Statin Therapy Case Study

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).

High cholesterol level is a condition in which the concentration of high density lipids (HDL) specifically cholesterol, has significantly increased in the blood. The build up of these lipids in arteries reduce the supply of blood and hence, oxygen to the heart. Consequently, high cholesterol can lead to stroke or heart attack. Apo – Atorvastatin (Atorvastatin Calcium Tablets) is a medication that helps lower the concentration of cholesterol and other HDL in the blood (Apo-Atorvastatin, 2011) and is manufactured by Apotex Inc.

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

MR. David likewise takes atorvastatin (Lipitor); 10 mg every day, for hypercholesterolemia (hoisted LDL cholesterol, low HDL cholesterol, and raised triglycerides). He has endured this medicine and holds fast to the day by day plan. Amid the previous 6 months, he has likewise taken chromium picolinate,

In two separate presentations, Dr. Jonny Bowden and Dr. Stephen Sinatra discuss how and why they disagree with the concept that reducing cholesterol prevents heart disease. Their arguments boast that the true basis of heart disease consists of four key aspects, which include inflammation, oxidation, sugar, and stress. Both doctors assert that the actual disaster is the obsession with cholesterol which has shaped an industry that reaps over thirty billion dollars per year in statin pharmaceutical sales. Both Dr. Bowden and Dr. Sinatra claim that, cholesterol is not the source of heart disease.

Current guidelines state that ezetimibe,is considered the best alternative for LDL reduction and tolerability in statin-intolerant patients and considered an adjuvant in this trial. The primary end point was percentage change from baseline to week 12 in LDL cholesterol. Other end points included measures of safety and tolerability of different doses of AMG145 and AMG145 plus ezetimibe. Other objectives included assessment of the safety and tolerability of 3 different doses of AMG145 and AMG145 plus ezetimibe compared with placebo plus ezetimibe. One hundred sixty patients were randomized into 5 groups, to take AMG 145 as monotherapy once a month at 280mg, 320mg and 420mg, to take AMG 145 420mg once a month with ezetimibe 10mg daily or placebo once a month with ezetimibe 10mg daily. At week 12 the AMG 145 groups had a percent change of blood levels of LDL from baseline from -40.8 % to -50.7 % dose ascending monotherapy and -63.0% with combination with ezetimibe versus -14.8% with combination of placebo and ezetimibe. Reduction in total cholesterol percentwise was from -29.8 % to -37.7 % dose ascending monotherapy and -43.3% with combination with ezetimibe versus -10.7% with combination of placebo and ezetimibe. The overall incidence of all adverse effects was similar among patients receiving

The examples of drugs in this class are atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor). Statins is the first line to use for lowing blood cholesterol levels. Statins works by blocking the enzyme called HMG-CoA reductase in the liver which is necessary for making cholesterol. The statins blocks the active site of the HMG-CoA reductase enzyme so that it cannot converse to mevalonate. Therefore, there is more LDL receptor available in the liver. These receptors bind to passing LDL and VLDL (very low-density lipoprotein). The LDL and VLDL then enter the liver and are digested. So that there is less LDL level in blood stream. Even though, many drugs are in the same class, but the effectiveness of each drug is different. For example, 5-40 mg of Crestor seems to work best by lowering LDL by 47-65%; whereas 10-40 mg of pravachol can lower LDL by 22-34%. Most people who take statins do not experience serious side effects. The most common minor side effects include headache, pins and needle sensations, abdominal pain, bloating, diarrhea, feeling sick, and a rash. The provider normally starts statins in a low. The dosage may be increased if this target is not reached. Statins are contradicated in patient with active liver disease and consume a large amount of alcohol. The common side effects are GI upset and

A non-ST elevation acute coronary syndrome (NSTE-ACS) is a very common presentation to emergency departments everywhere, as well as primary care practices. Therefore, it is important that all providers be well informed on the effectivity of certain treatment regimens.

She is currently on a regimen of garlic and ezetimibe 10mg which is ineffectively treating or dyslipidemia. Ezetimibe which works by inhibiting absorption of cholesterol may only lower LDL by 10% and must be discontinued and replaced with another medication for M.T. (American Association of Clinical Endocrinologist (AACE), 2017). M.T. will be assessed for liver function, renal function and potential history of family intolerance to statins. With no possible complications assessed, M.T. will be prescribed pravastatin 40mg once daily in the evening. She will be instructed to take the medication in the evening for optimum effect and to be aware of possible side effects include GI upset and muscular pain (AACE, 2017). Pravastatin will be used secondary to an increased risk of new onset diabetes with the use of statins and is less common with the use of pravastatin (AACE,

" New England Journal of Medicine. N.p., 17 May 1990. Web. 26 Apr. 2017.

Fluvastatin is a highly regarded drug that is involved with treating hypercholesterolemia and preventing cardiovascular disease. The drug is used to lower both high cholesterol and triglycerides levels. The drug is able to perform this task by increasing good cholesterol levels (HDL) while, at the same time, reducing bad cholesterol levels (LDL). Fluvastatin decreases the production of bad cholesterol by blocking the action of the enzyme HMG- CoA reductase in the liver. This results in a decrease in the amount of cholesterol in liver cells and subsequently leads it

2. Gordon H. Guyatt, Elie A. Akl, Mark Crowther, David D. Gutterman, Holger J. Schuunemann. Antithrombotic Therapy and Prevention of Thrombosis. American College of Chest Physician Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141. 3. Neil J. Stone, Jennifer G. Robinson, Alice H. Lichtenstein, C. Noel Bairey Merz, Conrad B. Blum, Robert H. Eckel, Anne C. Goldberg, David Gordon, Daniel Levy, Donald M. Lloyd-Jones, Patrick McBride, J. Sanford Schwartz, Susan T. Shero, Sidney C. Smith Jr, Karol Watson, Peter W. F. Wilson. Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in

Thorough analysis of Bill’s, clinical presentation, risk factors and family history, indicates that he is suffering a S-T elevation myocardial infarction (STEMI). STEMI’s are one of many life-threatening diseases including unstable angina and sudden coronary death that are umbrellaed under the term acute coronary syndrome (ACS) (Kumar & Cannon, 2009; Roach et al., 2015). ACS’s are all characterised by incisive, reduction in coronary blood circulation to a particular region of the heart. More specifically a STEMI is the result of superimposed thrombus formation followed by atherosclerotic plaque rupture in a coronary artery (Bentzon, Otsuka, Virmani, & Falk, 2014). Atherosclerosis occurs due to cholesterol deposition over a long period of time and Bill’s history of hypercholesterolemia is a risk factor for this condition. Atherosclerotic plaque rupture or fissuration leads

Controlling blood glucose has been widely accepted as a method to reduce risk of atherosclerotic cardiovascular events and new-onset heart failure; although this observational relationship exists, no evidence from randomized controlled trials illustrates that improved glycemic control modifies risk. Many of the antihyperlipidemic agents, namely thiazolidinediones, dual peroxisome proliferator-activated receptor agonists, sulfonylureas, and insulin may cause adverse events such as increased plasma volume, exacerbation of heart failure, dysregulation of myocardial metabolism, and worsening of left ventricular function; therefore, a clinical concern exists with prescribing agents that may lead to morbidity and mortality.

These findings highlight the necessity of patient selection before adding an appropriate anti-ischemic therapy. It goes along with the European Medicines Agency practical recommendations [##] (updated after the SIGNIFY trial) to reduce risk of heart problems in patients taking the drug for stable angina. When used in that indication, ivabradine medication should only be started if the patient’s resting heart rate is at least 70 bpm. The starting dose of ivabradine should not exceed 5 mg twice a day, the maximum dose not to exceed 7.5 mg twice a day. This post-hoc analysis study confirms that, ivabradine, carefully prescribed can largely reduce symptoms of angina, especially in patients which resting heart rate is higher than 70bpm. Moreover, due to the non-interventional design of the study, it was possible to assess the treatment in routine clinical practice in terms of effectiveness and safety. Patient groups usually excluded from controlled clinical trials (elderly patients with multiple comorbidities) could be covered and evaluated in this