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Pang J, Sanfilippo FM, Chan DC, Watts GF. Adherence to pharmacotherapy: sine qua non for reducing cumulative risk of premature coronary disease in familial hypercholesterolemia. Curr Opin Endocrinol Diabetes Obes 2024; 31:22-30. [PMID: 37902122 DOI: 10.1097/med.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to atherosclerotic cardiovascular disease (ASCVD). The risk of ASCVD can be substantially reduced with lipid-lowering treatment (LLT). However, adherence to LLT remains a major challenge in FH patients and an under-recognized issue. We review several barriers to treatment adherence and implementation strategies for improving adherence in patients with FH. RECENT FINDINGS Barriers that negatively affect patient adherence to treatment include the misunderstanding of perceived and actual risk of FH and the benefits of LLT, inadequate knowledge, lack of standardization of treatment, insufficient monitoring of LDL-cholesterol level, and inequalities in healthcare resources. Education of patients, carers and healthcare providers, guideline-directed treatment goals, regular monitoring, medication regimen simplification and greater access to established and new drugs are crucial enablers for improving adherence to treatment. However, given FH is present from birth, strategies for life-long adherence from childhood or young adulthood is critically important and requires further study. To be effective, strategies should be multifaceted, targeted and patient-centred involving a multidisciplinary-team with support from family, communities and peer groups. SUMMARY FH confers a significant risk for ASCVD from a young age. Achieving better medication adherence is foundational for improving clinical outcomes and reducing the burden of atherosclerosis over a lifetime. Identification of key barriers and enablers are critical for implementing better adherence to treatment across the life-course of patients with FH.
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Affiliation(s)
- Jing Pang
- Medical School, University of Western Australia
| | - Frank M Sanfilippo
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia
| | - Dick C Chan
- Medical School, University of Western Australia
| | - Gerald F Watts
- Medical School, University of Western Australia
- Lipid Disorders Clinic, Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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Cai R, Chang C, Zhong X, Su Q. Lowering of Blood Lipid Levels with a Combination of Pitavastatin and Ezetimibe in Patients with Coronary Heart Disease: A Meta-Analysis. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2023. [DOI: 10.15212/cvia.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objectives: According to the findings of randomized controlled trials, blood lipid levels in patients with coronary heart disease (CHD) can be significantly decreased through a combination of pitavastatin and ezetimibe; however, the effects and clinical applications of this treatment remain controversial. This meta-analysis was aimed at objectively assessing the efficacy and safety of pitavastatin and ezetimibe in lowering blood lipid levels.
Design: Relevant studies were retrieved from electronic databases, including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, VIP, and WanFang Data, from database inception to June 8, 2022. The levels of low-density lipoprotein cholesterol, total cholesterol, triglycerides, and high-density lipoprotein cholesterol in patients’ serum after treatment were the primary endpoint.
Results: Nine randomized controlled trials (2586 patients) met the inclusion criteria. The meta-analysis indicated that pitavastatin plus ezetimibe resulted in significantly lower levels of LDL-C [standardized mean difference (SMD)=−0.86, 95% confidence interval (CI) (−1.15 to −0.58), P<0.01], TC [SMD=−0.84, 95% CI (−1.10 to −0.59), P<0.01], and TG [SMD=−0.59, 95% CI (−0.89 to −0.28), P<0.01] than pitavastatin alone.
Conclusions: Pitavastatin plus ezetimibe significantly decreased serum LDL-C, TC, and TG levels in patients with CHD.
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Affiliation(s)
- Ruping Cai
- Department of Rehabilitation Medicine, The Second Nanning People’s Hospital, Nanning, 530031, China
| | - Chen Chang
- Department of Cardiology, Guilin Medical University Affiliated Hospital, Guilin, 541000, China
| | - Xingjie Zhong
- Department of Rehabilitation Medicine, The Second Nanning People’s Hospital, Nanning, 530031, China
| | - Qiang Su
- Department of Cardiology, Guilin Medical University Affiliated Hospital, Guilin, 541000, China
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Talic S, Marquina Hernandez C, Ofori-Asenso R, Liew D, Owen A, Petrova M, Lybrand S, Thomson D, Ilomaki J, Ademi Z, Zomer E. Trends in the Utilization of Lipid-Lowering Medications in Australia: An Analysis of National Pharmacy Claims Data. Curr Probl Cardiol 2021; 47:100880. [PMID: 34108083 DOI: 10.1016/j.cpcardiol.2021.100880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Lipid-lowering medications comprise standard of care in the prevention of cardiovascular disease. This study examined the trends in the utilization of statin and non-statin medications in the Australian general population between 2013 and 2019. Pharmacoepidemiological analyses were performed using pharmacy dispensing data from Australian Pharmaceutical Benefits Scheme. One-year prevalence and incidence of statin and non-statin prescribing patterns were reported, and relative variations in prescribing examined via Poisson regression modelling. The one-year prevalence of statins' prescriptions decreased between 2013-2019 by 5.5% (from 25.0%-19.5%). Females were less likely than males to be prescribed statins (rate ratio [RR]=0.90, 95% confidence interval [CI] 0.89-0.91). The one-year prevalence of ezetimibe alone, and in combination with statins, increased consistently from 2013-2019 from 1.5%-3.6% (P<0.01) and 0.1%-1.1% (P<0.01), respectively. The prevalence was higher among those aged 61-80 years (RR=1.20, 95%CI 1.10-1.21) and those aged older than 80 years (RR=1.34, 95%CI 1.22-1.47), when compared to people aged <60 years. The incidence of ezetimibe prescriptions was highest in people aged 61-80 years (RR=1.36, 95%CI 1.31-1.41) compared to those aged <60 years. The one-year prevalence of proprotein convertase subtilisin/kexin type 9 inhibitor prescriptions was highest among those aged 46-60 years (RR=1.24, 95%CI 0.97-4.97) compared to people aged <46 and >60 years. Females were less likely than males to be prescribed a proprotein convertase subtilisin/kexin type 9 inhibitor (RR=0.87, 95%CI 0.75-0.98). Statins remain the most prevalent lipid-lowering medication prescribed in Australia. The prescribing of non-statin medications remains low, but is increasing.
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Affiliation(s)
- Stella Talic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marjana Petrova
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Borneol in cardio-cerebrovascular diseases: Pharmacological actions, mechanisms, and therapeutics. Pharmacol Res 2021; 169:105627. [PMID: 33892091 DOI: 10.1016/j.phrs.2021.105627] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022]
Abstract
With the coming acceleration of global population aging, the incidence rate of cardio-cerebrovascular diseases (CVDs) is increasing. It has become the leading cause of human mortality. As a natural drug, borneol (BO) not only has anti-inflammatory, anti-oxidant, anti-apoptotic, anti-coagulant activities and improves energy metabolism but can also promote drugs to enter the target organs or tissues through various physiological barriers, such as the blood-brain barrier (BBB), mucous membrane, skin. Thus, it has a significant therapeutic effect on various CVDs, which has been confirmed in a large number of studies. However, the pharmacological actions and mechanisms of BO on CVDs have not been fully investigated. Hence, this review summarizes the pharmacological actions and possible mechanisms of BO, which provides novel ideas for the treatment of CVDs.
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Yang Y, Sun Q, Xu X, Yang X, Gao Y, Sun X, Zhao Y, Ding Z, Ge W, Cheng R, Zhang J. Oral Administration of Succinoglycan Riclin Improves Diet-Induced Hypercholesterolemia in Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:13307-13317. [PMID: 31679333 DOI: 10.1021/acs.jafc.9b06034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Epidemiological studies have demonstrated that hypercholesterolemia is associated with an elevated risk of atherosclerosis and cardiovascular diseases. In addition to the available cholesterol-lowering drugs, nutritionally balanced diets containing functional foods have attracted much interest as potential candidates to improve hypercholesterolemia. In the study, we demonstrated that dietary succinoglycan riclin effectively alleviated diet-induced hypercholesterolemia. Compared with the high-cholesterol-diet (HCD) group, the high-riclin group significantly decreased levels of the serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), and hepatic cholesterol (34, 40, and 51%, respectively), consequently improving hepatic steatosis and reducing proinflammatory cytokine expressions. 1H nuclear magnetic resonance (NMR)-based lipidomics and metabolomics analyses revealed that the riclin group partially reversed metabolic profile changes induced by the HCD, approaching that of the normal diet (ND) group. Riclin has no direct effects on cholesterol metabolism-related gene expression among the three HCD model groups. Basically, riclin increased the solution viscosity and interfered in the process of bile acid-cholesterol emulsification, decreasing cholesterol digestion and promoting cholesterol and bile acid excretion in the feces. These results suggested potential therapeutic utility of succinoglycan riclin as a food additive for people suffering from hypercholesterolemia and related diseases.
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Affiliation(s)
- Yunxia Yang
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Qi Sun
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Xi Xu
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Xiao Yang
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Yan Gao
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Xiaqing Sun
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Yang Zhao
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Zhao Ding
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Wenhao Ge
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Rui Cheng
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
| | - Jianfa Zhang
- Center for Molecular Metabolism , Nanjing University of Science and Technology , Nanjing 210094 , China
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A nutraceutical formulation based on Annurca apple polyphenolic extract is effective on intestinal cholesterol absorption: A randomised, placebo-controlled, crossover study. PHARMANUTRITION 2018. [DOI: 10.1016/j.phanu.2018.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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A 10-Year Trend in Statin Use Among Older Adults in Australia: an Analysis Using National Pharmacy Claims Data. Cardiovasc Drugs Ther 2018; 32:265-272. [DOI: 10.1007/s10557-018-6794-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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