Control and Comparative Effect of Several Drugs on Nursing Hypercholesterolemia - Research Paper Example

Topic: Control and Comparative effect of several drugs on nursing Hypercholesterolemia  Module Introduction Practice issue Hypercholesterolemia has become a very common disease in various parts of the world. The researchers are trying to find more ways of its treatment as it can cause several other dangerous diseases if left untreated. The increased level of cholesterol in blood can cause heart attack and other diseases related to heart, arteries and veins. The patients are subjected to drugs that lower the level of cholesterol in the blood so that patient can have safe life. Hypercholesterolemia can not be left untreated as other major diseases arising due to it can cause even death of the patient. Clinical Significance of Hypercholesterolemia  In United States, the Card Vascular Disease (CVD) has become a serious cause of death, especially dangerous for the diabetic patients. The Card Vascular Disease (CVD) correlates with the different levels of plasma cholesterol and triglyceride contained particles. To increase the Card Vascular Disease (CVD), there are many types of lipids by containing those particles, which promote the plaque formation between the tissues (only transporting lipids are not harmful for the tissues) to increase the risk factors of diseases. Cardiovascular diseases are due to high level of low-density lipoprotein cholesterol, elevated level of triglyceride and low level of high-density lipoprotein cholesterol (HDL-C) (Runhua Hou, 2009). LDL-C level should be lowered to avoid CVD. The patients are treated with multiple drugs to achieve the goal of reducing its level 30% below the baseline. Some patients can be treated with single drug, but other needs more drugs including statins, bile acid sequestrants (BAS) and ezetimibe. Medical research has proved that there is positive relationship between Low Density Lipoprotein and the coronary heart disease. The nursing process to treat the patients has proved that the Statins drug is very beneficial for the heart patients to lower the disease risks. Statins are safe to use by mixing it with other drugs to benefit the patients for cholesterol-lowering therapy (Lawrence Baruch, 2008). Ezetimibe is mainly used to reduce the amount of lipids so also known as cholesterol absorption inhibitors. It blocks the passage of lipids through the intestine. Ezetimibe is used as monotherapy or it is combined with smvastatin (Lawrence Baruch, 2008).A high concentration of LDL-c causes hypercholesterolemia (hFL) and premature coronary heart diseases (Christos Pitsavos, 2008). Integration and Synthesis of the Evidence Presentation of the Evidence and Identification of the Study Decreasing the level of LDL-C is the first requirement to reduce the risk of cardiovascular diseases. The National Cholesterol Education Program Adult Treatment Panel III targeted LDL-C to treat hyperlipidemia. If the concentration of LDL-C is below 70 mg/dL, the patients are considered to have high risk of having coronary heart diseases (CHD). Risk factors causing the development of coronary heart diseases include family history of premature CHD, smoking, hypertension, age, gender and the most important, low level of HDHDL-C (Runhua Hou, 2009). Cardiovascular diseases are more common in females than males. The risk of having coronary heart diseases and CVD increases as the age increases. Blood pressure more than 140/90 mm Hg and HDL-C level less than 40 mg/dL also cause CVD (Runhua Hou, 2009). Another research was analyzed to review the evidence for the cholesterol lowering efficiency about ezetimibe and doubled statin doses for hypercholesterolemia patients at primary stage. For this purpose, a database of MEDLINE, EMBASE and Cochrane was searched out for the identification of the random controlled trials of combined ezetimibe statin vs. statin titration. The basis of the study was selected by using the already defined criteria. For screening the articles, two reviewers were conducted that are the data extraction and the critical appraisal. An extra third reviewer was resolved for disagreements. Statistical data was collected by calculating the mean percentage change from critical value n high density lipoprotein, low density lipoprotein and total cholesterol. The data was compared among same groups. The heterogeneity was also found by using I2 statistical formula. In this way, different ways of treatment were compared and results were obtained in mathematical form (Dimitri P. Mikhailidis, 2014). The meta-analysis comprised 5080 patients that were subjected to thirteen studies. Different methods of treating the disease with different agents were used and compared. They include simvastatin, rosuvastatin and atorastatin. The comparison of all these results gave clear indication that a combination of ezetimibe-statin gave maximum control against disease. So it was found that combination of statin and ezetimibe is more effective against cardiovascular and coronary heart disease as compared to application of them singly (Dimitri P. Mikhailidis, 2014). Comparative Evaluation of the Evidence to Practice Statin monotherapy can be compared with use of multi drugs to compare the effects single drug vs. combination of them. To reduce the level of LDL-C, The effect of ezetimibe/simvastatin combined with statin was observed. When the dose of statin was increased, most of the patients got less potent statins that were on ezetimibe/simvastatin. All the patients that were subjected to ezetimibe got less potent statins. It is found that implementation of combination of drugs is more effective as compared to the use of single drug. It is because of the reason that the cause of cardiovascular disease is more than one. So the use of a combination of drugs helps the patients to take control against more than one cause. It increases the chance to get treatment on greater extent. The amount of ezetimibe was tested in different amount. The most effective dose found was 5 mg which was comparable to its previous dose of 10 mg (Peter P. Toth, 2012). The effect of ezetimibe combined with simvastatin in treatment of hypercholesterolemia was compared with application of other drugs that were used without ezetimibe. Simvastatin alone is less effective in reducing LDL-C level. When the ezetimibe was combined with simstatin, its 10 mg dose gave same results as given by 80 mg dose in the absence of ezetimibe. The cholesterol absorption was reduced to very good extent. It is much effective strategy to lower the lipid concentration in patients (ANNE C. GOLDBERG & ADITI SAPRE, 2004). Feasibility of changing practice Hypercholesterolemia can cause heart failure and even death in extreme cases. Several education and clinical practices are needed to avoid this disease. People should be educated to have healthy life style. Booklets comprising all knowledge of hypercholesterolemia should be given to all people so that they learn of adapting things that will maintain the cholesterol level in blood (ANNE C. GOLDBERG & ADITI SAPRE, 2004). Barriers to change: perceived or real Unfortunately, there are several barriers that are leading to induce hypercholesterolemia in people. People are more likely to eat fast foods rather than fruits and vegetables. They are inclined to eat unhealthy diet that can cause high level of cholesterol in the blood. Another great barrier is lack of regular medical checkups. People are so much busy in their daily life that they do not find time to go to doctor. They come to know about such diseases when the level of cholesterol becomes much high in the blood and drugs have to be given for treatment (ANNE C. GOLDBERG & ADITI SAPRE, 2004). Summary and Discussions Hypercholesterolemia has found to be a source of cardiovascular diseases. The coronary heart diseases are also result of high amount of lipids in body than required. People having high level of cholesterol can get many other diseases that are arisen basically due to hypercholesterolemia. The patients are subjected to several drugs to treat this disease. The causes of hypercholesterolemia are several that include age factor, gender, genetic background etc. there are other diseases that can cause hypercholesterolemia. For example diabetes is a great cause of hypercholesterolemia. Several drugs have been found effective to treat hypercholesterolemia. They were tested either alone or in combination with other drugs. The dose amount was also changed to get optimum results. It is found that ezetimibe is most effective drug that is used as 5 mg tablet dose. It increases the effectiveness of other drugs when combined with them. Simvastatin is one of those drugs that have increased their effectiveness to great extent when combined with ezetimibe. Bile Acid Sequestrants have also been used since 1970s. Three of them are available in market in USA, these are: Cholestyramine, colestipol and colesevelam. They have been test and have found to be useful against coronary diseases. The addition of BAS to stating increases its efficiency. The patients who have lipid abnormalities, a combination of niacin and fibrates is found to be much effective. Statins have been found to be most effective drugs in treatment of hypercholesterolemia. It is to increase their efficiency that other drugs are also combined with them. We can conclude that both statin and ezetimibe are beneficial to reduce level of LDL-C. The dose is to be given for 12 months follow up to provide beneficial and safe treatment to the patients. The hypercholesterolemia results by increased level of cholesterol level in the blood. It can be avoided by making change in diet plan. Food rich in fats has found to be a great cause of high cholesterol level in the blood. The patients as well as normal people should use fibrous diet rather consisting of lipids and fats. Most of the causes of hypercholesterolemia are self created besides genetic one. Even the genetic cause also needs the support of physical and dietary wrong habits. It is clear from the evidences that hhypercholesterolemia can be avoided easily if one is eager to manage. Once a person gets hhypercholesterolemia, he has to rely on medicines for short or long time depending on cholesterol level in blood. Hypercholesterolemia has been found a cause of many other diseases so it should be treated soon if diagnosed. The patients are required to change their daily life habits. People who do regular exercises and keep themselves busy in activities are less likely to have Hypercholesterolemia than those who are obese and do not do physical exercises. The diet plan is most important thing in controlling Hypercholesterolemia. References ANNE C. GOLDBERG, M., & ADITI SAPRE, J. L. (2004). Efficacy and Safety of Ezetimibe Coadministered With Simvastatin in Patients With Primary Hypercholesterolemia: A Randomized,Double-Blind, Placebo-Controlled Trial. Christos Pitsavos, I. S. (2008). The impact of ezetimibe and high-dose of statin treatment on LDL levels in patients with heterozygous familial hypercholesterolemia. Dimitri P. Mikhailidis, R. W.-L. (2014). Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia: systematic review and meta-analysis. Current Medical Research & Opinion Vol. 27. Lawrence Baruch, B. G.-B. (2008). Ezetimibe 5 and 10 mg for Lowering LDL-C: Potential Billion-Dollar Savings With Improved Tolerability. THE AMERICAN JOURNAL OF MANAGED CARE. Peter P. Toth, C. M. (2012). Changes in prescription patterns before and after reporting of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression trial (ENHANCE) results and expected effects on low-density lipoprotein-cholesterol reduction. Journal of Clinical Lipidology (2012) 6, 180–191. Runhua Hou, M. A. (2009). Lowering Low-Density Lipoprotein Cholesterol : Statins,Ezetimibe, Bile Acid Sequestrants, and Combinations:Comparative Efficacy and Safety. Endocrinol Metab Clin N Am 38. Read More