(3S-5S-6E)-7-[3-(4-fluorophenyl)-1-(propan-2-yl)-1H-indol-2-yl]-3-5-dihydroxyhept-6-enoic-acid and Myositis

Familial hypercholesterolemia (FH) carries a markedly increased risk for coronary artery disease (CAD). Reduction of plasma low-density lipoprotein cholesterol (LDL-C) levels to the normal range may prevent premature atherosclerosis and usually requires a combination of cholesterol-lowering drugs. The major objective of this study is to compare two different drug combinations for the treatment of heterozygous FH.. The current investigation is a short-term, double-blind study comparing the efficacy and safety of fluvastatin when combined with cholestyramine (group 1) or with bezafibrate (group 2) in 38 patients with heterozygous FH.. After 6 weeks of combination treatment, in comparison to a drug-free baseline (patients receiving single-blind placebo during the lead-in period of an earlier study, ie, before ever receiving fluvastatin), the combination of 40 mg/d of fluvastatin with 400 mg/d of bezafibrate in group 2 reduced plasma LDL-C levels by 35% as compared with 32% in group 1, and reduced the LDL-C/high-density cholesterol (HDL-C) ratio by 46%, compared to 37% in group 1 (a non-significant difference for both comparisons). When compared to an intermittent 6-week open-label administration of 40 mg fluvastatin monotherapy, the addition of cholestyramine or bezafibrate each reduced LDL-C by an additional 13% (P < 0.01 for both regimens).. Fluvastatin-bezafibrate is superior to a fluvastatin-cholestyramine combination for lowering serum triglycerides and elevating HDL-C serum levels in patients in conjunction with a significant lowering of LDL-C/HDL-C ratios, and may be an effective synergistic therapy for heterozygous FH. No episodes of myositis were seen in this short-term study, a finding that is in agreement with most of the reported studies on statin-fibrate combinations reviewed here.

Topics: Adult; Aged; Anticholesteremic Agents; Bezafibrate; Cholesterol, HDL; Cholesterol, LDL; Cholestyramine Resin; Double-Blind Method; Drug Combinations; Fatty Acids, Monounsaturated; Female; Fluvastatin; Heterozygote; Humans; Hyperlipoproteinemia Type II; Indoles; Male; Middle Aged; Myositis; Placebos; Safety; Single-Blind Method; Triglycerides

Antilipidemics are widely applied to reduce the risk of cardio- and cerebrovascular events. The purpose of this case report is to illustrate the clinical and radiological findings of focal myositis as a side effect of statins and fibrates in 2 patients with forearm involvement. These 2 cases demonstrate that a targeted medical history taking and use of MRI to support the suspected diagnosis, can efficiently facilitate the route to an appropriate therapy.

Topics: Anticholesteremic Agents; Atorvastatin; Bezafibrate; Coronary Disease; Drug Therapy, Combination; Fatty Acids, Monounsaturated; Female; Fluvastatin; Follow-Up Studies; Forearm; Heptanoic Acids; Humans; Hyperlipidemias; Image Interpretation, Computer-Assisted; Indoles; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Myositis; Pyrroles

Topics: Atorvastatin; Dose-Response Relationship, Drug; Fatty Acids, Monounsaturated; Fluvastatin; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Indoles; Muscular Diseases; Myositis; Pravastatin; Pyrroles; Rhabdomyolysis; Simvastatin