ABSTRACT
Statin-intolerance (SI) has prevalence between 8.0â¯% and 10â¯%, and muscular complaints are the most common reason for discontinuation. Bempedoic acid (BA), an ATP citrate lyase inhibitor, decreases hepatic generation of cholesterol, upregulates low-density lipoprotein (LDL) receptor expression in the liver, and eventually clears circulating LDL-cholesterol from the blood. Multiple randomized clinical trials studying BA demonstrate a reduction in LDL levels by 17-28â¯% in SI. The CLEAR OUTCOME trial established significant cardiovascular benefits with BA. A dose of 180â¯mg/day of BA showed promising results. BA alone or in combination with ezetimibe is US Food and Drug Administration-approved for use in adults with heterozygous familial hypercholesterolemia and/or established atherosclerotic cardiovascular disease. BA reduced HbA1c by 0.12â¯% (pâ¯<â¯0.0001) in patients with diabetes. Adverse events of BA include myalgia (4.7â¯%), anemia (3.4â¯%), and increased aminotransferases (0.3â¯%). BA can cause up to four times higher risk of gout in those with a previous gout diagnosis or high serum uric acid levels. Reports of increased blood urea nitrogen and serum creatinine were noted. Current evidence does not demonstrate a reduction in deaths from cardiovascular causes. More studies that include a diverse population and patients with both high and low LDL levels should be conducted. We recommend that providers consider BA as an adjunct to statin therapy in patients with a maximally tolerated dosage to specifically target LDL levels.
Subject(s)
Dicarboxylic Acids , Fatty Acids , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Dicarboxylic Acids/therapeutic use , Dicarboxylic Acids/adverse effects , Cholesterol, LDL/blood , Ezetimibe/therapeutic use , Randomized Controlled Trials as Topic , Anticholesteremic Agents/adverse effects , Anticholesteremic Agents/therapeutic use , Hypercholesterolemia/drug therapyABSTRACT
BACKGROUND: Our centre's median forced expiratory volume in one second (FEV1) reported in the 2005 Cystic Fibrosis (CF) Foundation Patient Registry was below the national median. The focus of our quality improvement initiative was to improve lung function through re-education of airway clearance techniques (REACT). AIM: The global aim was to improve the median FEV1 in our patients. The specific aim was to encourage adherence to airway clearance techniques (ACT). To achieve these goals we implemented the REACT programme for patients. METHODS: Educational sessions introduced the concept of improving clinical outcomes and the importance of airway clearance in achieving optimal lung function. The REACT programme utilised an anonymous survey, in-clinic questionnaire and ACT demonstration to assess knowledge, practices and barriers to ACT. Patients were then categorised as non-adherent or adherent with correct or incorrect technique. Improper techniques were corrected. All patients were re-educated on the rationale for ACT. RESULTS: Our surveys revealed that 43% of patients had barriers to ACT and 53% were non-adherent. Following implementation of REACT, median FEV1 increased from 84% to 92% (national median 91-94%) from 2005 to 2010 for patients aged 6-17. For patients 18 and older, median FEV1 increased from 56% to 64% (national median 62-65%) from 2005 to 2010. CONCLUSIONS: By introducing a programme focused on technique and adherence, we were able to improve median FEV1 in patients with CF. Sustained improvement of FEV1 was accomplished by continued use of the REACT programme.
