(Statins) and Fixed-dose Combination Products Containing a Statin

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Final Report Update 5 Drug Effectiveness Review Project The American Heart Association/American College of Cardiology guidelines qualify this recommendation as follows: “When the 20%. In the latter 2 types of high-risk patients, the recommended lowdensity lipoprotein cholesterol goal of
Final Report Update 5 Drug Effectiveness Review Project improving the lipid profile by inhibiting lipolysis of adipose tissue, inhibiting hepatic synthesis of triglycerides, and likely suppressing apo A-1 hepatic removal. 7 The result of this is reduction in triglycerides, elevation of high-density lipoprotein, and reduction of low-density lipoprotein. Niacin has been shown to reduce the risk of myocardial infarction. 8 Ezetimibe inhibits the absorption of cholesterol from the small intestine by binding to the Niemann-Pick C1-Like 1 receptor on the brush border. The effect is a lowering of low-density lipoprotein cholesterol. 9 Table 2. Included fixed-dose combination products Fixed-dose combination product Strength Dose range Usual starting dose Lovastatin/Niacin-ER (Advicor ® ) Simvastatin/Niacin-ER (Simcor ® ), not available in Canada Simvastatin/Ezetimibe (Vytorin ® ), not available in Canada 20/500 mg 20/750 mg 20/1000 mg 40/1000 mg 20/500 mg 20/750 mg 20/1000 mg 10/10 mg 10/20 mg 10/40 mg 10/80 mg Abbreviations: LDL-C, low-density lipoprotein cholesterol. Purpose and Limitations of Systematic Reviews 20/500 mg – 80/2000 mg once daily 10/500 – 40/2000 mg 10/10 – 10/80 mg 20/500 mg 20/500 mg if niacin naive 10/20 mg (10/40 if need >55% LDL-C reduction) Systematic reviews, also called evidence reviews, are the foundation of evidence-based practice. They focus on the strength and limits of evidence from studies about the effectiveness of a clinical intervention. Systematic reviews begin with careful formulation of research questions. The goal is to select questions that are important to patients and clinicians then to examine how well the scientific literature answers those questions. Terms commonly used in systematic reviews, such as statistical terms, are provided in Appendix A and are defined as they apply to reports produced by the Drug Effectiveness Review Project. Systematic reviews emphasize the patient’s perspective in the choice of outcome measures used to answer research questions. Studies that measure health outcomes (events or conditions that the patient can feel, such as fractures, functional status, and quality of life) are preferred over studies of intermediate outcomes (such as change in bone density). Reviews also emphasize measures that are easily interpreted in a clinical context. Specifically, measures of absolute risk or the probability of disease are preferred to measures such as relative risk. The difference in absolute risk between interventions depends on the number of events in each group, such that the difference (absolute risk reduction) is smaller when there are fewer events. In contrast, the difference in relative risk is fairly constant between groups with different baseline risk for the event, such that the difference (relative risk reduction) is similar across these groups. Relative risk reduction is often more impressive than absolute risk reduction. Another useful measure is the number needed to treat (or harm). The number needed to treat is the number of patients who would need be treated with an intervention for 1 additional patient to benefit Statins Page 9 of 128
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(Statins) and Fixed-dose Combination Products Containing a Statin

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