MXPA05003599A - Simvastatin combinations for improving the lipid profile and reducing risk factors of cardiovascular diseases in patients with dyslipidemic disorders - Google Patents

Abstract

The present invention is related to the pharmaceutical industry and, more specifically, the industry involved in the manufacture of pharmaceutical products used to treat cardiovascular diseases in patients with dyslipidemic disorders. The invention is advantageous over similar existing compositions in that it performs a more suitable handling of the blood lipid concentration, thus reducing risk factors of cardiovascular diseases in patients with dyslipidemic disorders, and providing a more powerful effect in the treatment of both symptoms. Side effects of each of the components are reduced, as well as doses, the performance of the drug being optimised. The composition includes simvastatin along with a component selected from a combination of an agent for reducing hemocysteine levels, a platelet antiaggregant, a soluble fiber for reducing atherogenic lipids and a combination of two or more of the aforementioned components.

Description

SIMVASTATIN COMBINATIONS TO IMPROVE THE LIPID PROFILE AND DECREASE THE RISK OF CARDIOVASCULAR DISEASE IN PATIENTS WITH DISL1P1DEM1A FIELD OF THE INVENTION The present invention is related to the pharmaceutical industry in general and the pharmaceutical manufacturing industry for the treatment of cardiovascular diseases in patients with dyslipidemia.

BACKGROUND OF THE INVENTION An aggressive management of dyslipidemia is of vital importance in the prevention of cardiovascular risk. The primary objective in the management of dyslipidemia is to maintain the concentrations of LDL (low density lipoproteins) and VLDL (low density lipoproteins) below 130 mg / mL, as well as HDL concentrations (Lipoproteins of high density) above 40 mg / mL. To achieve these objectives, modifications in lifestyle (diet and exercise) as well as pharmacological treatment have been suggested.

The reductase inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) also known as statins, are widely used for the treatment of hypercholesterolemia due to their potent effect on lowering blood cholesterol (Grundy SM: Low-density lipoprotein, non-high density lipoprotein, and apolipoprotein B as targets of li-Io wering therapy Circulation 2002, 106: 2526-2529) Numerous studies have shown that statins reduce the incidence of coronary events, in addition to prevent cardiovascular diseases. These clinical benefits are attributed both to the ability to lower LDL and its anti-thrombotic and anti-inflammatory properties (Farmer JA, Pleiotropic effects of statins, Curr Atheroscl Rep 2000; 2: 208-217; Blake GJ, Ridker PM. inflammatory? Curr Control Triáis Cardiovasc Med 2000; 1: 161-165; Rosenson RS, Tangney CC, Antiatherothrombotic properties of statins: impli-cations for cardiovascular events reduction, JAMA 1998; 279: 1643-1650.) Fibrates effectively decrease triglyceride levels by increasing the activity of lipoprotein lipase, which increases HDL, also increases the synthesis of apoA1, allows a better output of cholesterol from cells thereby increasing the concentration of HDL in 10 to 20% (Steiner G, Hamsten A, Hosking J, et al .: Effect of fenofibrate on progression of coronary artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomized study, Lancet 2001, 357: 905-910) Niacin reduces triglycerides, LDL, free fatty acids and lipoprotein (a). It blocks free fatty acids from adipose tissue and suppresses liver assembly and VLDL release, thereby reducing the concentration of triglycerides and dense LDL. It can also block a catabolic receptor for the intrahepatic degradation of HDL, which increases the half-life of HDL and its concentration. It has been shown that niacin reduces mortality from cardiovascular disease and is the only drug that decreases the particle size of LDL in non-diabetic individuals (MacKenney JM, McCormick LS, Schaefer EJ, et al.) Effect of niacin and atorvastatin on lipoprotein subclasses in patients wlth atherogenic dyslipidemia Am J Cardiol 2001; 88: 270-274; Guyton JR, Goldber AC, Kreisberg RA, et al., Effectiveness of eleven-n ightly dosing of extended release niacin alone and n combination for hypercholesterolemia. J Cardiol 1998; 82: 737-743; Miller BD, Alderman EL, Haskell WL, et al., Pre-dominance of dense low-density lipoprotein particles predicted an-giographic benefit of therapy in the Stanford coronary intervention intervention project.; 94: 2146-2153) However, its use has been limited in patients with diabetes mellitus type 2 because it affects glycemic control (Grundy SM: Low-density lipoprotein, non-high density lipoprotein, and apolipoprotein B as targets of lipid-lowering therapy. Circulation 2002, 106: 2526-2529) Omega-3 fatty acids (fish oil) reduce the incidence of cardiovascular disease and the risk of death from ischemic heart disease. It has been shown to increase the stability of the atherosclerotic plaque and its mechanism indicates that it stimulates peroxisome proliferator system activated by the alpha receptor (Kris-Etherton PM, Harris WS, Appel LJ: Fish, fish oil, omega-3 fatty acids and cardiovascular disease Circulation 2002, 106: 2747-2757.) (Thies F, McGarry JM, Yagook P, et al .: Association of n-3 polyunsaturated fatty acids with stability of atherosclerotic plaques: a randomized controlled trial Lancet 2003, 361 : 477-485) Ezetimibe is the first of a new class of compounds that selectively inhibit the intestinal absorption of dietary cholesterol and related plant sterols, without interfering with the absorption of triglycerides or fat-soluble vitamins I (Dar-kes M, Poole R, Goa K. Ezetimibe (Drug profile) American Journal of Cardiovascular Drugs 2003; 3: 67-76) Ezetimibe reduces the plasma concentration of LDL-cholesterol (low-density lipoprotein), by preventing the selective absorption of intestinal cholesterol at the intestinal level. diet and bile salts, in addition to increasing high-density lipoproteins (Rudel LL Preclinical and clinical pharmacology of a new class of lipid management agents Am J [anag Care 2002; 8 (2 suppl): S33-S35), Resins (cholestyramine and colestipol) are drugs that can lower blood cholesterol levels by acting at the gastrointestinal level. It binds to bile acids, synthesized in the liver from cholesterol, and prevents their reabsorption, being eliminated in the faeces. It can prevent circulatory problems caused by the accumulation of cholesterol in the veins and arteries of the body. They are less effective than statins (they reduce total cholesterol by approximately 15%) and may aggravate the problem of hypertriglyceridemia, although its use is considered when the patient does not tolerate statins or fibrates.

Dyslipidemia is a major cardiovascular risk factor that has increased its prevalence within the last decade. At present, statins such as simvastatin are drugs whose usefulness in the treatment of hypercholesterolemia is fully proven, in addition to reducing the risk of coronary heart disease. However, treatment with statins, although safe, is not free of risks, with an increase in the prevalence of side effects as the dose increases.

In order to decrease the prevalence of adverse effects of sequential treatment with statins, new pharmacological compounds have been introduced that can be combined with statins, providing a synergistic effect in reducing cholesterol concentrations, decreasing the concentration of LDL and increase in HDL.

The combination of statins with fibrates emerged as a good option for the proper management of the lipidic profile, since both have complementary action. Fibrates are the first line of action for elevating HDL and decreasing triglyceride levels (Watts GF, Coronary disease, dyslipidemia and clinical triais in type 2 diabetes mellitus, Pract Diabetes 2000; 17: 54-58). that fibrates are very effective in lowering triglyceride levels, has a very modest effect on the decrease of LDL levels, on the other hand statins have an important effect on the cholesterol decrease but very modest in the levels of triglycerides. Fibrates, however, are not recommended for patients with renal dysfunction, which has been associated with a very high risk of coronary heart disease (Armita-ge L. Lipid-lowering triais in diabetes, Eur Heart J 1999; 1 (Suppl. : M13-M17) Fibrates and statins were prescribed together for the treatment of patients with high levels of LDL and triglycerides and low HDL levels. In August 2001, Bayer withdrew its statin (cerivastatin) from the market, when the drug was relapsed with a large number of cases of rhabdomyolysis, particularly in patients who were prescribed in conjunction with gemfibrozil fibrate. In fact, nowadays the use of this combination is in disuse since the adverse effects of fibrates are enhanced in the presence of statins.

The therapeutic role of simvastatin in the treatment of hypercholesterolemia is evident. Currently there are no therapeutic options that can be combined with simvastatin in order to improve the therapeutic response and decrease the incidence of side effects with the consequent improvement in chronic tolerance to treatment, and in order to reduce the occurrence of cardiovascular events associated with atherogenicity and endothelial dysfunction. In addition, there are no additional combinations of drugs and substances that can protect the endothelium from oxidative stress damage, especially the synergistic effect they may have with simvastatin.

In the literature, some patent documents were found in which HMG-CoA inhibitors are combined with other therapeutic agents, mainly angiostensin-converting enzyme inhibitors.

Guivar'ch et al, in US Pat. No. 6,534,088, developed a pharmaceutical composition for the treatment of high levels of cholesterol based on the combination of simvastatin and fenofibrate. Although effective, this combination has some disadvantages such as the non-inclusion of agents that act on other factors that determine the risk of cardiovascular disease, such as antiplatelet agents and regulators of homocysteine levels. In addition, the combination of statins with fibrates is not recommended because the adverse effects of the administration of fibrates are enhanced in the presence of statins (National Cholesterol Education Program, Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, National Institute if Health, May 2001) Olukotun et al in U.S. Patent No. 5,622,985; McGovern et al in US Patent No. 5,240,012; Tschollar et al in US Patent No. 5,461,039 and 5,593,971, disclose that the combination of drugs that lower cholesterol levels such as inhibitors of HMG-CoA activity, in conjunction with other drugs such as converting enzyme inhibitors of angiostensin, reduce the risk of heart attack in patients with normal cholesterol levels. However, these documents do not consider the addition of one or more agents such as aspirin as an antiplatelet agent and B-complex vitamins, such as folic acid, which reduce homocysteine levels, having a greater effect on the incidence of atherosclerosis. and risk of myocardial infarction.

Weissman in the patent US 6,323,188; Weissman et al in patent US 6,121,249, Heibel et al in patent US 6,274,170, developed treatments for the prevention of cardiovascular diseases and risks of heart attack, based on the use of certain vitamins and acetylsalicylic acid, however, in this patent the addition of compounds for the adequate management of lipids is not considered, which are known to accelerate the process of atherosclerosis associated with the risk of cardiovascular diseases.

A large number of individuals are at risk of suffering cardiovascular events that put their lives under some threat. An adequate management of lipids is of vital importance in the prevention of cardiovascular complications.

In previous pages, some therapeutic options currently used for lipid management were described. However, dyslipidemia is only one of the multiple risk factors associated with cardiovascular events. Recent data from the Steno-2 study have shown that an intensive intervention of the multiple risk factors, such as that posed with the combination of this invention, not only decreases microvascular complications in patients with diabetes mellitus, but also reduces the risk of cardiovascular diseases by about 50% (Gaede P, Vedel P, Larsen N, et al .: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes N Engl J Med 2003, 348: 383-393) Acetylsalicylic acid has a very important effect as anti-platelet aggregator and several clinical studies have shown that it produces a decrease in morbidity and mortality due to coronary diseases (Eikelboom JW, Hirsh J, Weitz Jl, et al.) Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, cardiovascular death in patients at high risk for cardiovascular events Circulation 2002; 105: 1650-1656) Similar evidence exists in the use of statin therapy in patients with coronary heart disease and the effect of Aspirin and statins is additive. Therefore, the addition of acetylsalicylic acid to statin therapy will significantly reduce the risks of coronary heart disease due to the complementary effect of both drugs.

Elevated levels of homocysteine (an amino acid not found in proteins) in serum are highly correlated with atherosclerosis, heart disease, infarction and peripheral vascular disease. Many studies have shown that oral administration of some vitamins such as folic acid reduces homocysteine levels and thus reduces the incidence of atherosclerosis and myocardial infarction. The addition of folic acid to statin anti-dyslipidemic therapy will decrease the risk of cardiovascular disease unlike the use of simvastatin individually (Hunter-Lavin C, Hudson PR, Mukherjee, et al.) Folate supplementation reduces serum hsp 70 levéis in patients with type 2 diabetes, Cell Stress Chaperones 2004. 9: 344-349) On the other hand, in order to improve the profile of atherogenic lipids, several non-pharmacological therapies have been used, among which is the ingestion of dietary fibers. It has been reported that the frequent consumption of certain types of water-soluble fibers and that they are fermentable, can decrease the total serum cholesterol in a range of between 2 and 32% (Balcazar-Muñoz BR, Martí-nez-Abundis E, González- Ortiz M. Effect of oral administration of inulin on lipid profile and insulin sensitivity in individuals with obesity and dyslipidemia Rev Med Chile 2003; 131: 597-604) Inulin is a prebiotic from fructose, non-digestible, resistant to hydrolysis of the gastrointestinal tract and with a low caloric level. In non-obese rats inulin has been shown to decrease lipogenesis in liver and adipose tissue (Cheng HH, Lai MH, Fermentation of resistant rice starch produces propionate reducing serum and hepatic cholesterol in rats J Nutr 2000; 130: 1991-1995) Some studies have shown that the administration of inulin improves the lipid profile of obese people (Williams CM, Effects of inulin on lipid parameters in humans J Nutr 1999; 129: 1471S-1473S) OBJECTIVES OF THE INVENTION One of the objectives of the invention is to make possible a management to improve the concentration of lipids in blood "and decrease the risk of cardiovascular disease in patients with dyslipidemia.

Another objective of the present invention is to achieve a more powerful effect on these two frames.

Still another objective is to achieve a composition that reduces the side effects of each of the components separately.

Still another objective is to achieve the above by decreasing the doses of each of them, but at the same time achieving a better performance of the medication.

Other objects and advantages of the present invention may be apparent from the study of the following description.

BRIEF DESCRIPTION OF THE INVENTION In short, the present invention deals, on the one hand, with a combination therapy to improve the lipid profile and reduce the risk of cardiovascular disease in patients with dyslipidemia. The aforementioned therapy is based on the combined use of two or more pharmacological agents with different but synergistic mechanisms of action. On the other hand it is a composition with the combination of a statin with acetylsalicylic acid, folic acid and a soluble fiber provides greater effectiveness in the prevention of cardiovascular events and synergism in the protection of the endothelium to vascular damage and atherogenicity .

In its simplest form, the present invention lies in the combination of two pharmacological agents, ie, for example, the combination of a statin with acetylsalicylic acid, or a statin with folic acid.

The administration of a preparation containing folic acid, acetylsalicylic acid, simvastatin and inulin will have certain advantages with respect to the current preparations in the management of the lipid profile and vascular risk due to the effect they have on different factors that determine the disease, in addition to decreasing -nuir the adverse effects of the assets.

In other words, a combination therapy was developed to improve the lipid profile and decrease the risk of cardiovascular disease in patients with dyslipidemia. This therapy consists of the combination of a hypolipidemic agent belonging to the family of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors also known as statins, a reducing agent of hemocysteine levels ( folic acid), a palpable antiaggregant (acetylsalicylic acid) and a soluble atherogenic lipid-lowering fiber.

DETAILED DESCRIPTION OF THE INVENTION The invention of the present invention in its broadest form consists of a pharmaceutical composition for improving the lipid profile and decreasing the risk of cardiovascular disease in patients with dyslipidemia comprising a combination of different agents with complementary effects in the treatment of these morbidities.

Dyslipidemia is a disorder in which the circulating concentrations of lipids or lipoprotein fractions are abnormal, due to genetic or environmental situations or both, which alter the production, catabolism or elimination of circulating plasma lipoproteins. The alteration in the concentration of different lipoproteic fractions, as well as the increase in postprandial lipemia and abnormalities in the metabolism of apoA1 and apoB, together accelerate the process of atherosclerosis, which, combined with other disorders of the metabolic syndrome, is combined to cause cardiovascular disease.

Cardiovascular diseases are one of the main causes of morbidity and mortality in the general population worldwide. The dyslipidemia that has a more direct relationship with cardiovascular disease is hypercholesterolemia, in particular the increase in plasma concentrations of cholesterol transported in low density lipoproteins (LDL). The latter contain an average of 70% of cholesterol in the blood, in addition to which it has been demonstrated that these can be one of the main risk indicators in diabetic and non-diabetic people. In this way, an adequate management of dyslipidemias is one of the main objectives of cardiovascular disease prevention.

Stated another way, the therapy subject of the invention is formed by the combination of a drug of the group of statins with acetylsalicylic acid, folic acid and a soluble fiber. The main problem involved in the development of the invention is the selection of adequate doses of acetyl-isalic acid (aspirin). The combination contains aspirin as an inhibitor of platelet aggregation, which makes it effective in the prevention of arterial occlusion. Aspirin performs its function as a platelet antiaggregant by inhibiting the prostaglandin synthetase enzyme G / H (Cyclooxygenase, COX), which catalyzes the first step of prostagiandin synthesis. The minimum dose of aspirin required to inhibit platelet aggregation remains highly controversial. Unit doses of aspirin as low as 5 mg cause COX inhibition in both normal patients and patients with vascular disease. However, there is evidence that doses of 80 mg of aspirin produce an inadequate inhibition of platelet aggregation. It has been observed that doses of aspirin between 300-325 mg not only inhibit platelet aggregation but also influence other components of the endothelium-platelet interaction that can help prevent or limit thrombus formation, however, large doses of aspirin are not used clinically due to the negative effects that could occur in the activation of plasminogen, inhibition in the formation of prostacyclines and severe gastrointestinal effects. Therefore in commercial preparations available doses between 50-500 mg are used, which are what we are proposing.

Combination therapy to improve the lipid profile of patients with dyslipidemia in addition to reducing the risks of cardiovascular disease. These agents have different mechanisms of action that are complementary to each other. The union of these components that is the reason of this invention allows to attack the dyslipidemia and the risk of cardiovascular diseases using less doses of each of the agents with the consequent reduction of the adverse effects to the organism, remarkably increasing its effectiveness.

After a multitude of tests it could then be found that the quantitative composition of the combination object of the present invention could comprise the following amounts: about 5 to 80 mg of simvastatin, 50 to 500 mg of acetylsalicylic acid, 1 to 8 mg of folic acid and 2 to 20 g of inulin.

A preferred embodiment of the combination therapy consists of simvastatin in a dose of 20 mg, 75 mg of acetylsalicylic acid, 5 mg of folic acid and 7 g of inulin.

The treatment is given as oral mono-therapy once a day.

Claims (4)

R E I V I N D I C A C I O N S Having sufficiently described the invention, it is considered as a novelty and therefore is claimed as property io expressed and contained in the following claim clauses.

1. Combinations of simvastatin to improve the lipid profile and decrease the risk of cardiovascular disease in patients with dyslipidemia, characterized in that simvastatin is found together with a component selected from the group consisting of a reducing agent of hemocysteine levels, a platelet antiaggregan-te , a soluble atherogenic lipid reducing fiber and combination of two or more of these.

2. Combinations of simvastatin to improve the lipid profile and decrease the risk of cardiovascular disease in patients with dyslipidemia, as claimed in the previous claim, characterized in that the agent reducing agent of homocysteine levels is folic acid; the platelet antiaggregant is acetylsalicylic acid and the atherogenic lipid-reducing soluble fiber is inulin.

3. Combinations of simvastatin to improve the lipid profile and decrease the risk of cardiovascular disease in patients with dyslipidemia, as claimed in the previous claim, characterized in that they comprise from approximately 5 to 80 mg of simvastatin, 50 to 500 mg of acid aceti Is al icí 1 ico, 1 to 8 mg of folic acid and 2 to 20 g of inulin.

4. Combinations of simvastatin to improve the lipid profile and decrease the risk of cardiovascular disease in patients with dyslipidemia, as claimed in the preceding claim, further characterized by comprising approximately 20 mg of simvastatin, 75 mg of acetylsalicylic acid, 5 mg of folic acid and 7 g of inulin. SUMMARY The present invention is related to the pharmaceutical industry in general and the pharmaceutical manufacturing industry for the treatment of cardiovascular diseases in patients with dyslipidemia. The advantages of the present invention with respect to the compositions of the state of the art lies in the fact that the present makes possible a more adequate handling of the concentration of lipids in the blood and decrease the risk of cardiovascular disease in patients with dyslipidemia, with an effect more powerful on these two tables, reduces the side effects of each of the components separately and decreases the doses of each of them, but at the same time achieving a better performance of the drug. The composition is formed by simvastatin together with a component selected from the group consisting of a reducing agent of hemocysteine levels, a platelet antiaggregant, a soluble atherogenic lipid reducing fiber and a combination of two or more of these.