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 :
- Askandar Tjokroprawiro*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
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Volume : 42 / No. : 2 / Pub. : 2006-04 |
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