To the Editor,
Pisaniello et al. Citation[1] reviewed the ongoing challenges for the pharmacotherapy of dyslipidaemia. Drugs like statins, fibrates, niacin and omega-3 fatty acids are mentioned Citation[1] but bile acid sequestrants (BAS) and ezetimibe were not included.
There are no recent large trials assessing the benefit of BAS on cardiovascular (CV) outcomes. However, colesevelam (a BAS) is of some interest because it lowers low-density lipoprotein cholesterol (LDL-C) and can also improve glycaemia Citation[2].
Ezetimibe in combination with a statin has been associated with controversial results Citation[3,4], as well as some benefit in patients with advanced chronic kidney disease Citation[5]. A more recent trial, the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) showed that adding ezetimibe to simvastatin when compared with simvastatin monotherapy significantly reduces CV events in patients with acute coronary syndromes Citation[6]. However, we need to wait for the full paper to be published. Furthermore, genetically determined decreased intestinal cholesterol transporter (NPC1L1) function (the target for ezetimibe) is associated with significantly lower plasma LDL-C levels and CV risk Citation[7].
We appreciate that the review by Pisaniello et al. Citation[1] was submitted before the IMPROVE-IT results were presented. Nevertheless, BAS and ezetimibe would probably have been worthy of a brief mention, especially since the evidence for some of the other drugs mentioned by the authors Citation[1] is not definitive regarding CV outcomes.
We agree that high-density lipoprotein and LDL quality may help predict CV risk Citation[8,9].
Declaration of interest
AP Agouridis is supported by a grant from the Hellenic Atherosclerosis Society. TD Filippatos has given talks and attended conferences sponsored by Bristol-Myers Squibb, Pfizer, Lilly, Abbott, Amgen, AstraZeneca, Novartis, Vianex, Teva and MSD. N Katsiki has given talks, attended conferences and participated in trials sponsored by Novartis, Novo Nordisk, MSD, Winmedica and AstraZeneca. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Bibliography
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- Tziomalos K, Karagiannis A, Mikhailidis DP, et al. Colesevelam: a new and improved bile acid sequestrant? Curr Pharm Des 2013;19:3115-23
- Doggrell SA. Comment on: Clinical benefits of ezetimibe: absence of proof is just that. Expert Opin Pharmacother 2013;14:2611-2
- Gouni-Berthold I, Mikhailidis DP, Rizzo M. Author’s response. Expert Opin Pharmacother 2013;14:2612-3
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- Mikhailidis DP, Elisaf M, Rizzo M, et al. “European panel on low density lipoprotein (LDL) subclasses”: a statement on the pathophysiology, atherogenicity and clinical significance of LDL subclasses. Curr Vasc Pharmacol 2011;9:533-71