Treatment of dyslipidaemias – Related resources

Cochrane reviews

• Fibrates appear to lower the risk for cardiovascular (CVD) and coronary events in primary prevention without increasing or decreasing overall mortality or non-CVD mortality, but the absolute treatment effects are modest (absolute risk reductions < 1%) .
• There is insufficient evidence on the effectiveness of a cholesterol-lowering diet, or any of the other dietary interventions suggested for familial hypercholesterolaemia .
• Simplification of drug regimen, improved patient information/education, and reminding may all improve patient adherence to lipid lowering drugs .Artichoke leaf extract seems to lower cholesterol levels although the evidence is insufficient .
• Statins for the primary prevention of cardiovascular diseases reduce all-cause mortality and combined fatal and non-fatal cardiovascular disease endpoints.
• Garlic may reduce blood pressure and have small short-term benefits on lipid-lowering and antiplatelet factors compared with placebo, but there is insufficient evidence on mortality and cardiovascular morbidity .
• There is insufficient evidence on the effect of isoflavones on lowering of cholesterol levels in people with hypercholesterolaemia .

Other evidence summaries

• Statin treatment may reduce cardiovascular morbidity and even improve liver tests in coronary heart disease patients with mild-to-moderately abnormal liver tests at baseline (up to 3 times the upper limit of normal) that are potentially attributable to non-alcoholic fatty liver disease .
• Aerobic exercise training appears to produce small favourable changes in blood lipids in previously sedentary adults .
• There is little evidence that low or reduced serum cholesterol concentration significantly increases mortality from any cause other than haemorrhagic stroke. This risk affects only people with a very low concentration and even in these the risk is outweighed by the benefits from the low risk of ischaemic heart disease at least in patients with ischaemic heart disease .
• Soy protein-containing diet appears to decrease serum cholesterol, LDL cholesterol and triglyceride levels .
• The most effective nutrition education programs appear to be those that are behaviourally focused, ongoing, and multifaceted .
• There is little reduction in risk of ischaemic heart disease in the first two years after lowering cholesterol. Five or more years after reduction of cholesterol concentration by 0.6 mmol/l the reduction of incidence of ischaemic heart disease is 25% according to controlled trials and 27% according to cohort studies .
• Lipid lowering by drugs, especially HMG-CoA reductase inhibitors, may be effective in patients with renal disease . Fenofibrate reduces serum triglycerides, total cholesterol and low-density lipoprotein cholesterol .
• Statins may have a small effect in slowing the rate of loss of kidney function, especially in patients with cardiovascular disease .
• Intensive lipid lowering with high-dose statin therapy appears to provide a benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events in patients with stable coronary heart disease or acute coronary syndrome .
• Higher intensity statin compared to lower intensity statin therapy may increase the incidence of transaminase and CK elevations. The increased risk for transaminase elevation appears to be associated with the use of hydrophilic statins, and the increased risk for creatine kinase elevation appears to be associated with the use of lipophilic statins .

Clinical guidelines

• Cooper A, O'Flynn N, Guideline Development Group. Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance. BMJ 2008 May 31;336(7655):1246-8.

Literature

• The ACCORD Study Group. Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus. N Engl J Med 2010 Mar 14;():.
• Bhatnagar D, Soran H, Durrington PN. Hypercholesterolaemia and its management. BMJ 2008 Aug 21;337():a993.
• Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R, 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 Oct 8;366(9493):1267-78.
• McClure DL, Valuck RJ, Glanz M, Hokanson JE. Systematic review and meta-analysis of clinically relevant adverse events from HMG CoA reductase inhibitor trials worldwide from 1982 to present. Pharmacoepidemiol Drug Saf 2007 Feb;16(2):132-43.
• Brunzell JD. Clinical practice. Hypertriglyceridemia. N Engl J Med 2007 Sep 6;357(10):1009-17.
• Mills EJ, Rachlis B, Wu P, Devereaux PJ, Arora P, Perri D. Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. J Am Coll Cardiol 2008 Nov 25;52(22):1769-81.
• Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006 Aug 1;48(3):438-45.