Detail Article

Folia Medica Indonesiana

ISSN 0303-7932

Vol. 42 / No. 2 / Published : 2008-04

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Original Article :

Review article and clinical experience: bridging the gap in the lipid management: the roles of hdl-c in the cves and creating a new concepts for its raising

Author :

  1. Askandar Tjokroprawiro*1
  1. Diabetes and Nutrition Center Dr. Soetomo Teaching Hospital Airlangga University School of Medicine, Surabaya

Abstract :

TLC has the potential to reduce cardiovascular risk through several mechanisms beyond LDL lowering. In high-risk persons the recommended LDL-C goal is < 100 mg/dl. An LDL-C goal of 70 mg/dl is a therapeutic option on the basis of available clinical evidence, esp. for patients at very high risk. If LDL-C is ≥ 100 mg/dl, an LDL-lowering drug is indicated simultaneously with TLC. If baseline LDL-C is < 100 mg/dl, institution of an LDL-lowering drug to achieve an LDL-C level < 70 mg/dl is a therapeutic option on the basis of available critical trial evidence. If a high-risk person has TGs or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid (NA) with a LDL-lowering drug. When TGs are ≥ 200 mg/dl, non-HDL-C is a secondary target of therapy, with a goal 30 mg/dl higher than the identified LDL-C goal. When LDL-lowering drug therapy is employed in high-risk or moderately high-risk persons, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels. Nicotinic acid (NA) is one of the oldest known agents for the treatment of atherogenic dyslipidemia. However, cutaneous flushing is the most frequent side effect of therapy. Once-daily, modified-release NA (NA-MR) has been formulated in doses ranging from 1.000-2.000 mg given in the evening or at bedtime (flushing episode of NA-MR can be reduced by 80%).  Modified-release NA formulation has recently introduced (once-daily) in the UK and Europe, and it was reported the most effective agent for raising HDL-C. The three large studies, ADMIT (2000), ADVENT (2002) and ARBITER2 (2004) reported that by combining statin therapy with NA-MR in patients with T2DM and CHD, respectively, showed to be in favor of the effects of NA-MR. Treatment with NA-MR in ADVENT resulted in dose-related increases in HDL-C of 13-19% with 1.000 mg and of 22-24% with 1.500 mg. The addition to statin therapy in Arterial biology for the Investigation in the Treatment Effect of Reducing Cholesterol 2 (ARBITER2) with NA-MR in patients with Coronary Heart Disease (CHD) and moderately low High Density Lipoprotein – C (HDL-C) slowed the progression of atherosclerosis to a greater degree than treatment with a statin alone. NA-MR is creating a new concept for raising HDL-C, and bridging the gap in the novel treatment of atherogenic dyslipidemia.

Keyword :

HDL-C, Cardiovascular event, lipid management, LDL-C, modified-release NA (NA-MR) ,

References :

Feher, MD & Richmond, W,(1997) Lipid and Lipid Disorders. Pocket Picture Guides, 1st edn Chicago : Gower Medical Publishing, Mosby Wolfe

Goldberg, A, Alagona, P & Capuzzi, DM et al.,(2000) Multidose-efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia - : Am J Cardiol

Gordon, DJ, Probstfield, H & Garrison, RJ et al.,(1989) High-Density Lipoprotein Cholesterol and Cardiovascular Disease: Four Prospective American Studies - : Circulation

Archive Article

Cover Media Content

Volume : 42 / No. : 2 / Pub. : 2006-04
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  2. The Influence Of Extremely Low Frequency (elf) Magnetic Fields Induction To The Production Of Ifn- γ On Balb/c Mice
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  4. Role Of Mouthpiece On The Efficacy And Safety Of Budesonide Turbuhaler In The Treatment Of Asthmatic Children: Lesson From M3 Study
  5. The Effect Of Kegel On Management Of Urine Elimination Problems For Elderly A Quasy–experimental Study
  6. Prevalence Of Cataract In Diabetic Patients At Ophthalmology Outpatient Clinic, Dr Soetomo Hospital, Surabaya
  7. The Effects Of Orchidectomy And Detorsion After Unilateral Testicular Torsion Upon Immune Response In The Contralateral Testis
  8. Fecal Material (fm) In Appendiceal Lumen: Acute Or Chronic Inflammation?
  9. The Difference Of The Quality Of Life In The End State Renal Disease Patient Between Continuous Ambulatory Peritoneal Dialysisis And Haemodialysis Therapy
  10. Ocular Complication Of Ethambutol Used For Pulmonary Tuberculosis Therapy In Balai Pengobatan Dan Pemberantasan Penyakit Paru, Surabaya
  11. Review Article And Clinical Experience: Bridging The Gap In The Lipid Management: The Roles Of Hdl-c In The Cves And Creating A New Concepts For Its Raising