Interní Med. 2011; 13(1): 7-12

Mixed dyslipidemia: up-to-date treatment

MUDr.David Karásek, Ph.D., prof.MUDr.Helena Vaverková, CSc.
III. interní klinika LF UP a FN Olomouc

Mixed dyslipidemia represents a heterogenic group of lipid disorders. Cardiovascular events are the main complications of this disease

(atherogenic dyslipidemia), acute pancreatitis may be caused by severe hypertriglyceridemia. Detailed assessment of lipid parameters

helps with better estimation of patient’s risk and appropriate hypolipidemic treatment. Statins are the first choice treatment for mixed

dyslipidemia (except the severe hypertriglyceridemia). Nevertheless, even patients on adequate dose of statins often have a high residual

risk, which could be decreased by another hypolipidemic drug. Authors present up-to-day treatment of mixed dyslipidemia including

combination therapy in this review.

acids.

Keywords: mixed dyslipidemia, non-HDL-cholesterol, apolipoprotein B, statins, fibrates, nicotinic acid, omega-3 polyunsaturated fatty

Published: January 14, 2011  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Karásek D, Vaverková H. Mixed dyslipidemia: up-to-date treatment. Interní Med. 2011;13(1):7-12.
Download citation

References

  1. Vaverková H, Soška H, Rosolová, et al. Doporučení pro diagnostiku a léčbu dyslipidemií v dospělosti vypracované výborem České společnosti pro aterosklerózu. Cor Vasa 2007; (Suppl. 11/49): 47-60.
  2. Šimon J, a kol. Epidemiologie a prevence ischemické choroby srdeční. Praha: Grada Publishing 2001: 264 s.
  3. Češka R, a kol. Cholesterol a ateroskleróza, léčba dyslipidemií. Praha: Triton 2005: 343 s.
  4. Recommendations of the European Atherosclerosis Society prepared by the International Task Force for Prevention of Coronary Heart Disease: prevention of coronary heart disease: scientific background and new clinical guidelines. Nutr Metab Cardiovasc Dis 1992; 2: 113-156.
  5. Austin MA, Hokanson JE. Epidemiology of triglycerides, small dense low-density lipoprotein, and lipoprotein (a) as risk factors for coronary heart disease. Med Clin North Am 1994; 78: 99-115. Go to original source... Go to PubMed...
  6. Campos H, Genest JJ Jr, Blijlevens E, et al. Low density lipoprotein particle size and coronary artery disease. Arterioscler Thromb 1992; 12: 187-195. Go to original source... Go to PubMed...
  7. Griffin BA, Freeman DJ, Tait GW, et al. Role of plasma triglyceride in the regulation of plasma low density lipoprotein (LDL) subfractions: relative contribution of small, dense LDL to coronary heart disease risk. Atherosclerosis 1994; 106: 241-253. Go to original source... Go to PubMed...
  8. Assman G, Schulte H, von Eckardstein A. Hypertriglyceridemia and elevated lipoprotein (a) are risk factors for major coronary events in middle - aged men. Hypertriglyceridemia and elevated lipoprotein (a) are risk factors for major coronary events in middle-aged men. Am J Cardiol 1996; 77: 1179-1184. Go to original source... Go to PubMed...
  9. Jeppesen J, Hein OH, Suadicani P, et al. Triglyceride concentration and ischemic heart disease: an eight-year follow-up in the Copenhagen Male Study. Circulation 1998; 97: 1029-1036. Go to original source... Go to PubMed...
  10. Sarwar N, Danesh J, Eiriksdottir G, et al. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies. Circulation 2007; 115: 450-458. Go to original source... Go to PubMed...
  11. Gordon DJ, Rifkind BM. High-density lipoprotein-the clinical implications of recent studies. N Engl J Med 1989; 321: 1311-1316. Go to original source... Go to PubMed...
  12. Kannel WB. CHD risk factors: a Framingham study update. Hosp Pract (Off Ed) 1990; 25: 119-127. Go to original source... Go to PubMed...
  13. Gordon DJ, Probstfield JL, Garrison RJ, et al. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989; 79: 8-15. Go to original source... Go to PubMed...
  14. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499-502. Go to original source...
  15. Liu J, Sempos CT, Donahue RP, et al. Non-high-density lipoprotein and very-low-density lipoprotein cholesterol and their risk predictive values in coronary heart disease. Am J Cardiol 2006; 98: 1363-1368. Go to original source... Go to PubMed...
  16. Barter PJ, Ballantyne CM, Carmena R, et al. Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel. J Intern Med 2006; 259: 247-258. Go to original source... Go to PubMed...
  17. de Graaf J, Couture P, Sniderman A. A diagnostic algorithm for the atherogenic apolipoprotein B dyslipoproteinemias. Nat Clin Pract Endocrinol Metab 2008; 4: 608-618. Go to original source... Go to PubMed...
  18. Grundy SM. Atherogenic dyslipidemia associated with metabolic syndrome and insulin resistance. Clin Cornerstone 2006; 8(Suppl. 1): S21-S27. Go to original source... Go to PubMed...
  19. Elovson J, Chatterton JE, Bell GT, et al. Plasma very low density lipoproteins contain a single molecule of apolipoprotein B. J Lipid Res 1988; 29: 1461-1473. Go to original source...
  20. Chapman MJ, Laplaud PM, Luc G, et al. Further resolution of the low density lipoprotein spectrum in normal human plasma: physicochemical characteristics of discrete subspecies separated by density gradient ultracentrifugation. J Lipid Res 1988; 29: 442-458. Go to original source...
  21. Marcovina SM, Albers JJ, Kennedy H, et al. International Federation of Clinical Chemistry standardization project for measurements of apolipoproteins A-I and B. IV. Comparability of apolipoprotein B values by use of International Reference Material. Clin Chem 1994; 40: 586-592. Go to original source...
  22. Sniderman AD. Applying apoB to the diagnosis and therapy of the atherogenic dyslipoproteinemias: a clinical diagnostic algorythm. Curr Opin Lipidol 2004; 15: 433-438. Go to original source... Go to PubMed...
  23. McQueen MJ, Hawken S, Wang X, et al. INTERHEART study investigators. Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study. Lancet 2008; 372: 224-233. Go to original source... Go to PubMed...
  24. Vasudevan AR, Ballantyne CM. Cardiometabolic risk assessment: an approach to the prevention of cardiovascular disease and diabetes mellitus. Clin Cornerstone 2005; 7: 7-16. Go to original source... Go to PubMed...
  25. Vaverkova H, Karasek D, Novotny D, et al. Apolipoprotein B versus LDL-cholesterol: Association with other risk factors for atherosclerosis. Clin Biochem 2009; 42: 1246-1251. Go to original source... Go to PubMed...
  26. Davidson M. A review of the current status of the management of mixed dyslipidemia associated with diabetes mellitus and metabolic syndrome. Am J Cardiol 2008; 102: 19L-27L. Go to original source... Go to PubMed...
  27. Fazio S. Management of mixed dyslipidemia in patients with or at risk for cardiovascular disease: a role for combination fibrate therapy. Clin Ther 2008; 30: 294-306. Go to original source... Go to PubMed...
  28. Preiss D, Sattar N. Lipids, lipid modifying agents and cardiovascular risk: a review of the evidence. Clin Endocrinol (Oxf) 2009; 70: 815-828. Go to original source... Go to PubMed...
  29. Chapman MJ, Redfern JS, McGovern ME, et al. Niacin and fibrates in atherogenic dyslipidemia: pharmacotherapy to reduce cardiovascular risk. Pharmacol Ther 2010; 126: 314-345. Go to original source... Go to PubMed...
  30. Baigent C, Keech A, Kearney PM, et al. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267-1278. Go to original source... Go to PubMed...
  31. Cholesterol Treatment Trialists' (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371: 117-125. Go to original source... Go to PubMed...
  32. Deedwania P, Barter P, Carmena R, et al. Treating to New Targets Investigators. Reduction of low-density lipoprotein cholesterol in patients with coronary heart disease and metabolic syndrome: analysis of the Treating to New Targets study. Lancet 2006; 368: 919-928. Go to original source... Go to PubMed...
  33. Alagona P Jr. Beyond LDL cholesterol: the role of elevated triglycerides and low HDL cholesterol in residual CVD risk remaining after statin therapy. Am J Manag Care 2009; 15(3 Suppl): S65-S73. Go to PubMed...
  34. Fruchart JC, Sacks F, Hermans MP, et al. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol 2008; 102(Suppl. 10): 1K-34K. Go to original source... Go to PubMed...
  35. Jones PH. Expert perspective: reducing cardiovascular risk in metabolic syndrome and type 2 diabetes mellitus beyond low-density lipoprotein cholesterol lowering. Am J Cardiol 2008; 102: 41L-47L. Go to original source... Go to PubMed...
  36. Keech A, Simes RJ, Barter P, et al. FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366: 1849-1861. Go to original source... Go to PubMed...
  37. ACCORD Study Group, Ginsberg HN, Elam MB, Lovato LC, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1563-1574. Go to original source... Go to PubMed...
  38. Toth PP. Fibrate therapy in the management of diabetic dyslipidemia: there is no ACCORD to be found. Curr Atheroscler Rep 2010; 12: 331-335. Go to original source... Go to PubMed...
  39. Jones PH, Davidson MH. Reporting rate of rhabdomyolysis with fenofibrate + statin versus gemfibrozil + any statin. Am J Cardiol 2005; 95: 120-122. Go to original source... Go to PubMed...
  40. Kamanna VS, Kashyap ML. Mechanism of action of niacin. Am J Cardiol 2008; 101: 20B-26B. Go to original source... Go to PubMed...
  41. Vaverková H. Fixní kombinace ER niacin/laropiprant. Remedia 2010; 20: V39-V48.
  42. Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol 1986; 8: 1245-1255. Go to original source... Go to PubMed...
  43. Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001; 345: 1583-1592. Go to original source... Go to PubMed...
  44. Bruckert E, Labreuche J, Amarenco P. Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis. Atherosclerosis 2010; 210: 353-361. Go to original source... Go to PubMed...
  45. Ballantyne CM, Davidson MH, McKenney J, et al. Comparison of the safety and efficacy of a combination tablet of niacin extended release and simvastatin vs simvastatin monotherapy in patients with increased non-HDL cholesterol (from the SEACOAST I study). Am J Cardiol 2008; 101: 1428-1436. Go to original source... Go to PubMed...
  46. Miller M. Niacin as a component of combination therapy for dyslipidemia. Mayo Clin Proc 2003; 78: 735-742. Go to original source... Go to PubMed...




Internal Medicine for Practice

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.