Acute coffee ingestion does not affect LDL cholesterol level.

BACKGROUND: Although patients are instructed to abstain from food before having blood drawn for lipid analysis, many still drink coffee in the morning. It is unknown whether coffee consumed prior to drawing blood samples will impact fasting serum lipids. OBJECTIVE: To determine whether a single 6-oz cup of coffee with or without the addition of nondairy creamer and sugar will significantly affect fasting plasma lipid profiles. METHODS: This was a prospective, open-label, randomized crossover study. At the first of 2 visits, blood was drawn to measure initial fasting lipid panels, and participants were randomized to drink 6 oz of black coffee or coffee with nondairy creamer and sugar. Within 30-60 minutes of coffee consumption, blood was drawn for follow-up lipid panels. The procedure was repeated at the second visit, except the participants were crossed over to receive the alternate coffee preparation. RESULTS: Forty participants (26 men; age [mean +/- SD] 45 +/- 15 y) were enrolled. Total cholesterol (TC) increased from 188.2 +/- 38.1 to 191.3 +/- 39.9 mg/dL (p = 0.019) and high-density lipoprotein cholesterol (HDL-C) increased from 43.2 +/- 12.3 to 44.8 +/- 12.9 mg/dL (p < 0.001) after consumption of black coffee. Triglycerides decreased from 145.6 +/- 123.7 to 136.3 +/- 107.1 mg/dL (p = 0.014) after consumption of coffee with nondairy creamer and sugar. Changes in other lipid parameters, such as low-density lipoprotein cholesterol in either group, were not statistically significant. CONCLUSIONS: A single cup of coffee consumed within one hour before drawing blood resulted in statistically, but not clinically, significant differences in TC and HDL-C (black coffee) and triglycerides (coffee with creamer and sugar).

Ezetimibe: the first in a novel class of selective cholesterol-absorption inhibitors.

Zetia (ezetimibe) is the first medication in the novel class of selective cholesterol-absorption inhibitors to be released in the United States. Ezetimibe selectively inhibits the uptake of cholesterol from the intestinal lumen at the level of the enterocyte in the intestinal brush border while having no effect on other sterols or lipid-soluble vitamins. Ezetimibe 10 mg daily produces a consistent reduction in low-density lipoprotein cholesterol (LDL-C) by approximately 15 to 20% when used as monotherapy or in combination with 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) or fenofibrate and a 4 to 9% increase in high-density lipoprotein cholesterol. Unlike other lipid-lowering medications that act in the gastrointestinal tract, ezetimibe does not appear to worsen hypertriglyceridemia. Ezetimibe also has an adverse-event profile that is similar to placebo when used as monotherapy or in combination with statins and fenofibrate. Studies of longer duration and with niacin, bile acid sequestrants, and gemfibrozil are warranted to more completely assess the safety of ezetimibe in combination therapy. To date, no clinically significant drug-drug interactions have been noted with the use of ezetimibe; however, further studies are warranted. Ezetimibe will be useful as monotherapy in patients who need modest reductions in LDL-C or are intolerant to other lipid-lowering medication, and in combination with a statin in patients who are unable to tolerate large doses of statins or need further reductions in LDL-C despite maximum doses of a statin. The long-term safety and the effect on cardiovascular morbidity and mortality of ezetimibe are unknown.

Lovastatin and extended-release niacin combination product: the first drug combination for the management of hyperlipidemia.

Advicor (lovastatin and extended-release niacin) is the first cholesterol-lowering combination product to become available for the management of hyperlipidemia. Lovastatin significantly lowers low-density lipoprotein cholesterol, whereas niacin significantly lowers triglycerides and lipoprotein (a) and markedly increases high-density lipoprotein cholesterol. These effects are ideal for managing a variety of lipid disorders, including metabolic syndrome. Lovastatin and niacin reduce coronary heart disease mortality in primary and secondary prevention patients, respectively. The extended-release niacin component uses a unique technology to minimize adverse effects (e.g., flushing and hepatotoxicity) while retaining the same lipid-altering effects as immediate-release niacin. The combination product appears to be well tolerated, with discontinuation due to adverse effects other than flushing occurring in a similar percent of patients as for lovastatin in clinical trials. Approximately 9% of patients discontinued the combination product due to flush. No confined cases of myopathy or hepatotoxicity have been reported with this product. Once-daily dosing provides ease of administration that should improve compliance and result in a greater proportion of patients meeting their low-density lipoprotein cholesterol goals. The nomenclature surrounding niacin products used to treat dyslipidemias is confusing. While only two types of niacin formulations exist (immediate-release formulations and formulations which dissolve more slowly than immediate-release formulations), government regulations allow for slowly dissolved niacin formulations to be divided into two types of niacin products; those that are available over-the-counter (OTC) and those that are available by prescription only. Over-the-counter slowly dissolved niacin preparations are not classified as OTC per se, but are considered "nutritional supplements". For this reason, they fall under the jurisdiction of the Federal Trade Commission and do not fall under the umbrella of the FDA branch that controls dyslipidemic products (Endocrine and Metabolic Division of the Center for Drug Evaluation and Research). The slowly dissolved niacin nutritional supplements have not been reviewed by the FDA for safety nor efficacy in the treatment of dyslipidemia nor are they required to meet generic drug rules (even though various brands are available). These brands are described on their labels as "sustained-release", "timed-release", and "slow-release" for example. Only two slowly absorbed niacin products have been approved by the FDA for the treatment of dyslipidemia; they are Niaspan (Kos Pharmaceuticals, Inc., Miami, FL) and Advicor (Kos Pharmaceuticals, Inc., Miami, FL). The term "extended-release" has been given to these two products to simplify the terminology and differentiate the products from immediate-release niacin. In this review, we will use "extended-release" to refer to the FDA approved slowly dissolving niacin preparation and "sustained-release" to refer to the nutritional supplements (not FDA approved).