Ezetimibe On Statin Therapy After Acute Coronary Syndromes

Cardiovascular diseases has affected large number of population worldwide and in developed countries it is responsible for half of all deaths, coronary artery disease (CAD) alone is responsible for 1 of every 4.7 deaths in the United States (Eichner et al., 2002).

Hyperlipidemia is the abnormal elevation of any lipoproteins present in the blood. HMG-CoA reductase inhibitors (statins) are commonly used for the treatment of hyperlipidemia, specifically lowering the levels of low-density lipoproteins (LDL) levels. As with most classes of medications, there are many potential side effects. A less common but serious side effect of statins is myopathy. Myopathy is a dose-related side effect that causes skeletal muscle weakness, aching, cramping, pain, stiffness and tightness. The mechanism of this occurrence is unknown, but as will be shown, there is a possible correlation between low vitamin D levels and increased occurrence of statin induced myopathy. The vast numbers of patients on statins results in a high number of patients with statin-induced myopathy throughout the world. This consultation will determine whether vitamin D prophylaxis is safe and effective in the prevention of statin-induced myopathy.

The following summary is an updated case study of a 47 year old male patient, Jim who was diagnosed with Coronary Artery Disease. The patient did receive information on what CAD is and was informed that test were needed to fully diagnose and be evaluated for underlying conditions (high blood pressure, high blood cholesterol levels, diabetes and blockage. I will discuss the type of test needed for this condition and tests for any underlying conditions that are related to this disease. The type of treatment needed to control and lower his risk factor. I will also give the patient information about complementary and alternative medicine so the patient will be well informed about different types of treatment. The patient will be informed about the prognosis of the disease, and the options that the patient has to succeed in the changes in his lifestyle that are needed.

A higher level of fats in the body puts the patient at higher risk for Cardiovascular diseases(CAD). The patient's' family has a history of CAD. Her mom and one of her sister have CAD (Lewis et al., 2014, pp. 733-734). The patient states that she has been taking her meds for cholesterol atorvastatin regularly. Her lipase level was 8272 on 11/11/16 and 2829 on 11/12/16 U/L 1069 on 11/13/16 (Ref range 73-393 U/L). Her HDL cholesterol level was 21 ( ref range>49 mg/dl), LDL Cholesterol level 148 ( ref range: <130 mg/dL). Patient statin drug was on hold because it is contradicted on the patient with an elevated level of ALT 80, 61(Ref range 0-50 U/L) and AST 61 on 11/12/16 and 64 on 11/13/16 (ref range 0-45 U/L). The uncontrolled level of could be the cause of concern for stroke or acute myocardial

He has never been on any statin therapy. His most recent lipids were done in January showing total cholesterol 213, triglycerides 172, HDL 61, LDL is 118.

Many organizations have developed practice guidelines for a myriad of clinical scenarios which include the use of specific drugs or classes of medications, typically in a step-wise pattern. These “Best Practice” guidelines are built on evidence based criteria and systematic reviews. It has been shown that these clinical guidelines, with their list of essential medications, improve the quality of care and lead to better outcomes, but have not been shown to reduce costs.4,5 The practice of medicine has moved dramatically towards the use of these guidelines in recent years. For example, best practices for diabetic care recommends that all patients be placed on an ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker) for prevention of diabetic nephropathy and a statin for prevention of coronary artery disease. However, each patient’s insurance may cover a different medication in this class

Acute coronary syndrome (ACS) is the most common form of cardiovascular disease.1 In 2006, about 733,000 ACS patients were discharged from hospitals costing the United States $150 billion annually.2 Eighty percent of these cases were either unstable angina (UA) or no ST- elevation myocardial infarction (NSTEMI), and the remaining 20% were ST-elevation myocardial infarction (STEMI).

In 2012, the phase 1 trials were published in The Journal of the American College of Cardiology. The phase 1 trials had two arms. Phase 1a were healthy subjects and phase 1b has subjects with hypercholestemia receiving stable statin therapy. The aim of this study was to evaluate the safety, tolerability and effects of AMG 145. Phase 1a had 56 subjects at 1 U.S. center, who were randomized to either get a single dose of placebo, 7mg to 420mg of AMG 145 subcutaneously or 21mg or 420mg via a one hour intravenous infusion. Percentagewise 69% of the subjects in the AMG 145 group experienced a treatment-emergent adverse event compared to 71% of the subjects in the placebo group. There was zero discontinuation due to adverse events in this arm of

Two completely different viewpoints of randomized clinical trials are given, article one is against the idea and article two is for it. Article one argues that when a patient sees a physician; the physician has the duty to provide the best treatment for that

The PRODIGY trial which was an unblinded, multicenter, randomized trial by Valgimigli et al, they evaluated the impact of up to 6 versus 24 month duration of dual antiplatelet therapy in patients

Presently, the treatment strategies used are risk factor modification, conventional pharmacology and surgical revascularization. These strategies have hitherto not been of enormous solution as the disease progression still result in recurrent symptoms. This has now led to the exploitation of advances in comprehending the vascular biology of atherogenesis to introduce novel cell and molecular-based therapies. The application of immunomodulation, lipid-lowering agents like statins, gene transfer, antisense technology and so on has resulted in new therapeutic strategies to interrupt cell proliferation and disorder of the vessel wall. In this essay, immunomudulation and lipid-lowering agent shall be discussed.

It is important that medication is reliable in its treatment effectiveness as well as the cost aspect. A study conducted by Brunetti, et al., compared the clinical outcomes and costs of albuterol versus levalbuterol for treatment of

Hence FDA announced to incorporate the risk of rhabdomyolysis due to treatment of statins in product label as mandatory

Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

Empagliflozin has been shown to result in weight loss, reduce blood pressure without increasing heart rate, favorable effects on markers of arterial stiffness and vascular resistance and visceral adiposity. Empagliflozin has also been associated with an increase in both LDL and HDL cholesterol. These surrogate markers