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News: Prescriber's Letter December 2013
DYSLIPIDEMIA
    You'll start to see more lipid drugs get indications based on HARD clinical outcomes...such as reducing MI or stroke risk.
   Drugs are often approved just due to their ability to improve SURROGATE endpoints...lipids, blood pressure, glucose, etc.
   For example, the omega-3 fatty acid, Vascepa (icosapent ethyl) is currently approved JUST to lower triglycerides ≥ 500 mg/dL...NOT to lower the risk of CV events or pancreatitis.
   The manufacturer of Vascepa hoped to also be able to market it as an add-on to statins for patients with triglycerides ≥ 200 mg/dL.
   But an FDA panel voted AGAINST this additional indication...because there's no proof Vascepa reduces CV risk more than a statin alone.
   Plus other recent trials suggest that adding niacin or a fibrate to a statin DOESN'T reduce major cardiovascular events.
   Continue to use a statin first if triglycerides are less than 500 mg/dL...and patients need one anyway to lower LDL and CV risk. Statins can reduce triglycerides by up to 30%...and the higher the triglyceride level, the bigger the reduction.
   Emphasize other strategies to lower triglycerides such as weight loss...exercise...limiting simple sugars and alcohol...eliminating trans fats...and improving glycemic control in diabetes patients.
   Also look for meds that may increase triglycerides...oral estrogens, glucocorticoids, bile acid sequestrants, retinoic acid, etc.
   Save omega-3 fatty acids (Vascepa, Lovaza, fish oil supplements), fibrates, or niacin for patients with triglycerides over 500 mg/dL...or even approaching 1000 mg/dL.
   Keep in mind there's no good evidence yet that using these drugs to lower triglycerides reduces CV events...or prevents pancreatitis.
   To hear our team discuss when and how to lower triglycerides, go to our PL Detail-Document and listen to PL VOICES.
   See our PL Charts, Characteristics of the Statins and Non-Statin Lipid Lowering Agents, for help selecting a therapy for dyslipidemia.   

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