monotherpay with statins. In this randomized, non-blinded, prospective study 102 patients with Acute Coronary Syndrome (ACS) who previously had angioplasty were randomly assigned to one of four groups: atrovastatin 20mg daily (n=25); simvastatin 40mg (n=27); atrovastatin/fenofibrate combination 10mg/day-200mg/day respectively (n=25) or simvastatin/fenofibrate 20mg/day-200mg/day respectively (n=25). The serum lipid and plasma fibrinogen were measured at baseline and then tree months following therapy. The study showed that combination therapy with fenofibrates further reduced the TG and LDL levels, increased HDL and significantly decreased plasma fibrinogen. 2 The Veteran Affairs HDL Intervention Trial (VA-HIT) investigated the effect of the fenofibrates derivative, gemfibrozil, on the occurrence of majo... ... middle of paper ... ...k of CVD. Works Cited 1. Grundy SM, Gleeman JI, Mertz CN et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39 2. HD Shah, KH Parikh, MC Chag, et al. Beneficial effects of the addition of fenofibrate to statin therapy in patients with acute coronary syndrome after percutaneous coronary interventions: Exp Clin Cardiol 2007;12(2):91-96) 3. Sander J. Robins; Dorothea Collins; Janet T. Wittes; et al. Relation of Gemfibrozil Treatment and Lipid Levels With Major Coronary Events: VA-HIT: A Randomized Controlled Trial, JAMA. 2001;285(12):1585-1591 (doi:10.1001/jama.285.12.1585) 4. The ACCORD Study Group, Buse JB, Bigger JT, Byington RP. Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus; NEJM oa 1001282. published at March 14, 2010)
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