Advertisement

Expert Commentary: Gastrointestinally Active Lipid-Lowering Drug Safety

Published:November 29, 2006DOI:https://doi.org/10.1016/j.amjcard.2006.11.023
      Atherosclerosis is a widely prevalent, insidious disease that causes acute coronary syndromes (ACS), intermittent claudication, ischemic stroke, and a high percentage of sudden deaths, among other complications. Given the well-known observations that populations worldwide are living longer, that more patients are surviving ACS, and that there are evolving epidemics of obesity, metabolic syndrome, and diabetes mellitus encompassing the globe, the number of patients expected to be afflicted by atherosclerotic disease continues to escalate precipitously. Both sexes and all racial and ethnic groups are at risk for the development of atherosclerotic disease, with some disproportionately so. Managing a patient’s global cardiovascular risk burden through a combination of lifestyle modification and pharmacologic intervention is crucial to any effort directed at reducing risk for cardiovascular morbidity and mortality. An internal milieu favoring the development of a proinflammatory, pro-oxidative, and prothrombotic state, in conjunction with derangements in lipoprotein metabolism, promotes arterial wall remodeling and atheromatous lesion development and progression.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Avorn J.
        • Monette J.
        • Lacour A.
        • Bohn R.L.
        • Monane M.
        • Mogun H.
        • LeLorier J.
        Persistence of use of lipid-lowering medications: a cross-national study.
        JAMA. 1998; 279: 1458-1462
        • Altmann S.W.
        • Davis Jr, H.R.
        • Zhu L.J.
        • Yao X.
        • Hoos L.M.
        • Tetzloff G.
        • Iyer S.P.
        • Maguire M.
        • Golovko A.
        • Zeng M.
        • et al.
        Niemann-Pick C1 like 1 protein is critical for intestinal cholesterol absorption.
        Science. 2004; 303: 1201-1204
        • McKenney J.M.
        • Farnier M.
        • Lo K.W.
        • Bays H.E.
        • Perevozkaya I.
        • Carlson G.
        • Davies M.J.
        • Mitchel Y.B.
        • Gumbiner B.
        Safety and efficacy of long-term co-administration of fenofibrate and ezetimibe in patients with mixed hyperlipidemia.
        J Am Coll Cardiol. 2006; 47: 1584-1587
        • Bays H.E.
        • Moore P.B.
        • Drehobl M.A.
        • Rosenblatt S.
        • Toth P.D.
        • Dujovne C.A.
        • Knopp R.H.
        • Lipka L.J.
        • LeBeaut A.P.
        • Yang B.
        • et al.
        Effectiveness and tolerability of ezetimibe in patients with primary hypercholesterolemia: pooled analysis of two phase II studies.
        Clin Ther. 2001; 23: 1209-1230
        • Davidson M.H.
        • McGarry T.
        • Bettis R.
        • Melani L.
        • Lipka L.J.
        • LeBeaut A.P.
        • Suresh R.
        • Sun S.
        • Veltri E.P.
        Ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia.
        J Am Coll Cardiol. 2002; 40: 2125-2134
        • Ballantyne C.M.
        • Houri J.
        • Notarbartolo A.
        • Melani L.
        • Lipka L.J.
        • Suresh R.
        • Sun S.
        • LeBeaut A.P.
        • Sager P.T.
        • Veltri E.P.
        Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: a prospective, randomized, double-blind trial.
        Circulation. 2003; 107: 2409-2415
        • Ballantyne C.M.
        • Blazing M.A.
        • King T.R.
        • Brady W.E.
        • Palmisano J.
        Efficacy and safety of ezetimibe co-administered with simvastatin compared with atorvastatin in adults with hypercholesterolemia.
        Am J Cardiol. 2004; 93: 1487-1494
        • Feldman T.
        • Koren M.
        • Insull Jr, W.
        • McKenney J.
        • Schrott H.
        • Lewin A.
        • Shah S.
        • Sidisin M.
        • Cho M.
        • Kush D.
        • Mitchel Y.
        Treatment of high-risk patients with ezetimibe plus simvastatin co-administration versus simvastatin alone to attain National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol goals.
        Am J Cardiol. 2004; 93: 1481-1486
        • Fux R.
        • Morike K.
        • Gundel U.F.
        • Hartmann R.
        • Gleiter C.H.
        Ezetimibe and statin-associated myopathy.
        Ann Intern Med. 2004; 140: 671-672
        • Phillips P.S.
        Ezetimibe and statin-associated myopathy [letter].
        Ann Intern Med. 2004; 141: 649
      1. Strony J, Suresh R, Veltri E. Safety and efficacy of long-term (up to 24 months) ezetimibe therapy in hypercholesterolemic patients. Poster presented at the XIV International Symposium on Atherosclerosis; June 18–22, 2006; Rome, Italy.

        • Sager P.T.
        • Melani L.
        • Lipka L.
        • Strony J.
        • Yang B.
        • Suresh R.
        • Veltri E.
        Effect of coadministration of ezetimibe and simvastatin on high-sensitivity C-reactive protein.
        Am J Cardiol. 2003; 92: 1414-1418
      2. The Lipid Research Clinics Coronary Primary Prevention Trial results.
        JAMA. 1984; 251: 351-364
        • Watts G.F.
        • Lewis B.
        • Brunt J.N.
        • Lewis E.S.
        • Coltart D.J.
        • Smith L.D.
        • Mann J.I.
        • Swan A.V.
        Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St. Thomas’ Atherosclerosis Regression Study (STARS).
        Lancet. 1992; 339: 563-569
        • Davidson M.H.
        • Dittakavi V.
        • Bandari A.
        • Davidson D.J.
        • Maki K.C.
        • Subbaiah P.V.
        Colesevelam HCl decreases atherosclerosis and may activate reverse cholesterol transport in cholesterol-fed rabbits.
        J Appl Res. 2006; 6: 4-13
        • Donovan J.M.
        • Stypinski D.
        • Stiles M.R.
        • Olson T.A.
        • Burke S.K.
        Drug interactions with colesevelam hydrochloride, a novel, potent lipid-lowering agent.
        Cardiovasc Drugs Ther. 2000; 14: 681-690
        • Hunninghake D.
        • Insull Jr, W.
        • Toth P.
        • Davidson D.
        • Donovan J.M.
        • Burke S.K.
        Coadministration of colesevelam hydrochloride with atorvastatin lowers LDL cholesterol additively.
        Atherosclerosis. 2001; 158: 407-416
        • Knapp H.H.
        • Schrott H.
        • Ma P.
        • Knopp R.
        • Chin B.
        • Gaziano J.M.
        • Donovan J.M.
        • Burke S.K.
        • Davidson M.H.
        Efficacy and safety of combination simvastatin and colesevelam in patients with primary hypercholesterolemia.
        Am J Med. 2001; 110: 352-360
        • Xydakis A.M.
        • Guyton J.R.
        • Chiou P.
        • Stein J.L.
        • Jones P.H.
        • Ballantyne C.M.
        Effectiveness and tolerability of ezetimibe add-on therapy to a bile acid resin-based regimen for hypercholesterolemia.
        Am J Cardiol. 2004; 94: 795-797
        • Davidson M.H.
        • Dillon M.A.
        • Gordon B.
        • Jones P.
        • Samuels J.
        • Weiss S.
        • Isaacsohn J.
        • Toth P.
        • Burke S.K.
        Colesevelam hydrochloride (cholestagel): a new, potent bile acid sequestrant associated with a low incidence of gastrointestinal side effects.
        Arch Intern Med. 1999; 159: 1893-1900