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Pitavastatin: novel effects on lipid parameters.
- Source :
-
Atherosclerosis. Supplements [Atheroscler Suppl] 2011 Nov; Vol. 12 (3), pp. 277-84. - Publication Year :
- 2011
-
Abstract
- Atherogenic dyslipidemia is characterised by high levels of triglycerides, low levels of high-density lipoprotein-cholesterol (HDL-C), and moderate to marked elevations in low-density lipoprotein-cholesterol (LDL-C) concentrations; such dyslipidemia is further characterised by high apolipoprotein B (apoB): apolipoprotein A1 (apoA1) ratios. Numerous clinical trials have demonstrated that statins are effective in lowering LDL-C and reducing cardiovascular (CV) risk in people with dyslipidemia. However, the most effective treatments should target all of the key atherogenic features, rather than LDL-C alone. Pitavastatin is a new member of the statin class whose distinct pharmacological features translate into a broad spectrum of action on both apoB-containing and apoA1-containing lipoprotein components of the atherogenic lipid profile. The efficacy and safety of this statin has been demonstrated by a large clinical development programme conducted both in Japanese and Caucasian populations. Phase III and IV studies in a wide range of patients with primary hypercholesterolemia or combined dyslipidemia showed that 12 weeks' treatment with pitavastatin l-4 mg was well tolerated, significantly improved lipid profiles (including LDL-C, TG, and HDL-C levels) and increased the EAS-/NCEP ATP Ill-recommended LDL-C target attainment rate to a similar or greater degree as comparable doses of atorvastatin, simvastatin, or pravastatin. Results were similar across all patient groups and were generally sustained after 52 weeks of treatment. However, whereas the effects of atorvastatin and simvastatin on HDL-C levels remained constant over the long term, pitavastatin-treated patients experienced progressive and maintained elevations in HDL-C, ultimately increasing by up to 14.3% vs. initial baseline. In this context, it is significant that the in vitro studies of Yamashita et al. [J Atheroscler Thromb 2010;17:436-51] have shown pitavastatin to be distinguished by its potent stimulation of apoA1 production in hepatocyte-like cells. These findings suggest that pitavastatin may be highly efficacious in raising levels of lipid-poor apoA1 particles, which are known to be highly active in ABCA1-mediated cellular cholesterol efflux, an observation which is pertinent to the excessive accumulation of cholesterol in macrophage foam cells of the atherosclerotic plaque. Indeed, the intravascular remodelling and maturation of lipid-poor apoA1 particles is known to drive flux of apoA1, cholesterol and phospholipid through the HDL pathway. It is equally relevant that pitavastatin therapy has been shown to be efficacious in markedly reducing coronary atheroma volume in acute coronary syndrome patients in the JAPAN-ACS trial, a therapeutic effect which may be linked to its impact on apoA1/HDL metabolism and function. Overall, Phase III and IV studies demonstrate that pitavastatin 1-4 mg is well tolerated, attenuates the atherogenic lipid profile and increases LDL-C target attainment rates with a similar or greater efficacy to comparable doses of atorvastatin, simvastatin and pravastatin. Furthermore, pitavastatin may be particularly beneficial in high-risk patients with elevated concentrations of TG-rich lipoproteins and low levels of HDL-C, and in whom the atheroprotective function of HDL particles is typically defective; significantly, such patients typically exhibit persistent, residual cardiometabolic risk even when LDL-C is at goal. In this context, it is relevant that such patient groups cover a wide spectrum of metabolic diseases, including metabolic syndrome, type 2 diabetes, coronary disease, familial and non-familial forms of hypercholesterolemia, auto-immune diseases such as rheumatoid arthritis and lupus, renal disease and some forms of hepatic insufficiency.<br /> (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
- Subjects :
- Apolipoprotein A-I blood
Apolipoproteins B blood
Atherosclerosis etiology
Atherosclerosis prevention & control
Atorvastatin
Cholesterol, HDL blood
Cholesterol, LDL blood
Clinical Trials, Phase III as Topic statistics & numerical data
Clinical Trials, Phase IV as Topic statistics & numerical data
Coronary Artery Disease drug therapy
Coronary Artery Disease pathology
Double-Blind Method
Dyslipidemias blood
Dyslipidemias complications
Europe
Heptanoic Acids pharmacology
Heptanoic Acids therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Japan
Multicenter Studies as Topic statistics & numerical data
Plaque, Atherosclerotic drug therapy
Plaque, Atherosclerotic pathology
Pyrroles pharmacology
Pyrroles therapeutic use
Quinolines therapeutic use
Randomized Controlled Trials as Topic statistics & numerical data
Russia
Simvastatin pharmacology
Simvastatin therapeutic use
Triglycerides blood
Dyslipidemias drug therapy
Hydroxymethylglutaryl-CoA Reductase Inhibitors pharmacology
Lipids blood
Quinolines pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 1878-5050
- Volume :
- 12
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Atherosclerosis. Supplements
- Publication Type :
- Academic Journal
- Accession number :
- 22152282
- Full Text :
- https://doi.org/10.1016/S1567-5688(11)70887-X