Specific drug-drug interactions are important to consider when initiating lipid-lowering therapy in HIV patients. Both protease inhibitors and non-nucleoside reverse-transcriptase inhibitors can affect cytochrome P450 isoforms. In general, all protease inhibitors inhibit CYP3A4, with the highest level of inhibition with ritonavir, followed by indinavir, nelfinavir, amprenavir, and saquinavir. Delavirdine, a non-nucleoside reverse-transcriptase inhibitor, is also an inhibitor of CYP3A4, whereas nevirapine and efavirenz result in induction of the enzyme. Show
Both simvastatin and lovastatin blood levels increase dramatically with protease inhibitor use, and thus these statins are contraindicated with protease inhibitors because of the risk of rhabdomyolysis. Atorvastatin blood levels increase to a lesser extent, so that it may be used at lower doses. Pravastatin and fluvastatin are safe because they are not metabolized by CYP3A4, but their capacity to reduce LDL cholesterol levels is limited. Rosuvastatin has minimal P450 metabolism, although levels appear to be increased when it is used in combination with atazanavir/ritonavir and lopinavir/ritonavir, so limiting doses to 10 mg with those drugs is advised. A metaanalysis of 18 studies of antiretrovirally treated HIV-infected individuals receiving statin therapy reported that statin therapy significantly lowered the total cholesterol, LDL cholesterol, and triglyceride levels, with limited efficacy for HDL levels.61 Statin therapy, when dose adjusted for drug-drug interactions, was associated with low rates of adverse events. View chapter on ClinicalKey HyperlipidemiaManisha Chandalia, Nicola Abate, in Encyclopedia of Gastroenterology, 2004 Therapeutic Lifestyle ChangesLifestyle modification in patients with hyperlipidemia forms a very important backbone of the treatment plan. Therapeutic lifestyle changes comprise diet, weight management, and increased physical activity. Table III shows the nutrient composition recommended by ATP III of the National Cholesterol Education Panel. Dietary modifications may lead to a reduction in LDL cholesterol of 8 to 15%. A low-fat diet is a very important component of treatment for hypertriglyceridemia. In addition to improving the lipid panel, therapeutic lifestyle changes can help with weight reduction, improving insulin resistance, and blood pressure. Other dietary components, such as fish oil, plant stenol incorporated in margarine, and soy protein, have been shown to improve lipid levels and their inclusion in the diet should be mentioned in the advice given regarding diet. Regular exercise, such as a brisk walk for 30 min, has been shown to improve cardiovascular fitness and should be incorporated in the treatment plan. TABLE III. Nutrient Composition of Therapeutic Lifestyle Changes Diet NutrientRecommended intakeSaturated fataLess than 7% of total caloriesPolyunsaturated fatUp to 10% of total caloriesMonounsaturated fatUp to 20% of total caloriesTotal fat25–35% of total caloriesCarbohydrateb50–60% of total caloriesFiber20–30 g/dayProteinApproximately 15% of total caloriesCholesterolLess than 200 mg/dayTotal calories (energy)Balance energy intake and expenditure to maintain desirable body weight/prevent weight gain Note. Adapted from Adult Treatment Panel III at http://www.nhlbi.nih.gov, with permission. aTransfatty acid intake should be kept low.bCarbohydrates should be derived from foods rich in complex carbohydrates including grains, fruits, and vegetables.View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B0123868602003841 HyperlipidemiaElaine M. Urbina MD, Stephen R. Daniels MD, PhD, in Adolescent Medicine, 2008 OutcomeAdult studies clearly demonstrate the effectiveness of lipid-lowering therapy for the primary and secondary prevention of cardiovascular disease. However, even in adults, randomized trials have not included subjects with frequently seen lipid patterns, such as those with acceptable TC and low HDL-C levels or those with high TG levels. In the Framingham Heart Study, 40% of male and 80% of female subjects had lipid profiles that were not included in the randomized trials, and 25% of male and 66% of female subjects with CHD would have been ineligible for the trials. Although the long-term effects of treatment during childhood and adolescent remain unclear, short-term effects have been reported following medical therapy. In children with dyslipidemia, diet and exercise, antioxidants and statins, and folic acid have been shown to improve vascular function in the settings of obesity, FCH, and diabetes mellitus, respectively. In summary, adolescents who are at increased risk for adult cardiovascular disease can be easily identified with simple measurements of anthropometrics, blood pressure, lipids, and carbohydrate metabolism. Adult treatment trials along with limited pediatric data suggest that early treatment of risk factors, including dyslipidemia, can lead to improvements in target-organ function. Dyslipidemia is a prerequisite to the development of atherosclerosis. Ongoing declines in adult cardiovascular mortality over time depend on the prevention, identification, and treatment of dyslipidemia during childhood and adolescence. Most hyperlipidemia is caused by genetic polymorphisms in the setting of obesity, high-fat diet, and/or sedentary lifestyle. Identifiable familial forms of hyperlipidemia account for 2% of all hyperlipidemia cases yet carry the highest risk of premature cardiovascular disease. Most causes of secondary hyperlipidemia can be identified by measurement of serum thyroid stimulating hormone (TSH), renal function, liver function, and urinalysis. A screening lipoprotein analysis following a 12-hour fast should be performed prior to age 20 years for individuals whose parent has a TC level > 240 mg/dl, or whose parent or grandparent has evidence of cardiovascular disease by age 55 years. Lipid risk categories in individuals younger than age 20 years are defined as acceptable (LDL-C < 110 mg/dl), borderline (LDL-C = 110–129); and high risk (LDL-C > 130 mg/dl). Management of dyslipidemia begins with changes in diet and physical activity. The step-one diet is recommended for all individuals from age 2 years onward. The step-two diet is recommended for children and adolescents in the high-risk lipid category. •Statins are the agents of choice for adolescents with LDL-C levels > 190 mg/dl or > 160 in the presence of two or more other cardiovascular risk factors. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323040730100147 Lipids and KetonesMichael L. Bruss, in Clinical Biochemistry of Domestic Animals (Sixth Edition), 2008 A IntroductionHyperlipidemia refers to increased plasma levels of cholesterol (hypercholesterolemia) and triacylglycerols (hypertriacylglycerolemia or hypertriglyceridemia). Note that increased plasma levels of LCFA alone do not constitute hyperlipidemia. Because cholesterol and triacylglycerols must reside within lipoproteins in plasma, hyperlipidemia is synonymous with hyperlipoproteinemia. Lipemia is a term denoting that hyperlipidemia is severe enough that the plasma looks milky (i.e., lactescent). If lipemia is marked, whole blood may have a light red color or “tomato soup” appearance. The most common form of hyperlipidemia is postprandial hyperlipidemia, which is observed after an animal consumes a meal containing fat and is due primarily to increased chylomicron levels. For evaluation of possible abnormalities in lipid metabolism, it is important that blood samples be taken from fasting animals to avoid confusion caused by postprandial hyperlipidemia. One exception is adult ruminants, which are usually on a very low fat diet and, because of the volume of the rumen and fermentative nature of digestion there, have absorption spread over a considerable time period. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780123704917000040 Liver diseasesIn Diagnostic Techniques in Equine Medicine (Second Edition), 2009 HyperlipaemiaHyperlipaemia is a metabolic disease in which there is increased mobilization of fat deposits in response to some form of stress or nutritional deprivation. It is most often seen in female ponies and donkey mares and is frequently associated with non-specific illnesses or inadequate nutrition during late pregnancy. An increase in serum liver enzyme concentration may reflect either a cause or effect of hyperlipaemia. Thus, hyperlipaemia may be triggered by a primary hepatopathy. Alternatively, fatty liver disease is often a secondary effect of hyperlipaemia. What is first line treatment for hyperlipidemia?HMG-CoA reductase inhibitors, or statins, are the recommended first-line therapy for most patients. These are the most prescribed drugs in the world and are considered the most effective lipid-lowering agents available, both in lowering LDL-C levels and in the prevention of CV events.
Which of the following is the first drug of choice in hyperlipidemia?Statins are the first line drugs for treating lipid disorders and therefore one of the most widely utilized class of drugs. Statins have revolutionized the field of preventive cardiology and made an important contribution to the reduction in atherosclerotic cardiovascular events.
What is the best medication for hyperlipidemia?Statins are the first line medication for hyperlipidemia.. atorvastatin (Lipitor). fluvastatin (Lescol XL). lovastatin (Altoprev). pitavastatin (Livalo). pravastatin (Pravachol). rosuvastatin (Crestor). simvastatin (Zocor). What is the first line statin?Atorvastatin is the first-line choice of statin for most patients.
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