Page 655 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 35 Agents Used in Dyslipidemia 641

LaRosa JC et al: Safety and effect of very low levels of low density lipoprotein Silverman MG et al: Association between lowering LDL-C and cardiovascular risk
cholesterol on cardiovascular events. Am J Cardiol 2013;111:1221. reduction among different therapeutic interventions: A systematic review
Mampuya WM et al: Treatment strategies in patients with statin intolerance: The and meta-analysis. JAMA Cardiol 2016;316:1289.
Cleveland Clinic experience. Am Heart J 2013;166:597. Stone NJ et al: 2013 ACC/AHA guidelines on the treatment of blood choles-
Nduka C et al: Impact of antiretroviral therapy on serum lipoprotein levels terol to reduce atherosclerotic cardiovascular risk in adults. A report of the
and dyslipidemias: a systematic review and meta-analysis. Int J Cardiol American College of Cardiology/American Heart Association task force on
2015;199:307. practice guidelines. Circulation 2014; 129 (25 Suppl 2):S1. Erratum: Cir-
Perry CM: Lomitapide: A review of its use in adults with homozygous familial culation 2015;132:e396.
hypercholesterolemia. Am J Cardiovasc Drugs 2013;13:265. Swiger JK et al: Statins and cognition: A systematic review and meta-analysis of
Raal FJ, Stein EA: The effects of mipomersen on inhibiting hepatic VLDL short and long term cognitive effects. Mayo Clin Proceed 2013;88:1213.
apolipoprotein B 100 and propensity for hepatic steatosis. Clin Chem Tsujita K et al: Impact of dual-lipid lowering with ezetimibe and atorvastatin on
2016;62:1052. coronary plaque regression in patients with percutaneous coronary interven-
Reith C, Armitage J: Management of residual risk after statin therapy. Atheroscle- tion. The randomized controlled PRECISE-IVUS trial. J Am Coll Cardiol
rosis 2016;245;161. 2015;66:495.
Rodriguez F: Association between intensity of statin therapy and mortality Yahya R et al: Lomitapide effects HDL composition and function. Atherosclerosis
in patients with atherosclerotic cardiovascular disease. JAMA Cardiol 2016;251:15.
2016;2:47. Zimmer S et al: Cyclodextrin promotes atherosclerosis regression via macrophage
reprogramming. Sci Transl Med 2016;8:333ra50.

C ASE STUD Y ANSWER

The patient’s history of muscle symptoms should be care- LDL-C goal. If this is not tolerated or the goal is not reached,
fully evaluated. The genotype at the SLCO1B1 locus might be alternate drugs can be used, including a bile acid binding resin,
obtained to determine whether myositis is due to impaired intestinal sterol absorption inhibitor, or niacin (monitoring
metabolism of statins. If you agree that her muscle symptoms uric acid, glucose, and liver enzymes). These can be used in
were clearly associated with statin use but were not particu- combinations with each other or with a low dose statin. If all
larly severe and not associated with creatine kinase elevations else fails, use of a PCSK9 monoclonal antibody should be con-
significantly greater than normal, you could prescribe any sidered. Her homocysteine level should be measured because
one the agents she tried in the past or select a different statin. of the synergy between that amino acid and Lp(a) with respect
The starting dose should be low and the drug given on alter- to thrombotic risk. Also, because of her elevated Lp(a), she
nate days, increasing the dose and frequency to achieve the should be evaluated for aortic stenosis.