Matching articles for "Statins"

Comparison Table: Some Lipid-Lowering Drugs (online only)

   
The Medical Letter on Drugs and Therapeutics • September 19, 2022;  (Issue 1659)
...
View the Comparison Table: Some Lipid-Lowering Drugs
Med Lett Drugs Ther. 2022 Sep 19;64(1659):e152-6 | Show Full IntroductionHide Full Introduction

Inclisiran (Leqvio) for LDL-Cholesterol Lowering

   
The Medical Letter on Drugs and Therapeutics • March 21, 2022;  (Issue 1646)
The FDA has approved inclisiran (Leqvio – Novartis), a small interfering RNA (siRNA) directed to proprotein convertase subtilisin/kexin type 9 (PCSK9) mRNA, as an adjunct to diet and maximally tolerated...
The FDA has approved inclisiran (Leqvio – Novartis), a small interfering RNA (siRNA) directed to proprotein convertase subtilisin/kexin type 9 (PCSK9) mRNA, as an adjunct to diet and maximally tolerated statin therapy for subcutaneous (SC) treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease (ASCVD) who require additional lowering of low-density lipoprotein cholesterol (LDL-C). Inclisiran is the first FDA-approved PCSK9-directed siRNA therapeutic agent.
Med Lett Drugs Ther. 2022 Mar 21;64(1646):43-5 | Show Full IntroductionHide Full Introduction

Apoaequorin (Prevagen) to Improve Memory

   
The Medical Letter on Drugs and Therapeutics • November 1, 2021;  (Issue 1636)
A synthetic form of the protein apoaequorin is the active ingredient in the over-the-counter dietary supplement Prevagen (Quincy Bioscience), which is heavily marketed to improve...
A synthetic form of the protein apoaequorin is the active ingredient in the over-the-counter dietary supplement Prevagen (Quincy Bioscience), which is heavily marketed to improve memory.
Med Lett Drugs Ther. 2021 Nov 1;63(1636):175-6 | Show Full IntroductionHide Full Introduction

Bempedoic Acid (Nexletol) for Lowering LDL-Cholesterol

   
The Medical Letter on Drugs and Therapeutics • April 6, 2020;  (Issue 1595)
The FDA has approved the oral adenosine triphosphate-citrate lyase (ACL) inhibitor bempedoic acid for use alone (Nexletol – Esperion) and in a fixed-dose combination with the cholesterol absorption...
The FDA has approved the oral adenosine triphosphate-citrate lyase (ACL) inhibitor bempedoic acid for use alone (Nexletol – Esperion) and in a fixed-dose combination with the cholesterol absorption inhibitor ezetimibe (Nexlizet) as an adjunct to diet and maximally tolerated statin therapy in adults with heterozygous familial hypercholesterolemia (HeFH) or established atherosclerotic cardiovascular disease (ASCVD) who require additional lowering of LDL-cholesterol (LDL-C). Bempedoic acid is the first ACL inhibitor to be approved in the US.
Med Lett Drugs Ther. 2020 Apr 6;62(1595):53-5 | Show Full IntroductionHide Full Introduction

Reduction of Cardiovascular Risk with Icosapent Ethyl (Vascepa)

   
The Medical Letter on Drugs and Therapeutics • February 10, 2020;  (Issue 1591)
Icosapent ethyl (Vascepa – Amarin), the ethyl ester of eicosapentaenoic acid (EPA), has been approved by the FDA for use as an adjunct to maximally tolerated statin therapy to reduce the risk of...
Icosapent ethyl (Vascepa – Amarin), the ethyl ester of eicosapentaenoic acid (EPA), has been approved by the FDA for use as an adjunct to maximally tolerated statin therapy to reduce the risk of major adverse cardiovascular events in adults with hypertriglyceridemia (≥150 mg/dL) who have either established cardiovascular disease (CVD) or diabetes and ≥2 additional risk factors for CVD. It is the only omega-3 polyunsaturated fatty acid (PUFA) product to be approved in the US for this indication. Icosapent ethyl and two other omega-3 PUFA prescription products (Lovaza, Epanova), which contain both EPA and docosahexaenoic acid (DHA), were approved earlier for treatment of severe hypertriglyceridemia (≥500 mg/dL).
Med Lett Drugs Ther. 2020 Feb 10;62(1591):17-8 | Show Full IntroductionHide Full Introduction

In Brief: Ezallor Sprinkle - A New Formulation of Rosuvastatin

   
The Medical Letter on Drugs and Therapeutics • September 23, 2019;  (Issue 1581)
The lipid-lowering drug rosuvastatin is now available in a sprinkle capsule formulation (Ezallor Sprinkle – Sun Pharma). Rosuvastatin tablets (Crestor, and generics) have been available since 2003.1,2The new...
The lipid-lowering drug rosuvastatin is now available in a sprinkle capsule formulation (Ezallor Sprinkle – Sun Pharma). Rosuvastatin tablets (Crestor, and generics) have been available since 2003.1,2

The new formulation is being marketed specifically for residents of long-term care facilities who have difficulty swallowing. Ezallor Sprinkle capsules can be swallowed whole or opened and their contents sprinkled over applesauce or mixed with water for administration via nasogastric tube.

For those long-term care residents who still have a reasonable indication for a statin but have difficulty swallowing whole tablets, crushing generic rosuvastatin tablets would be a much less expensive option.

Expanded Table: Statins

  1. Rosuvastatin – a new lipid-lowering drug. Med Lett Drugs Ther 2003; 45:81
  2. Lipid-lowering drugs. Med Lett Drugs Ther 2019; 61:17.


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Med Lett Drugs Ther. 2019 Sep 23;61(1581):152 | Show Full IntroductionHide Full Introduction

Expanded Table: Statins (online only)

   
The Medical Letter on Drugs and Therapeutics • September 23, 2019;  (Issue 1581)
...
View the Expanded Table: Statins
Med Lett Drugs Ther. 2019 Sep 23;61(1581):e152 | Show Full IntroductionHide Full Introduction

Lipid-Lowering Drugs

   
The Medical Letter on Drugs and Therapeutics • February 11, 2019;  (Issue 1565)
Cholesterol management guidelines from the American College of Cardiology/American Heart Association Task Force have recently been published. See Table 1 for a brief summary of their...
Cholesterol management guidelines from the American College of Cardiology/American Heart Association Task Force have recently been published. See Table 1 for a brief summary of their recommendations.
Med Lett Drugs Ther. 2019 Feb 11;61(1565):17-24 | Show Full IntroductionHide Full Introduction

Expanded Table: Lipid-Lowering Drugs (online only)

   
The Medical Letter on Drugs and Therapeutics • February 11, 2019;  (Issue 1565)
...
View the Expanded Table: Lipid-Lowering Drugs
Med Lett Drugs Ther. 2019 Feb 11;61(1565):e24-30 | Show Full IntroductionHide Full Introduction

In Brief: Pitavastatin Magnesium (Zypitamag) for Hyperlipidemia

   
The Medical Letter on Drugs and Therapeutics • June 18, 2018;  (Issue 1549)
The FDA has approved the HMG-CoA reductase inhibitor (statin) pitavastatin magnesium (Zypitamag – Zydus) for use in adults with primary hyperlipidemia or mixed dyslipidemia. The FDA considers pitavastatin...
The FDA has approved the HMG-CoA reductase inhibitor (statin) pitavastatin magnesium (Zypitamag – Zydus) for use in adults with primary hyperlipidemia or mixed dyslipidemia. The FDA considers pitavastatin magnesium bioequivalent to pitavastatin calcium (Livalo), which was approved in 2009.1

Statins remain the treatment of choice for most patients who require lipid-lowering therapy. Taken as an adjunct to diet modification, increased exercise, and smoking cessation, statins can reduce the risk of primary and secondary cardiovascular events and death in patients with or at high risk for atherosclerotic cardiovascular disease.2 Even in patients at low risk for cardiovascular disease, treatment with a statin can significantly reduce the incidence of cardiovascular events.3

Controlled trials in patients with cardiovascular disease have shown that high-intensity statin therapy (defined as reducing LDL-cholesterol [LDL-C] by ≥50% on average) reduces the incidence of cardiac events, stroke, and coronary death significantly more than less intensive regimens. In one meta-analysis, each additional 1 mmol/L (39 mg/dL) reduction in LDL-C was associated with a 20% reduction in major vascular events and a 10% reduction in all-cause mortality.4 In a randomized trial in 13,054 Japanese patients with stable coronary artery disease, over a median follow-up of 3.9 years, patients taking pitavastatin calcium 4 mg daily were significantly less likely than those taking 1 mg daily to have a cardiovascular event (4.3% vs 5.4%).5

Approval of pitavastatin magnesium was based on the results of trials with pitavastatin calcium; no new efficacy trials were required. The Medical Letter's review of pitavastatin calcium concluded that recommended doses of the drug had not been shown to decrease LDL-C more than other statins with longer safety records and there was no good reason to use it. That conclusion applies to pitavastatin magnesium as well.

  1. Pitavastatin (Livalo) – the seventh statin. Med Lett Drugs Ther 2010; 52:57.
  2. Lipid-lowering drugs. Med Lett Drugs Ther 2016; 58:133.
  3. CTT Collaboration et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380:581.
  4. CTT Collaboration et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376:1670.
  5. I Taguchi et al. High-dose versus low-dose pitavastatin in Japanese patients with stable coronary artery disease (REAL-CAD): a randomized superiority trial. Circulation 2018; 137:1997.


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Med Lett Drugs Ther. 2018 Jun 18;60(1549):106 | Show Full IntroductionHide Full Introduction

Reduction of Cardiovascular Risk with Evolocumab (Repatha)

   
The Medical Letter on Drugs and Therapeutics • April 24, 2017;  (Issue 1519)
The results of the recently published FOURIER trial have shown a reduction in cardiovascular events with addition of the PCSK9 inhibitor evolocumab (Repatha) to statin therapy in patients with...
The results of the recently published FOURIER trial have shown a reduction in cardiovascular events with addition of the PCSK9 inhibitor evolocumab (Repatha) to statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD).
Med Lett Drugs Ther. 2017 Apr 24;59(1519):63-4 | Show Full IntroductionHide Full Introduction

Drug Interaction: Dabigatran (Pradaxa) and Statins

   
The Medical Letter on Drugs and Therapeutics • January 30, 2017;  (Issue 1513)
The results of a recently published study suggest that taking the oral direct thrombin inhibitor dabigatran etexilate (Pradaxa) with either simvastatin (Zocor, and others) or lovastatin (Altoprev, and...
The results of a recently published study suggest that taking the oral direct thrombin inhibitor dabigatran etexilate (Pradaxa) with either simvastatin (Zocor, and others) or lovastatin (Altoprev, and others) increases the risk of major hemorrhage.
Med Lett Drugs Ther. 2017 Jan 30;59(1513):26 | Show Full IntroductionHide Full Introduction

Addendum: Statins for Primary Prevention of Cardiovascular Disease

   
The Medical Letter on Drugs and Therapeutics • December 5, 2016;  (Issue 1509)
In our recent article on Lipid-Lowering Drugs,1 we said that statins can reduce the risk of first cardiovascular events and death (primary prevention) in patients at high risk for atherosclerotic cardiovascular...
In our recent article on Lipid-Lowering Drugs,1 we said that statins can reduce the risk of first cardiovascular events and death (primary prevention) in patients at high risk for atherosclerotic cardiovascular disease (CVD) and significantly reduce the incidence of cardiovascular events in patients at lower risk for CVD. Now the United States Preventive Services Task Force (USPSTF) has issued new recommendations on the appropriate use of statins for primary prevention of CVD.2

The USPSTF states that clinicians should periodically screen all persons 40-75 years old for cardiovascular risk factors and evaluate their 10-year risk of CVD using the ACC/AHA Pooled Cohort Equation.3 It recommends starting low- to moderate-intensity statin therapy (lowintensity statin therapy lowers LDL-cholesterol <30%; moderate-intensity statin therapy lowers it 30-<50%) in adults 40-75 years old without CVD who have one or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of >10%. For patients with the same characteristics but a 7.5-10% 10-year risk, the USPSTF recommends that clinicians "selectively offer" the same treatment.

The new recommendations do not apply to patients with familial hypercholesterolemia or LDL-cholesterol levels ≥190 mg/dL, who should take a statin regardless of calculated risk. The USPSTF found the evidence insufficient to recommend starting a statin for primary prevention in persons >75 years old.

  1. Lipid-lowering drugs. Med Lett Drugs Ther 2016; 58:133.
  2. US Preventive Services Task Force et al. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316:1997.
  3. American Heart Association and American College of Cardiology. ASCVD Risk Estimator. Available at: tools.acc.org. Accessed November 22, 2016.


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Med Lett Drugs Ther. 2016 Dec 5;58(1509):158 | Show Full IntroductionHide Full Introduction

Lipid-Lowering Drugs

   
The Medical Letter on Drugs and Therapeutics • October 24, 2016;  (Issue 1506)
Lipid-lowering drugs should be taken indefinitely; when they are stopped, plasma lipoproteins return to pretreatment levels. HMG-CoA reductase inhibitors (statins) remain the drugs of choice for treatment...
Lipid-lowering drugs should be taken indefinitely; when they are stopped, plasma lipoproteins return to pretreatment levels. HMG-CoA reductase inhibitors (statins) remain the drugs of choice for treatment of most patients who require lipid-lowering therapy.
Med Lett Drugs Ther. 2016 Oct 24;58(1506):133-40 | Show Full IntroductionHide Full Introduction

Alirocumab (Praluent) to Lower LDL-Cholesterol

   
The Medical Letter on Drugs and Therapeutics • August 17, 2015;  (Issue 1475)
The FDA has approved the subcutaneously injected PCSK9 (proprotein convertase subtilisin kexin type 9) inhibitor alirocumab (Praluent – Sanofi/Regeneron) as an adjunct to diet and maximally...
The FDA has approved the subcutaneously injected PCSK9 (proprotein convertase subtilisin kexin type 9) inhibitor alirocumab (Praluent – Sanofi/Regeneron) as an adjunct to diet and maximally tolerated statin therapy for adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease who require additional lowering of LDL-cholesterol (LDL-C). It was not approved for general use in statin-intolerant patients. Alirocumab is the first PCSK9 inhibitor to be approved in the US. Evolocumab (Repatha – Amgen), another PCSK9 inhibitor, was recently approved in Europe and has been recommended for approval for the same indications in the US by an FDA Advisory Committee.
Med Lett Drugs Ther. 2015 Aug 17;57(1475):113-5 | Show Full IntroductionHide Full Introduction

In Brief: Adding Ezetimibe to a Statin Improves Clinical Outcomes

   
The Medical Letter on Drugs and Therapeutics • December 8, 2014;  (Issue 1457)
Combining a statin with another drug that lowers low-density lipoprotein cholesterol (LDL-C), such as colesevelam (Welchol), niacin (Niaspan, and others), or ezetimibe (Zetia), can reduce LDL-C levels more than...
Combining a statin with another drug that lowers low-density lipoprotein cholesterol (LDL-C), such as colesevelam (Welchol), niacin (Niaspan, and others), or ezetimibe (Zetia), can reduce LDL-C levels more than a statin alone, but studies convincingly demonstrating that such combinations improve clinical outcomes have been lacking. The results of a long-term randomized, double-blind clinical trial (IMPROVE-IT) recently presented at the American Heart Association's Scientific Sessions 2014 indicate that addition of ezetimibe to simvastatin in high-risk patients reduces cardiovascular events.1

IMPROVE-IT compared the efficacy of simvastatin 40 mg plus placebo with that of simvastatin 40 mg plus ezetimibe 10 mg (Vytorin) in preventing the primary endpoint, a composite of cardiovascular events (cardiovascular death, MI, hospital admission for unstable angina, coronary revascularization, or stroke) in patients with acute coronary syndrome and normal LDL-C levels (≤125 mg/dL; mean 95 mg/dL). After one year, mean LDL-C was reduced further with the addition of ezetimibe (to 53.2 vs. 69.9 mg/dL with simvastatin alone). After 7 years, 2742 events had occurred among the 9077 patients taking simvastatin plus placebo and 2572 among the 9067 taking simvastatin plus ezetimibe (event rate: 34.7% vs. 32.7%; p = 0.016). There was no significant difference between the 2 groups in noncardiovascular adverse events, including gallbladder-related events, myopathy, or cancer.

  1. C Cannon et al. IMProved Reduction of Outcomes: Vytorin Efficacy International Trial. Available at www.timi.org. Accessed November 21, 2014.


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Med Lett Drugs Ther. 2014 Dec 8;56(1457):126 | Show Full IntroductionHide Full Introduction

Statins and Diabetes Risk

   
The Medical Letter on Drugs and Therapeutics • September 1, 2014;  (Issue 1450)
In 2012, the FDA required manufacturers of HMG-CoA reductase inhibitors (statins) to add a warning to their labels about reports of increased blood glucose and glycosylated hemoglobin (HbA1c) levels. Since...
In 2012, the FDA required manufacturers of HMG-CoA reductase inhibitors (statins) to add a warning to their labels about reports of increased blood glucose and glycosylated hemoglobin (HbA1c) levels. Since then, several new studies have been published.
Med Lett Drugs Ther. 2014 Sep 1;56(1450):79-80 | Show Full IntroductionHide Full Introduction

Drugs for Lipids

   
The Medical Letter on Drugs and Therapeutics • January 1, 2014;  (Issue 137)
HMG-CoA reductase inhibitors (statins) inhibit the enzyme that catalyzes the rate-limiting step in cholesterol synthesis. The subsequent reduction in hepatic cholesterol leads to increased expression of LDL...
HMG-CoA reductase inhibitors (statins) inhibit the enzyme that catalyzes the rate-limiting step in cholesterol synthesis. The subsequent reduction in hepatic cholesterol leads to increased expression of LDL receptors, which in turn increases uptake and clearance of LDL-C from the blood. Statins also lower very low-density lipoprotein cholesterol (VLDL-C) and triglycerides. Most statins increase high-density lipoprotein cholesterol (HDL-C), but only modestly.
Treat Guidel Med Lett. 2014 Jan;12(137):1-6 | Show Full IntroductionHide Full Introduction

Two New Drugs for Homozygous Familial Hypercholesterolemia

   
The Medical Letter on Drugs and Therapeutics • April 1, 2013;  (Issue 1413)
The FDA has approved mipomersen (Kynamro – Genzyme) and lomitapide (Juxtapid – Aegerion), each in addition to a low-fat diet and other lipid-lowering medications, to reduce cholesterol levels in patients...
The FDA has approved mipomersen (Kynamro – Genzyme) and lomitapide (Juxtapid – Aegerion), each in addition to a low-fat diet and other lipid-lowering medications, to reduce cholesterol levels in patients with homozygous familial hypercholesterolemia (HoFH).
Med Lett Drugs Ther. 2013 Apr 1;55(1413):25-7 | Show Full IntroductionHide Full Introduction

Drugs for Hypertriglyceridemia

   
The Medical Letter on Drugs and Therapeutics • March 4, 2013;  (Issue 1411)
Fibrates, niacin and fish oil are promoted for treatment of hypertriglyceridemia. HMG-CoA reductase inhibitors (statins) can lower elevated serum concentrations of triglycerides, but less so than fibrates,...
Fibrates, niacin and fish oil are promoted for treatment of hypertriglyceridemia. HMG-CoA reductase inhibitors (statins) can lower elevated serum concentrations of triglycerides, but less so than fibrates, niacins or fish oil. Lifestyle changes such as weight reduction, exercise and decreasing alcohol intake can also lower serum triglyceride levels and should be tried first.
Med Lett Drugs Ther. 2013 Mar 4;55(1411):17-9 | Show Full IntroductionHide Full Introduction

Statin Label Changes

   
The Medical Letter on Drugs and Therapeutics • March 19, 2012;  (Issue 1386)
Citing some recent reports, the FDA has announced changes in the safety labeling of all HMG-CoA reductase inhibitors...
Citing some recent reports, the FDA has announced changes in the safety labeling of all HMG-CoA reductase inhibitors (statins).
Med Lett Drugs Ther. 2012 Mar 19;54(1386):21 | Show Full IntroductionHide Full Introduction

What about Niacin?

   
The Medical Letter on Drugs and Therapeutics • November 28, 2011;  (Issue 1378)
The results of the AIM-HIGH trial conducted by the US National Heart, Lung and Blood Institute (NHLBI) were recently published. The goal of the trial was to test whether addition of niacin to intensive...
The results of the AIM-HIGH trial conducted by the US National Heart, Lung and Blood Institute (NHLBI) were recently published. The goal of the trial was to test whether addition of niacin to intensive statin therapy would further reduce the risk of cardiovascular disease. The trial was stopped prematurely after an average follow-up of 3 years because niacin therapy had not shown any clinical benefit.
Med Lett Drugs Ther. 2011 Nov 28;53(1378):93-4 | Show Full IntroductionHide Full Introduction

Sitagliptin and Simvastatin (Juvisync)

   
The Medical Letter on Drugs and Therapeutics • November 14, 2011;  (Issue 1377)
The FDA has approved Juvisync (Merck), a fixed-dose combination of the antihyperglycemic DPP-4 inhibitor sitagliptin (Januvia) and the HMG-CoA reductase inhibitor simvastatin (Zocor, and...
The FDA has approved Juvisync (Merck), a fixed-dose combination of the antihyperglycemic DPP-4 inhibitor sitagliptin (Januvia) and the HMG-CoA reductase inhibitor simvastatin (Zocor, and others).
Med Lett Drugs Ther. 2011 Nov 14;53(1377):89 | Show Full IntroductionHide Full Introduction

New Simvastatin Dosing Recommendations

   
The Medical Letter on Drugs and Therapeutics • August 8, 2011;  (Issue 1370)
The FDA has announced changes in the labeling of simvastatin to reduce the risk of myopathy. These changes include limiting the use of the 80-mg maximum dose to patients who have been taking it for 12 months or...
The FDA has announced changes in the labeling of simvastatin to reduce the risk of myopathy. These changes include limiting the use of the 80-mg maximum dose to patients who have been taking it for 12 months or more without evidence of myopathy and new recommendations for use of simvastatin with other drugs. Simvastatin is available alone (Zocor, and others) and in combination with ezetimibe (Vytorin) and with niacin (Simcor).
Med Lett Drugs Ther. 2011 Aug 8;53(1370):61-2 | Show Full IntroductionHide Full Introduction

Drugs for Lipids

   
The Medical Letter on Drugs and Therapeutics • March 1, 2011;  (Issue 103)
Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. Lipid-regulating drugs must be taken...
Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. Lipid-regulating drugs must be taken indefinitely; when they are stopped, plasma lipoproteins return to pretreatment levels in 2-3 weeks.
Treat Guidel Med Lett. 2011 Mar;9(103):13-20 | Show Full IntroductionHide Full Introduction

Pitavastatin (Livalo) - The Seventh Statin

   
The Medical Letter on Drugs and Therapeutics • July 26, 2010;  (Issue 1343)
The FDA has approved the marketing of pitavastatin (Livalo – Kowa), an HMG-CoA reductase inhibitor (“statin”), for treatment of primary hyperlipidemia or mixed dyslipidemia. It has been available in...
The FDA has approved the marketing of pitavastatin (Livalo – Kowa), an HMG-CoA reductase inhibitor (“statin”), for treatment of primary hyperlipidemia or mixed dyslipidemia. It has been available in Japan since 2003. All of the statins now available in the US are listed in the table on page 58.
Med Lett Drugs Ther. 2010 Jul 26;52(1343):57-8 | Show Full IntroductionHide Full Introduction

Red Yeast Rice

   
The Medical Letter on Drugs and Therapeutics • September 7, 2009;  (Issue 1320)
Red yeast rice is a food product that has been used in Chinese cooking and medicine for centuries. It is available in the US in a capsule formulation and is often used by patients who want a "natural" product...
Red yeast rice is a food product that has been used in Chinese cooking and medicine for centuries. It is available in the US in a capsule formulation and is often used by patients who want a "natural" product to lower cholesterol.
Med Lett Drugs Ther. 2009 Sep 7;51(1320):71-2 | Show Full IntroductionHide Full Introduction

When a Statin Fails

   
The Medical Letter on Drugs and Therapeutics • July 27, 2009;  (Issue 1317)
The National Cholesterol Education Program recommends that LDL-C be lowered to less than 100 mg/dL (2.6 mmol/L) and considers a value...
The National Cholesterol Education Program recommends that LDL-C be lowered to less than 100 mg/dL (2.6 mmol/L) and considers a value <70 mg/dL (1.8 mmol/L) a reasonable goal for patients at very high risk.
Med Lett Drugs Ther. 2009 Jul 27;51(1317):58-60 | Show Full IntroductionHide Full Introduction

CRP and Statins for Primary Prevention of Coronary Artery Disease

   
The Medical Letter on Drugs and Therapeutics • December 15, 2008;  (Issue 1301)
Modestly elevated C-reactive protein (CRP) concentrations have been associated with an increased risk of coronary heart disease. The recently published and heavily publicized results of the JUPITER trial will...
Modestly elevated C-reactive protein (CRP) concentrations have been associated with an increased risk of coronary heart disease. The recently published and heavily publicized results of the JUPITER trial will lead many patients to ask health care professionals whether they should have a CRP test to see if they should be taking a statin.
Med Lett Drugs Ther. 2008 Dec 15;50(1301):97-8 | Show Full IntroductionHide Full Introduction

Which Statin?

   
The Medical Letter on Drugs and Therapeutics • April 21, 2008;  (Issue 1284)
Advertisements for atorvastatin (Lipitor), the market leader facing generic competition, have been in the news recently in the US. Lovastatin, pravastatin and simvastatin are all available generically at a much...
Advertisements for atorvastatin (Lipitor), the market leader facing generic competition, have been in the news recently in the US. Lovastatin, pravastatin and simvastatin are all available generically at a much lower retail price or lower co-pay than atorvastatin.
Med Lett Drugs Ther. 2008 Apr 21;50(1284):29-31 | Show Full IntroductionHide Full Introduction

Simcor: A Niacin/Simvastatin Combination

   
The Medical Letter on Drugs and Therapeutics • April 7, 2008;  (Issue 1283)
The FDA has approved the marketing of a second fixed-dose combination of extended-release niacin (Niaspan) with a generic statin. Niaspan/simvastatin (Simcor - Abbott) is approved for use in patients with...
The FDA has approved the marketing of a second fixed-dose combination of extended-release niacin (Niaspan) with a generic statin. Niaspan/simvastatin (Simcor - Abbott) is approved for use in patients with hypercholesterolemia or mixed dyslipidemia (high LDL-cholesterol, low HDL-cholesterol and high serum triglycerides). Niaspan/lovastatin (Advicor) was marketed previously for the same indications.
Med Lett Drugs Ther. 2008 Apr 7;50(1283):25-6 | Show Full IntroductionHide Full Introduction

Drugs for Lipids

   
The Medical Letter on Drugs and Therapeutics • February 1, 2008;  (Issue 66)
Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. They should not be used as a substitute for...
Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. They should not be used as a substitute for lifestyle changes; a combination of diet, exercise and lipid-lowering drugs is optimal for prevention of coronary disease. Lipid-regulating drugs must be taken indefinitely; when they are stopped, plasma lipoprotein levels return to pretreatment levels in 2-3 weeks.
Treat Guidel Med Lett. 2008 Feb;6(66):9-16 | Show Full IntroductionHide Full Introduction

In Brief: Zetia and Vytorin: The ENHANCE Study

   
The Medical Letter on Drugs and Therapeutics • January 28, 2008;  (Issue 1278)
An unpublished 2-year randomized study (ENHANCE) on the effect of adding ezetimibe 10 mg to simvastatin 80 mg in 720 patients with heterozygous familial hypercholesterolemia has been in the news recently. About...
An unpublished 2-year randomized study (ENHANCE) on the effect of adding ezetimibe 10 mg to simvastatin 80 mg in 720 patients with heterozygous familial hypercholesterolemia has been in the news recently. About 80% of these patients had previously been treated with statins. The primary endpoint was the change in the intima-media thickness (IMT) of the carotid artery (baseline 0.68 and 0.69 mm); the IMT increased by 0.0111 mm with ezetimibe plus simvastatin and 0.0058 mm with simvastatin 80 mg alone (p=0.29). The ezetimibe- simvastatin combination lowered LDL-C by 58% compared to 41% lowering with simvastatin alone (p<0.01). The study was not powered to assess cardiovascular events; cardiovascular deaths occurred in 2 patients treated with both drugs and 1 on simvastatin alone.

Ezetimibe, an inhibitor of cholesterol absorption, is available both alone (Zetia) and in combination with 10, 20, 40 and 80 mg of simvastatin (Vytorin). No data have been published on the effect of ezetimibe on cardiovascular events with or without simvastatin. Whether addition of ezetimibe to a statin is as effective as raising the dose of the statin in decreasing the number of cardiovascular events remains to be determined in larger studies that are underway.

Neither Zetia or Vytorin is recommended for initial treatment of hypercholesterolemia.

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Med Lett Drugs Ther. 2008 Jan 28;50(1278):5 | Show Full IntroductionHide Full Introduction

Antifungal Drugs

   
The Medical Letter on Drugs and Therapeutics • January 1, 2008;  (Issue 65)
The drugs of choice for treatment of some fungal infections are listed in the tables. Some of the indications and dosages recommended here have not been approved by the FDA. Other guidelines are available from...
The drugs of choice for treatment of some fungal infections are listed in the tables. Some of the indications and dosages recommended here have not been approved by the FDA. Other guidelines are available from the Infectious Diseases Society of America (www.idsociety.org).
Treat Guidel Med Lett. 2008 Jan;6(65):1-8 | Show Full IntroductionHide Full Introduction

In Brief: Atorvastatin for Stroke Prevention

   
The Medical Letter on Drugs and Therapeutics • September 11, 2006;  (Issue 1243)
Statins have been shown to reduce the risk of stroke in patients at high risk for cardiovascular disease (Treat Guidel Med Lett 2005; 3:15). A recent issue of The New England Journal of Medicine includes the...
Statins have been shown to reduce the risk of stroke in patients at high risk for cardiovascular disease (Treat Guidel Med Lett 2005; 3:15). A recent issue of The New England Journal of Medicine includes the results of a study sponsored by the manufacturer in which 80 mg of atorvastatin (Lipitor – Pfizer) or placebo was given to 4731 patients without coronary artery disease who had had a stroke or transient ischemic attack (TIA) within one to six months before study entry (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels [SPARCL] Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355:549). Patients were not required to have elevated cholesterol levels to enroll. The authors conclude that the study results support starting atorvastatin treatment soon after a stroke or TIA.

The primary study endpoint was a nonfatal or fatal stroke. During a median follow-up of 4.9 years, patients treated with atorvastatin had 265 strokes compared to 307 strokes with placebo. Patients treated with atorvastatin had 56 fewer ischemic strokes and 22 more hemorrhagic strokes. They also had 39 fewer coronary events. There were 216 deaths among patients treated with atorvastatin and 211 among those treated with placebo.

Whether patients with a recent ischemic stroke or TIA would be as well protected against a recurrence and against coronary events by a lower dose of atorvastatin or by another less potent statin remains to be determined. The risk of myopathy and rhabdomyolysis with statins is dose-related; atorvastatin is the second-most potent statin on the US market (rosuvastatin is the most potent), and 80 mg is its maximum dose. Statins have an antithrombotic effect, and an increase in hemorrhagic stroke in patients with cerebrovascular disease treated with statins has been reported previously (Heart Protection Collaborative Study, Lancet 2004; 363:757). It is doubtful whether patients with a recent hemorrhagic stroke should be treated with statins at all, let alone a maximum dose of atorvastatin.

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Med Lett Drugs Ther. 2006 Sep 11;48(1243):75-6 | Show Full IntroductionHide Full Introduction

Coenzyme Q10

   
The Medical Letter on Drugs and Therapeutics • February 27, 2006;  (Issue 1229)
Coenzyme Q10, a fat-soluble antioxidant also known as ubidecarenone, ubiquinone and CoQ10, is marketed as a dietary supplement in the US, both as a single ingredient and in various combination...
Coenzyme Q10, a fat-soluble antioxidant also known as ubidecarenone, ubiquinone and CoQ10, is marketed as a dietary supplement in the US, both as a single ingredient and in various combination products.
Med Lett Drugs Ther. 2006 Feb 27;48(1229):19-20 | Show Full IntroductionHide Full Introduction

Statins for High-Risk Patients without Heart Disease or High Cholesterol

   
The Medical Letter on Drugs and Therapeutics • January 2, 2006;  (Issue 1225)
The FDA recently approved the use of atorvastatin (Lipitor) to reduce the risk of heart attack and stroke in patients without heart disease who have type 2 diabetes plus other risk factors, with or without...
The FDA recently approved the use of atorvastatin (Lipitor) to reduce the risk of heart attack and stroke in patients without heart disease who have type 2 diabetes plus other risk factors, with or without hypercholesterolemia. The agency also approved the drug's use to reduce the risk of stroke in high-risk nondiabetic patients without heart disease, whether or not they have hypercholesterolemia. Similar indications were previously approved for simvastatin (Zocor).
Med Lett Drugs Ther. 2006 Jan 2;48(1225):1-2 | Show Full IntroductionHide Full Introduction

Omega-3 Polyunsaturated Fatty Acids (Omacor) for Hypertriglyceridemia

   
The Medical Letter on Drugs and Therapeutics • November 7, 2005;  (Issue 1221)
A highly concentrated omega-3 polyunsaturated fatty acid (PUFA) preparation (Omacor - Reliant) has been approved by the FDA as an adjunct to diet for treatment of very high plasma triglyceride concentrations...
A highly concentrated omega-3 polyunsaturated fatty acid (PUFA) preparation (Omacor - Reliant) has been approved by the FDA as an adjunct to diet for treatment of very high plasma triglyceride concentrations (>=500 mg/dL). Omacor is a combination of the ethyl esters of icosapentaenoic (EPA) and docosahexaenoic (DHA) acids. It is the first drug derived from omega-3 PUFAs to be sold by prescription.
Med Lett Drugs Ther. 2005 Nov 7;47(1221):91-2 | Show Full IntroductionHide Full Introduction

CYP3A and Drug Interactions

   
The Medical Letter on Drugs and Therapeutics • July 4, 2005;  (Issue 1212)
Serious adverse interactions between drugs continue to be reported. Many of these are due to inhibition or induction of cytochrome P450 (CYP) enzymes, particularly CYP3A4. CYP3A is thought to be involved in the...
Serious adverse interactions between drugs continue to be reported. Many of these are due to inhibition or induction of cytochrome P450 (CYP) enzymes, particularly CYP3A4. CYP3A is thought to be involved in the metabolism of more than 50 percent of currently prescribed drugs.2 CYP3A4, which is more abundantly expressed than CYP3A5, accounts for most CYP3A activity in vivo.
Med Lett Drugs Ther. 2005 Jul 4;47(1212):54-5 | Show Full IntroductionHide Full Introduction

Drugs for Lipids

   
The Medical Letter on Drugs and Therapeutics • March 1, 2005;  (Issue 31)
Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. In controlled trials in patients with...
Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. In controlled trials in patients with coronary disease, some of these drugs have reduced mortality by 20% to 30%.
Treat Guidel Med Lett. 2005 Mar;3(31):15-22 | Show Full IntroductionHide Full Introduction

Safety of Aggressive Statin Therapy

   
The Medical Letter on Drugs and Therapeutics • November 22, 2004;  (Issue 1196)
New guidelines from The National Cholesterol Education Program recommend, as a therapeutic option, lowering treatment goals for LDL cholesterol (LDL-C) from...
New guidelines from The National Cholesterol Education Program recommend, as a therapeutic option, lowering treatment goals for LDL cholesterol (LDL-C) from <100 mg/dL to <70 mg/dL for patients at very high risk for coronary heart disease and from 130 mg/dL to <100 mg/dL for those at moderately high risk. A likely consequence of these recommendations is increased use of statins and use of higher doses with a concomitant increase in adverse effects.
Med Lett Drugs Ther. 2004 Nov 22;46(1196):93-5 | Show Full IntroductionHide Full Introduction

Vytorin: A Combination of Ezetimibe and Simvastatin

   
The Medical Letter on Drugs and Therapeutics • September 13, 2004;  (Issue 1191)
Vytorin, a fixed-dose combination of the cholesterol absorption inhibitor ezetimibe (Zetia - Merck/Schering Plough) and the HMG-CoA reductase inhibitor ("statin") simvastatin (Zocor - Merck), has been approved...
Vytorin, a fixed-dose combination of the cholesterol absorption inhibitor ezetimibe (Zetia - Merck/Schering Plough) and the HMG-CoA reductase inhibitor ("statin") simvastatin (Zocor - Merck), has been approved by the FDA for treatment of hypercholesterolemia. It is available as tablets containing 10 mg of ezetimibe combined with 10, 20, 40 or 80 mg of simvastatin.
Med Lett Drugs Ther. 2004 Sep 13;46(1191):73-4 | Show Full IntroductionHide Full Introduction

Amlodipine/Atorvastatin (Caduet)

   
The Medical Letter on Drugs and Therapeutics • July 5, 2004;  (Issue 1186)
Caduet (Pfizer), a combination of the calcium-channel blocker amlodipine (Norvasc - Pfizer) and the HMG-CoA reductase inhibitor (statin) atorvastatin (Lipitor - Pfizer), is now available in the US. It was...
Caduet (Pfizer), a combination of the calcium-channel blocker amlodipine (Norvasc - Pfizer) and the HMG-CoA reductase inhibitor (statin) atorvastatin (Lipitor - Pfizer), is now available in the US. It was approved by the FDA for use in patients with indications for treatment with both amlodipine, which is used to treat hypertension and/or angina pectoris, and atorvastatin, which is used to treat dyslipidemia. The combination is bioequivalent to the 2 components taken separately.
Med Lett Drugs Ther. 2004 Jul 5;46(1186):56 | Show Full IntroductionHide Full Introduction

Cholesterol Rethink for High-Risk Patients

   
The Medical Letter on Drugs and Therapeutics • May 10, 2004;  (Issue 1182)
The recent "PROVE IT" trial in patients with coronary heart disease showed clinical benefits associated with reducing LDL cholesterol concentrations lower than the 100 mg/dL (2.59 mmol/L) or less that had been...
The recent "PROVE IT" trial in patients with coronary heart disease showed clinical benefits associated with reducing LDL cholesterol concentrations lower than the 100 mg/dL (2.59 mmol/L) or less that had been considered optimal.
Med Lett Drugs Ther. 2004 May 10;46(1182):37-9 | Show Full IntroductionHide Full Introduction

Drugs for Intermittent Claudication

   
The Medical Letter on Drugs and Therapeutics • February 16, 2004;  (Issue 1176)
Management of intermittent claudication, the most common symptom of peripheral arterial disease (PAD), involves both risk factor modification and symptomatic treatment (WR Hiatt, N Engl J Med 2001; 344:1608; RM...
Management of intermittent claudication, the most common symptom of peripheral arterial disease (PAD), involves both risk factor modification and symptomatic treatment (WR Hiatt, N Engl J Med 2001; 344:1608; RM Schainfeld, J Am Board Fam Pract 2001; 14:443).
Med Lett Drugs Ther. 2004 Feb 16;46(1176):13-5 | Show Full IntroductionHide Full Introduction

Rosuvastatin - a New Lipid-lowering Drug

   
The Medical Letter on Drugs and Therapeutics • October 13, 2003;  (Issue 1167)
Rosuvastatin (Crestor - AstraZeneca), an HMG-CoA reductase inhibitor (or "statin"), was recently approved by the FDA for lowering serum cholesterol and triglyceride concentrations and raising HDL cholesterol...
Rosuvastatin (Crestor - AstraZeneca), an HMG-CoA reductase inhibitor (or "statin"), was recently approved by the FDA for lowering serum cholesterol and triglyceride concentrations and raising HDL cholesterol levels. Rosuvastatin, like other statins, inhibits the enzyme that catalyzes the rate-limiting step in cholesterol synthesis, but it is claimed to be more potent than the others. All of these drugs must be taken indefinitely; if they are discontinued, lipid levels return to baseline.
Med Lett Drugs Ther. 2003 Oct 13;45(1167):81-3 | Show Full IntroductionHide Full Introduction

Drugs For Lipid Disorders

   
The Medical Letter on Drugs and Therapeutics • August 1, 2003;  (Issue 12)
Drugs that lower low-density lipoprotein (LDL) cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, and also improve vasodilatation. In controlled...
Drugs that lower low-density lipoprotein (LDL) cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, and also improve vasodilatation. In controlled trials in patients with coronary disease, they have reduced mortality by 30% to 40%. Lipid-regulating drugs must be taken indefinitely; when they are stopped, plasma lipid levels return to pretreatment levels in 2-3 weeks.
Treat Guidel Med Lett. 2003 Aug;1(12):77-82 | Show Full IntroductionHide Full Introduction

Three New Drugs for Hyperlipidemia

   
The Medical Letter on Drugs and Therapeutics • March 3, 2003;  (Issue 1151)
The FDA recently approved three new drugs for treatment of hyperlipidemia. Ezetimibe (ez et' i mibe; Zetia) is the first in a new class of drugs that inhibit intestinal absorption of cholesterol....
The FDA recently approved three new drugs for treatment of hyperlipidemia. Ezetimibe (ez et' i mibe; Zetia) is the first in a new class of drugs that inhibit intestinal absorption of cholesterol. Extended-release lovastatin (Altocor) is a new formulation of lovastatin (Mevacor, and others). Extended-release niacin plus (immediate-release) lovastatin (Advicor) is the first fixed-dose combination of lipid-lowering drugs.
Med Lett Drugs Ther. 2003 Mar 3;45(1151):17-9 | Show Full IntroductionHide Full Introduction

Drugs That May Cause Psychiatric Symptoms

   
The Medical Letter on Drugs and Therapeutics • July 8, 2002;  (Issue 1134)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
Med Lett Drugs Ther. 2002 Jul 8;44(1134):59-62 | Show Full IntroductionHide Full Introduction

Choice of Lipid-Regulating Drugs

   
The Medical Letter on Drugs and Therapeutics • May 28, 2001;  (Issue 1105)
New recommendations for drug treatment of hypercholesterolemia, if widely followed, will lead to a marked increase in the number of people taking lipid-regulating...
New recommendations for drug treatment of hypercholesterolemia, if widely followed, will lead to a marked increase in the number of people taking lipid-regulating drugs.
Med Lett Drugs Ther. 2001 May 28;43(1105):43-8 | Show Full IntroductionHide Full Introduction

Drugs For Prevention and Treament of Postmenopausal Osteoporosis

   
The Medical Letter on Drugs and Therapeutics • October 16, 2000;  (Issue 1090)
Many drugs are now marketed for prevention and treatment of postmenopausal osteoporosis. All regimens should include an adequate intake of calcium and vitamin...
Many drugs are now marketed for prevention and treatment of postmenopausal osteoporosis. All regimens should include an adequate intake of calcium and vitamin D.
Med Lett Drugs Ther. 2000 Oct 16;42(1090):97-100 | Show Full IntroductionHide Full Introduction

Amprenavir: A New HIV Protease Inhibitor

   
The Medical Letter on Drugs and Therapeutics • July 16, 1999;  (Issue 1057)
Amprenavir is the fifth protease inhibitor to become available for treatment of HIV infection. It was approved by the FDA for use with other drugs in the treatment of HIV-infected adults and children at least...
Amprenavir is the fifth protease inhibitor to become available for treatment of HIV infection. It was approved by the FDA for use with other drugs in the treatment of HIV-infected adults and children at least four years old.
Med Lett Drugs Ther. 1999 Jul 16;41(1057):63-6 | Show Full IntroductionHide Full Introduction

Choice of Lipid-lowering Drugs

   
The Medical Letter on Drugs and Therapeutics • December 18, 1998;  (Issue 1042)
Drugs that lower-density-lipoprotein (LDL) cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, improve coronary vasodilatation, and decrease...
Drugs that lower-density-lipoprotein (LDL) cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, improve coronary vasodilatation, and decrease mortality from coronary heart disease. All of these drugs must be continued indefinitely; when they are stopped, plasma cholesterol concentrations generally return to pretreatment levels. Elevated serum triglyceride concentrations appear to be an independent risk factor for cardiovascular disease in both women and men, but direct evidence of clinical benefit from triglyceride reduction is lacking.
Med Lett Drugs Ther. 1998 Dec 18;40(1042):117-22 | Show Full IntroductionHide Full Introduction

Fenofibrate for Hypertriglyceridemia

   
The Medical Letter on Drugs and Therapeutics • July 3, 1998;  (Issue 1030)
Micronized fenofibrate (Tricor - Abbott), a fibric acid derivative structurally similar to clofibrate (Atromid-S, and others) and gemfibrozil (Lopid, and others), has been approved by the FDA for treatment of...
Micronized fenofibrate (Tricor - Abbott), a fibric acid derivative structurally similar to clofibrate (Atromid-S, and others) and gemfibrozil (Lopid, and others), has been approved by the FDA for treatment of hypertriglyceridemia. Increased serum triglyceride concentrations have been associated with an increased risk of coronary heart disease (J Jeppesen et al, Circulation, 97:1029, 1998).
Med Lett Drugs Ther. 1998 Jul 3;40(1030):68-9 | Show Full IntroductionHide Full Introduction

Cerivastatin for Hypercholesterolemia

   
The Medical Letter on Drugs and Therapeutics • January 16, 1998;  (Issue 1018)
Cerivastatin (Baycol - Bayer), a new HMG-CoA reductase inhibitor (or "statin"), has been approved by the FDA for treatment of hypercholesterolemia. Cerivastatin is the sodium salt of a synthetic fluorophenyl...
Cerivastatin (Baycol - Bayer), a new HMG-CoA reductase inhibitor (or "statin"), has been approved by the FDA for treatment of hypercholesterolemia. Cerivastatin is the sodium salt of a synthetic fluorophenyl pyridinyl-substituted heptanoic acid.
Med Lett Drugs Ther. 1998 Jan 16;40(1018):13-4 | Show Full IntroductionHide Full Introduction

Choice of Lipid-Lowering Drugs

   
The Medical Letter on Drugs and Therapeutics • August 2, 1996;  (Issue 980)
Drugs that lower elevated plasma cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, and may also improve coronary vasodilatation (JW Jukema et...
Drugs that lower elevated plasma cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, and may also improve coronary vasodilatation (JW Jukema et al, circulation, 91:2528, 1995: CB Treasure er al, N Engl J Med, 332:481, 1995; TJ Anderson et al, N Engl J Med, 332:488, 1995). All these drugs must be continued indefinitely; when htey are stopped, plasma cholesterol concentrations generally return to pretreatment levels.
Med Lett Drugs Ther. 1996 Aug 2;38(980):67-70 | Show Full IntroductionHide Full Introduction