CAIs: Reaching optimal cholesterol goals

A new class of lipid-lowering therapy could make it easier for patients with high cholesterol levels to reach their optimal cholesterol goals.

Such was the good news relayed by Dr. Werner Katzmann, Ph.D., Far East regional medical director of the Schering-Plough Research Institute, in a lecture during the joint annual convention of the Philippine Society of Hypertension and Philippine Lipid Society recently.

Cholesterol absorption inhibitors (CAI), a new class of cholesterol-lowering drugs, have been shown to have dual inhibition effect when used with a statin, reducing low-density lipoprotein cholesterol (LDL-C) levels in the blood by an additional 25 percent.

This will help patients achieve their guideline targets for cholesterol reduction without having to increase their statin dosage, Katzmann said.

According to Katzmann, ezetimibe, the first of the CAIs, works distinctly from other lipid-lowering agents. It lowers LDL-C or the bad cholesterol in the body by selectively inhibiting the absorption of cholesterol at the brush border of the small intestine. It prevents cholesterol from being re-absorbed through the bowel, reducing the cholesterol delivered to the liver.

What statin can do only is work on the liver but they do not work on the small intestines where cholesterol absorption happen. "Ezetimibe works on one pathway, while statins work on another pathway, and the combination provides the desired results via dual inhibition," Katzmann said.

Cholesterol management by administering statin is important in treating cardiovascular disease (CVD) and its complications such as heart attack and stroke. However, some patients experience side-effects or tolerance problems with higher doses of statins.

Ezetimibe optimizes the LDL-lowering effects of statins. It can be taken any time of the day with or without food, and may be taken at the same time with any statin.

Currently approved in several countries, including the United States and Europe, once-daily ezetimibe 10 mg is indicated in co-administration with a statin as adjunctive therapy to diet in patients with primary hypercholesterolemia.

Ezetimibe is launched in the Philippines by Schering-Plough Corp.