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Matthew K Ito

Publications and source records attributed to Matthew K Ito.

12 recordsLinked to original sources
PubMed2006

Key articles, guidelines, and consensus papers relative to the treatment of dyslipidemias--2005.

Hypercholesterolemia is a major risk factor for development of coronary heart disease. Proper diagnosis and adequate treatment are vital to reducing morbidity and mortality associated with elevated serum lipid levels. The amount of literature in this area is overwhelming. To aid practitioners and educators in organizing this large body of information, we compiled key articles, guidelines, and consensus papers relative to the treatment of dyslipidemias. Research articles were chosen based on the significance of findings, relevance to practice, quality of research, and timeliness; recent articles were given priority over earlier ones unless they demonstrated groundbreaking findings.

Consensus↗
PubMed2006

Statin-associated pleiotropy: possible beneficial effects beyond cholesterol reduction.

Because elevated serum cholesterol levels are strongly associated with coronary heart disease, cholesterol reduction by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (or statins) has been assumed to be the predominant, if not the only, mechanism underlying the beneficial effects of these drugs in cardiovascular diseases. Subgroup analyses of large clinical trials, however, have suggested that the beneficial effects of statins may extend to mechanisms beyond cholesterol reduction. Indeed, recent experimental and clinical evidence indicates that some of the cholesterol-independent or "pleiotropic" effects of statins may be mediated through improving or restoring endothelial function, enhancing the stability of atherosclerotic plaques, and decreasing oxidative stress and vascular inflammation.

Atherosclerosis↗
PubMed2005

Acute coffee ingestion does not affect LDL cholesterol level.

BACKGROUND: Although patients are instructed to abstain from food before having blood drawn for lipid analysis, many still drink coffee in the morning. It is unknown whether coffee consumed prior to drawing blood samples will impact fasting serum lipids. OBJECTIVE: To determine whether a single 6-oz cup of coffee with or without the addition of nondairy creamer and sugar will significantly affect fasting plasma lipid profiles. METHODS: This was a prospective, open-label, randomized crossover study. At the first of 2 visits, blood was drawn to measure initial fasting lipid panels, and participants were randomized to drink 6 oz of black coffee or coffee with nondairy creamer and sugar. Within 30-60 minutes of coffee consumption, blood was drawn for follow-up lipid panels. The procedure was repeated at the second visit, except the participants were crossed over to receive the alternate coffee preparation. RESULTS: Forty participants (26 men; age [mean +/- SD] 45 +/- 15 y) were enrolled. Total cholesterol (TC) increased from 188.2 +/- 38.1 to 191.3 +/- 39.9 mg/dL (p = 0.019) and high-density lipoprotein cholesterol (HDL-C) increased from 43.2 +/- 12.3 to 44.8 +/- 12.9 mg/dL (p < 0.001) after consumption of black coffee. Triglycerides decreased from 145.6 +/- 123.7 to 136.3 +/- 107.1 mg/dL (p = 0.014) after consumption of coffee with nondairy creamer and sugar. Changes in other lipid parameters, such as low-density lipoprotein cholesterol in either group, were not statistically significant. CONCLUSIONS: A single cup of coffee consumed within one hour before drawing blood resulted in statistically, but not clinically, significant differences in TC and HDL-C (black coffee) and triglycerides (coffee with creamer and sugar).

Adult↗
PubMed2003

The metabolic syndrome: pathophysiology, clinical relevance, and use of niacin.

OBJECTIVE: To review the pathophysiology and clinical relevance for using niacin to treat the metabolic syndrome. DATA SOURCES: Primary articles were identified through a MEDLINE search (1966-January 2003), and recommendations for treatment were obtained from the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III guidelines. STUDY SELECTION AND DATA EXTRACTION: Published studies showing the effects of the metabolic syndrome, atherogenic dyslipidemia, and niacin were evaluated and reviewed. DATA SYNTHESIS: The metabolic syndrome is a highly prevalent condition that affects 24% of American adults and significantly increases the risk of coronary heart disease (CHD). Most patients with metabolic syndrome have atherogenic dyslipidemia characterized by elevated triglycerides, low high-density-lipoprotein cholesterol (HDL-C), and small, dense low-density-lipoprotein cholesterol (LDL-C) particles. The NCEP-ATP III identifies patients with the metabolic syndrome as candidates for intensified therapy. Lifestyle modifications and drug therapy are recommended. Niacin represents a good option for treating the triad of lipid abnormalities seen in the metabolic syndrome because it raises HDL-C, lowers triglycerides, and increases LDL-C particle size. CONCLUSIONS: Treatment of the metabolic syndrome is recommended by NCEP-ATP III to further reduce CHD risk after the LDL-C target has been met. Prospective clinical studies are needed to define the impact of niacin and other lipid-modifying agents on CHD morbidity and mortality in patients with the metabolic syndrome.

Adult↗
PubMed2003

Advances in the understanding and management of dyslipidemia: using niacin-based therapies.

The use of niacin, alone and in combination, for the treatment of dyslipidemia in patients with or at risk for coronary heart disease (CHD), is discussed. Cardiovascular risk is independently predicted not only by high levels of low-density lipoprotein cholesterol (LDL-C), but also low levels of high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides. Moreover, we now understand that LDL particle size and number are associated with differing levels of atherogenicity. Metabolic syndrome, increasingly being recognized as a marker for elevated cardiovascular risk, is associated with atherogenic dyslipidemia characterized by low HDL-C, high triglycerides, and small, dense LDL particles. Controlled clinical studies have shown that niacin therapy effectively increases HDL-C and lowers triglyceride and LDL-C levels while causing a shift toward larger, less atherogenic LDL particles. Niacin, alone or in combination, prevents progression and promotes regression of coronary atherogenic lesions and significantly reduces CHD-related morbidity and mortality. Statin monotherapy causes modest increases in HDL-C and decreases triglycerides, while more potently reducing LDL-C. Combinations of lipid-modifying agents may better address the full spectrum of lipoprotein abnormalities in some patients. Investigations have shown that combining statin therapy with niacin results in additive improvement in the major lipids and lipoproteins and improves clinical outcome. With recently broadened treatment recommendations, it seems likely that combination therapy will be increasingly deemed the appropriate choice for addressing a range of lipid abnormalities.

Chemistry, Pharmaceutical↗
PubMed2003

Role of the pharmacist in establishing lipid intervention programs.

Despite the availability of the National Cholesterol Education Program Adult Treatment Panel (ATP) guidelines for the management of hyperlipidemia since 1988, most patients do not achieve their target low-density lipoprotein cholesterol (LDL) goals. With the publication of the most recent guidelines (ATP III), which contain more aggressive treatment recommendations, the cholesterol treatment gap is likely to widen further. Factors responsible for patients not receiving adequate treatment include a lack of focus on asymptomatic diseases, time and reimbursement constraints, inadequate training, a reluctance to prescribe aggressive treatment regimens, and poor communication among health care professionals. Results of several studies evaluating intervention programs indicate that pharmacists can play a key role in improving cholesterol management whether in lipid clinics, community pharmacies, or hospitals. In these intervention programs, pharmacists provided a wide range of functions that included reviewing the medical history, monitoring laboratory values, selecting lipid-lowering therapies, and educating patients regarding drug therapies and the importance of compliance. These interventions produced significant improvements in lipid parameters and in the number of patients who achieved LDL treatment goals. Most important, these interventions were associated with decreases in clinical events. Pharmacist intervention also was highly cost-effective and time efficient. These results suggest that pharmacists are in a unique position and possess the requisite skills to improve the treatment of patients with hyperlipidemia.

Clinical Trials as Topic↗
PubMed2002

Niacin-based therapy for dyslipidemia: past evidence and future advances.

Updated guidelines published recently by the National Cholesterol Education Program place greater emphasis on atherogenic dyslipidemia, characterized by low high-density lipoprotein (HDL) cholesterol; elevated triglycerides; and small, dense, low-density lipoprotein (LDL) particles, as well as the drugs that can alter the condition. Both low HDL cholesterol and elevated triglycerides are independent risk factors for coronary artery disease. Low-density lipoprotein particles can be divided into subclasses with differing atherogenicity. Phenotype A is characterized by large buoyant LDL particles, and phenotype B by small, dense particles associated with increased atherogenicity. The frequency of phenotype B in patients increases as triglyceride levels increase and HDL cholesterol levels decrease. Fibrates and niacin have been shown to improve atherogenic dyslipidemia in clinical trials. Niacin effectively lowers triglycerides, raises HDL cholesterol, and shifts LDL particles to a less atherogenic phenotype (phenotype A). The various niacin formulations available differ in terms of safety and efficacy. When administered alone or in combination with other lipid-modifying agents, niacin prevents progression and promotes regression of coronary atherogenic lesions and reduces coronary risk. Combination therapy is also an effective option for improving multiple lipoprotein abnormalities. In studies, a once-daily, single-tablet combination of niacin extended-release/lovastatin showed additive LDL cholesterol lowering and was more effective than would be anticipated from doubling the component lovastatin dose. Combination products provide a viable strategy for treating the full spectrum of lipid abnormalities seen in some patients, including those with atherogenic dyslipidemia, and will be increasingly used in the treatment of dyslipidemia. Other combination products are currently undergoing clinical testing.

Adult↗
PubMedDate not supplied

Lovastatin and extended-release niacin combination product: the first drug combination for the management of hyperlipidemia.

Advicor (lovastatin and extended-release niacin) is the first cholesterol-lowering combination product to become available for the management of hyperlipidemia. Lovastatin significantly lowers low-density lipoprotein cholesterol, whereas niacin significantly lowers triglycerides and lipoprotein (a) and markedly increases high-density lipoprotein cholesterol. These effects are ideal for managing a variety of lipid disorders, including metabolic syndrome. Lovastatin and niacin reduce coronary heart disease mortality in primary and secondary prevention patients, respectively. The extended-release niacin component uses a unique technology to minimize adverse effects (e.g., flushing and hepatotoxicity) while retaining the same lipid-altering effects as immediate-release niacin. The combination product appears to be well tolerated, with discontinuation due to adverse effects other than flushing occurring in a similar percent of patients as for lovastatin in clinical trials. Approximately 9% of patients discontinued the combination product due to flush. No confined cases of myopathy or hepatotoxicity have been reported with this product. Once-daily dosing provides ease of administration that should improve compliance and result in a greater proportion of patients meeting their low-density lipoprotein cholesterol goals. The nomenclature surrounding niacin products used to treat dyslipidemias is confusing. While only two types of niacin formulations exist (immediate-release formulations and formulations which dissolve more slowly than immediate-release formulations), government regulations allow for slowly dissolved niacin formulations to be divided into two types of niacin products; those that are available over-the-counter (OTC) and those that are available by prescription only. Over-the-counter slowly dissolved niacin preparations are not classified as OTC per se, but are considered "nutritional supplements". For this reason, they fall under the jurisdiction of the Federal Trade Commission and do not fall under the umbrella of the FDA branch that controls dyslipidemic products (Endocrine and Metabolic Division of the Center for Drug Evaluation and Research). The slowly dissolved niacin nutritional supplements have not been reviewed by the FDA for safety nor efficacy in the treatment of dyslipidemia nor are they required to meet generic drug rules (even though various brands are available). These brands are described on their labels as "sustained-release", "timed-release", and "slow-release" for example. Only two slowly absorbed niacin products have been approved by the FDA for the treatment of dyslipidemia; they are Niaspan (Kos Pharmaceuticals, Inc., Miami, FL) and Advicor (Kos Pharmaceuticals, Inc., Miami, FL). The term "extended-release" has been given to these two products to simplify the terminology and differentiate the products from immediate-release niacin. In this review, we will use "extended-release" to refer to the FDA approved slowly dissolving niacin preparation and "sustained-release" to refer to the nutritional supplements (not FDA approved).

Clinical Trials as Topic↗
PubMedDate not supplied

Ezetimibe: the first in a novel class of selective cholesterol-absorption inhibitors.

Zetia (ezetimibe) is the first medication in the novel class of selective cholesterol-absorption inhibitors to be released in the United States. Ezetimibe selectively inhibits the uptake of cholesterol from the intestinal lumen at the level of the enterocyte in the intestinal brush border while having no effect on other sterols or lipid-soluble vitamins. Ezetimibe 10 mg daily produces a consistent reduction in low-density lipoprotein cholesterol (LDL-C) by approximately 15 to 20% when used as monotherapy or in combination with 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) or fenofibrate and a 4 to 9% increase in high-density lipoprotein cholesterol. Unlike other lipid-lowering medications that act in the gastrointestinal tract, ezetimibe does not appear to worsen hypertriglyceridemia. Ezetimibe also has an adverse-event profile that is similar to placebo when used as monotherapy or in combination with statins and fenofibrate. Studies of longer duration and with niacin, bile acid sequestrants, and gemfibrozil are warranted to more completely assess the safety of ezetimibe in combination therapy. To date, no clinically significant drug-drug interactions have been noted with the use of ezetimibe; however, further studies are warranted. Ezetimibe will be useful as monotherapy in patients who need modest reductions in LDL-C or are intolerant to other lipid-lowering medication, and in combination with a statin in patients who are unable to tolerate large doses of statins or need further reductions in LDL-C despite maximum doses of a statin. The long-term safety and the effect on cardiovascular morbidity and mortality of ezetimibe are unknown.

Anticholesteremic Agents↗