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Non-Statin Treatment of Dyslipidemia

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Lipid Management
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Abstract

The intent of this chapter is to provide information regarding non-statin medications utilized to treat patients with dyslipidemia. The goal of treating dyslipidemia is to reduce the risk of cardiovascular disease rather than just altering some aspect of cholesterol metabolism or to achieve an improved number for some cholesterol fraction. Reduction of risk is best established by randomized, controlled trials that evaluate cardiovascular outcome such as reduction in acute myocardial infarctions, nonfatal myocardial infarctions, cardiovascular death and the effect on total mortality. Accordingly, randomized controlled trials will be discussed in this chapter when such information is available. Further, the design of the randomized controlled trials will be presented since the design may strongly influence the result. When appropriate, perspective on results of the study will be presented. Furthermore, the chapter will provide some historical data, mechanism of action, effect on lipids, benefits of medications, and adverse effects. For some newer drugs that are still in phase 2 or currently unreported phase 3 trials, information that is currently available will be presented.

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References

  1. Altschul R, Hoffer A, Stephen J. Influence of nicotinic acid on serum cholesterol in man. Arch Biochem Biophys. 1955;54:558–9 (letter).

    Article  CAS  PubMed  Google Scholar 

  2. Christensen NA, Achor RW, Berg KG, Mason HL. Nicotinic acid treatment of hypercholesterolemia, comparison of plain and sustained action preparations, and report of 2 cases of jaundice. JAMA. 1961;177:546–50.

    Article  CAS  PubMed  Google Scholar 

  3. Parsons WB. Studies of nicotinic acid in hypercholesterolemia: changes in hepatic function, carbohydrate tolerance and uric acid metabolism. Arch Intern Med. 1961;107:653–67.

    Article  CAS  PubMed  Google Scholar 

  4. Parsons WB. Treatment of hypercholesteremia by nicotinic acid: progress report with review of studies regarding mechanism of action. Arch Intern Med. 1961;107:639–52.

    Article  CAS  PubMed  Google Scholar 

  5. The AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. NEJM. 2011;365:2255–67.

    Article  Google Scholar 

  6. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med. 1977;62(5):707–14.

    Article  CAS  PubMed  Google Scholar 

  7. Bruckert E, Labreuche J, Amarenco P. Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and artherosclerosis. Atherosclerosis. 2010;210(2):353–61. doi:10.1016/j.atherosclerosis.

    Article  CAS  PubMed  Google Scholar 

  8. Capuzzi DM, Morgan JM, Brusco OA Jr, Inteno CM. Niacin dosing: relationship to benefits and adverse effects. Curr Atheroscler Rep. 2000;2:64–71.

    Article  CAS  PubMed  Google Scholar 

  9. Grundy SM, Mok HYI, Zech L, Berman M. Influence of nicotinic acid on metabolism of cholesterol and triglycerides in man. J Lipid Res. 1981;22:21–35.

    Google Scholar 

  10. Pieper JA. Understanding niacin formulations. Am J Manag Care. 2002;8(12 Suppl):S308–14.

    PubMed  Google Scholar 

  11. Capuzzi DM, Guyton JR, Morgan JM, Goldberg AC, Kreigsberg RA, Brusco OA, Brody J. Efficacy and safety of an extended-release niacin (Niaspan): a long-term study. Am J Cardiol. 1998;82(12A):74U-81U (discussion 85U-86U).

    Article  CAS  PubMed  Google Scholar 

  12. The Coronary Drug Project Research Group. Clofibrate and niacin in coronary heart disease. JAMA. 1975;231:360–81.

    Article  Google Scholar 

  13. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, Friedewald W. Fifteen year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986;8(6):1245–55.

    Article  CAS  PubMed  Google Scholar 

  14. Brown BG, Zhao XQ, Chait A, Fisher LD. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345(22):1583–92.

    Article  CAS  PubMed  Google Scholar 

  15. Villines TC, Stanek EJ, Devine PJ, Turco M, et al. The ARBITER 6-HALTS Trial (arterial biology for the investigation of the treatment effects of reducing cholesterol 6-HDL and LDL treatment strategies in atherosclerosis): final results and the impact of medication adherence, dose, and treatment duration. J Am Coll Cardiol. 2010;55(24):2721–6.

    Article  PubMed  Google Scholar 

  16. HPS2-THRIVE Collaborative Group. HPS2-THRIVE randomized placebo-controlled trial in 25673 high-risk patients of ER niacin/laropiprant: trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment. Eur Heart J. 2013;34(17)1279–91.

    Article  PubMed Central  Google Scholar 

  17. Vo E, Goldberg SJ. An investigation of immediate release niacin effect at different levels of LDL-C, HDL-C, triglycerides, and lipoprotein (a). J Clin Lipidol 2014;8:348–9 (abstract + tables).

    Article  Google Scholar 

  18. Barter PJ, Caulfield M, Eriksson M, Grundy SM, Kastelein JJ, Komajda M, et al. ILLUMINATE Investigators. Effects of torcetrapid in patients at high risk for coronary events. N Engl J Med. 2007;357(21):2109–22.

    Article  CAS  PubMed  Google Scholar 

  19. Roche, Inc. Roche provides update on Phase III study of dalcetrapib [press release]. May 12, 2012.

    Google Scholar 

  20. Hunninghake DB, Peterson F, Swenson M, Kurtz K, Bell C. Efficacy of once versus twice a day dosage of cholestyramine and type IIa hyperlipoproteinemia. Pharmacologist. 1979;21:176 (abstract).

    Google Scholar 

  21. Davidson MH, Dillon MA, Gordon B, et al. Colesevelam hydrochloride (cholestagel): a new, potent bile acid sequestrant associated with a low incidence of gastrointestinal side effects. Arch Intern Med. 1999;159(16):1893–900.

    Article  CAS  PubMed  Google Scholar 

  22. No authors listed. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA. 1984;251(3):351–64.

    Article  Google Scholar 

  23. Insull W Jr., Toth P, Mullican W. Effectiveness of colesevelam hydrochloride in decreasing LDL cholesterol in patients with primary hypercholesterolemia: a 24-week randomized controlled trial. Mayo Clin Proc. 2001;76(10):971–82.

    Article  CAS  PubMed  Google Scholar 

  24. Knapp HH, Schrott H, Ma P, et al. Efficacy and safety of combination simvastatin and colesevelam in patients with primary hypercholesterolemia. Am J Med. 2001;110(5):352–60.

    Article  CAS  PubMed  Google Scholar 

  25. Hunninghake D, Insull W, Toth P, et al. Coadministration of colesevelam hydrochloride with atorvastatin lowers LDL cholesterol additively. Atherosclerosis. 2001;158(2):407–16.

    Article  CAS  PubMed  Google Scholar 

  26. Brendel C, Schoonjans K, Botrugno OA, Treuter E, Auwerx J. The small heterodimer partner interacts with the liver X receptor alpha and represses its transcriptional activity. Mol Endocrinol. 2002;16(9):2065–76.

    Article  CAS  PubMed  Google Scholar 

  27. Rivers SM, Kane MP, Busch RS, Bakst G, Hamilton RA. Colesevelam hydrochloride-ezetimibe combination lipid-lowering therapy in patients with diabetes or metabolic syndrome and a history of statin intolerance. Endocr Pract. 2007;13(1):11–6.

    Article  PubMed  Google Scholar 

  28. Bays H, Rhyne J, Abby S, Lai YL, Jones M. Lipid-lowering effects of colesevelam HCl in combination with ezetimibe. Curr Med Res Opin. 2006;22(11):2191–200.

    Article  CAS  PubMed  Google Scholar 

  29. Preuksaritanont T, Zhao JJ, Ma B. Mechanistic studies on metabolic interactions in gemfibrozil and statins. J Pharmacol Exp Ther. 2002;301:1042–51.

    Article  Google Scholar 

  30. Wysowski DK, Kennedy DL, Gross TP. Prescribed use of cholesterol lowering drugs in the United States, 1978–1988. JAMA. 1990;263:2185.

    Article  CAS  PubMed  Google Scholar 

  31. Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, Huttunen JK, Kaitaniemi P, Koskinen P, Manninen V. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987;317:1237–45.

    Article  CAS  PubMed  Google Scholar 

  32. Manninen V, Elo MO, Frick MH, Haapa K, Heinonen OP, Heinsalmi P, Helo P, Huttunen JK, Kaitaniemi P, Koskinen P, et al. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA. 1988;260:641–51.

    Article  CAS  PubMed  Google Scholar 

  33. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, Faas FH, Linares E, Schaefer EJ, Schectman G, Wilt TJ, Wittes J. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Eng J Med. 1999;341:410–8.

    Article  CAS  Google Scholar 

  34. Rubins HB, Robbins SJ, Collins D, et al. Distribution of lipids and 8500 men with coronary artery disease. Am J Cardiol. 1995;75:1196–201.

    Article  CAS  PubMed  Google Scholar 

  35. Otvos JD, Collins D, Freedman DS, et al. Low-density lipoprotein and high-density lipoprotein particle subclasses predict coronary events and are favorably changed by gemfibrozil therapy in the veterans affairs high-density lipoprotein intervention trial. Circulation. 2006;113(12):1556–63.

    Article  CAS  PubMed  Google Scholar 

  36. Diabetes Atherosclerosis Intervention Study Investigators. Effects of fenofibrate on progression of coronary artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomized study. Lancet. 2001;357:905–10.

    Article  Google Scholar 

  37. The FIELD Study Investigators. Effects of long-term fenofibrate therapy on cardiovascular events and 7995 people with type II diabetes mellitus (the FIELD study): randomized controlled trial. Lancet. 2005;366:1849–61.

    Article  Google Scholar 

  38. The BIP Study Group. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease, The Bezafibrate Infarction Prevention (BIP) Study. Circulation. 2000;102:21–7.

    Article  Google Scholar 

  39. Goldenberg I, Benderly B, Goldbourt U. Secondary prevention with bezafibrate therapy for the treatment of dyslipidemia. An extended follow-up of the BIP trial. J Am Coll Cardiol. 2007;51:459–65.

    Article  Google Scholar 

  40. Smalley CM, Goldberg SJ. A pilot study in the efficacy and safety of gemfibrozil in a pediatric population. J Clin Lipidol. 2008;2:106–11.

    Article  PubMed  Google Scholar 

  41. Prescribing Information for LOVAZA, GlaxoSmithKline.

    Google Scholar 

  42. Davidson MH, Stein EA, Bays HE, Maki KC, Doyle RT, Shalwitz RA, Ballantyne CM, Ginsberg HN. Efficacy and tolerability of adding prescription Omega-3 fatty acids 4 g/d to Simvastatin 40 mg/d in hypertriglyceridemic patients: an 8-week, randomized, double-blind, placebo-controlled study. Clin Ther. 2007;29:1354–67.

    Article  CAS  PubMed  Google Scholar 

  43. Bays HE, Ballentyne CN, Kastelein JJ, Isaacsohn JL, Braeckman RA, Paresh NS. Eicosapentaenoic acid ethyl ester (AMR101) therapy in patients with very high triglyceride levels. Am J Cardiol. 2011;108:682–90.

    Article  CAS  PubMed  Google Scholar 

  44. Ballentyne CN, Bays HE, Kastelein JJ, Stein E, Isaacsohn JL, Braeckman RA, Paresh NS. Efficacy and safety of eicosapentaenoic acid ethyl ester (AMR 101) therapy and statins treated patients with persistent high triglycerides (from the ANCHOR study). Am J Cardiol. 2012;110:984–92.

    Article  Google Scholar 

  45. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369:1090–98.

    Article  CAS  PubMed  Google Scholar 

  46. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, Franzosi MG, Geraci E, Levantesi G, Maggioni AP, Mantini L, Marfisi RM, Mastrogiuseppe G, Mininni N, Nicolosi GL, Santini M, Schweiger C, Tavazzi G, Tognoni G, Tucci C, Valagussa F GISSI-Prevenzione Investigators. Early protection against sudden coronary death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002;105:1897–903.

    Article  CAS  PubMed  Google Scholar 

  47. The ORIGIN Trial Investigators. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012;367:309–18.

    Article  Google Scholar 

  48. Altmann SW, Davis HR Jr, Zhu LJ. Niemann-Pick C1 Like 1 protein is critical for intestinal cholesterol absorption. Science. 2004;303:1201–4.

    Article  CAS  PubMed  Google Scholar 

  49. Davis HR Jr, Zhu LJ, Hoos LM. Niemann-Pick C1 Like 1 (NPC1L1) is the intestinal phytosterol and cholesterol transporter and a key modulator of whole-body cholesterol homeostasis. J Biol Chem. 2004;279:33586–92.

    Article  CAS  PubMed  Google Scholar 

  50. Prescribing information. Merck and Co, White House New Jersey.

    Google Scholar 

  51. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt-Rasmussen B, Krairittichai U, Ophascharoensuk V, Fellström B. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet. 2011;377:2181–92.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  52. Kastelein JJP, Akdim F, Stroes ESG, Zwinderman AH, Bots ML, Anton FH. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008;358:1431–43.

    Article  CAS  PubMed  Google Scholar 

  53. Hegele RA, Guy J, Ban MR, Wang J. NPC1L1 haplotype is associated with inter-individual variation in plasma low-density lipoprotein response to ezetimibe. Lipids Health Dis. 2005;4:16–21.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Raal FJ, Santos RD, Blom DJ, Marais BA, Charng MJ, Cromwell WC, Lachmann RH, Gaudet D, Tan JL, Chasan-Taber S, Tribble DL, Flaim JD, Crooke ST. Mipromersen, and apolipoprotein B synthesis inhibitor, for lowering of LDL cholesterol concentration in patients with homozygous familial hypercholesterolemia: a randomized, double-blind, placebo-controlled trial. Lancet. 2010;375:998–1006.

    Article  CAS  PubMed  Google Scholar 

  55. McGowan MP, Tardif JC, Ceska R, Burgess LJ, Soran H, Gouini-Berthold J, Wagener G, Chasen-Taber S. Randomized, placebo-controlled trial of mipomersen in patients with severe hypercholesterolemia receiving maximally tolerated lipid-lowering therapy. PloS One. 2012;7(11):e49006.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. Brown ML, Inazu A, Hesler CB, Agellon LB, Mann C, Whitlock ME, Marcel YL, Milne RW, Koizumi J, Mabuchi H, et al. Molecular basis of lipid transfer protein deficiency in a family with increased high-density lipoproteins. Nature. 1989;342:448–51.

    Article  CAS  PubMed  Google Scholar 

  57. Inazu A, Brown ML, Hesler CB, Agellon LB, Koizumi J, Takata K, Maruhama Y, Mabuchi H, Tall AR. Increased high-density lipoprotein levels caused by a common cholesteryl-ester transfer protein gene mutation. N Engl J Med. 1990;323:1234–8.

    Article  CAS  PubMed  Google Scholar 

  58. Amgen press release regarding evolocumab. March 30, 2014.

    Google Scholar 

  59. Desai NR, Giugliano RP, Zhou J, Kohli P, Somaratne R, Hoffman E, Liu T, Scott R, Wasserman SM, Sabatine MS. AMG 145, a monoclonal antibody against PCSK9, facilitates achievement of national cholesterol education program-adult treatment panel III low-density lipoprotein cholesterol goals among high-risk patients: an analysis from the LAPLACE-TIMI 57 trial (LDL-C assessment with PCSK9 monoclonal antibody inhibition combined with statin therapy-thrombolysis in myocardial infarction 57). J Am Coll Cardiol. 2014;63(5):430–3.

    Article  CAS  PubMed  Google Scholar 

  60. Robinson JG, Nedergaard BS, Rogers WJ, Fialkow J, Neutel JM, Ramstad D, Somaratne R, Leggn JC, Nelson P, Scott R, Wasserman SM, Weiss R. Effect of evolocumab or ezetimibe added to moderate- or high-intensity statin therapy on LDL-C lowering in patients with hypercholesterolemia: the LAPLACE-2 randomized clinical trial. JAMA. 2014;311(18):1870–82.

    Article  PubMed  Google Scholar 

  61. Raal FJ, Giugliano RP, Sabatine MS, Koren MJ, Langslet G, Bays H, Blom D, Eriksson M, Dent R, Wasserman SM, Huang F, Xue A, Albizem M, Scott R, Stein EA. Reduction in lipoprotein(a) with PCSK9 monoclonal antibody evolocumab (AMG 145): a pooled analysis of more than 1300 patients in 4 phase II trials. J Am Coll Cardiol. 2014;63(13):1278–88.

    Article  CAS  PubMed  Google Scholar 

  62. Roth EM, McKenney JM, Hanotin C, Asset G, Stein EA. Atorvastatin with or without an antibody to PCSK9 in primary hypercholesterolemia. N Engl J Med. 2012;367:1891–900.

    Article  CAS  PubMed  Google Scholar 

  63. Balwani M, Breen C, Enns GM, Deegan PB, Honzik T, Jones S, Kane JP, Malinov V, Sharma R, Stock EO, Valayannopoulos V, Wraith JE, Burg J, Eckert S, Schneider E, Quinn AG. Clinical effect and safety profile of recombinant human lysosomal acid lipase in patients with cholesterol ester storage disease. Hepatology. 2013;58:950–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  64. Isis Pharmaceuticals press release regarding antisense Clll. May 8, 2014.

    Google Scholar 

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Correspondence to Stanley J. Goldberg MD .

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Goldberg, S. (2015). Non-Statin Treatment of Dyslipidemia. In: Yassine, H. (eds) Lipid Management. Springer, Cham. https://doi.org/10.1007/978-3-319-11161-2_12

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  • DOI: https://doi.org/10.1007/978-3-319-11161-2_12

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