Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/194—Carboxylic acids, e.g. valproic acid having two or more carboxyl groups, e.g. succinic, maleic or phthalic acid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/06—Antihyperlipidemics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis

Definitions

• lipoproteins are particles responsible for transporting non-aqueous lipids throughout the body, and are generally classified into four major categories with the associated general functions; chylomicrons, large triglyceride containing lipoproteins produced by the intestine during the processes of absorbing dietary fat, very low density lipoproteins (VLDL) triglyceride-rich lipoproteins produced by the liver and facilitates transport of triglycerides to muscle and adipose tissue for energy and storage, low density lipoproteins (LDL), cholesterol-rich particles that transport cholesterol to cells for growth, repair, production of bile acids, or for storage as cholesteryl esters as a reservoir of cholesterol for steroid production, and finally high density lipoprotein, a phospholipid-rich lipoprotein, that facilitates removal of excess cholesterol from cells.
• Each type of lipoprotein is comprised of polar and
• LDL-cholesterol LDL-cholesterol
• HDL-C high levels of HDL-cholesterol
• VLDL-C very low density lipoprotein- cholesterol
• plasma triglycerides are important in the prevention of cardiovascular diseases.
• the Framingham Risk Score is based on data obtained from the Framingham Heart Study and is used to estimate the 10-year cardiovascular risk of an individual.
• the Framingham Risk Score is a calculated estimated risk for developing fatal or non-fatal cardiovascular event based on a composite score based on a pre-existing risk factors, including: age, gender, systolic blood pressure level (+/- treatment), HDL cholesterol level, and smoker status.
• a patient's risk score gives and indication of the likely benefits of prevention and also can be a useful metric to determine the effects of treatments.
• 2004-Updated NCEP ATPIII guidelines present treatment guidelines for patients with elevated LDL-C, triglycerides and other genetic or environmental risk factors. Briefly, the 2004-updated NCEP ATP III treatment guidelines recommend LDL-C lowering guidance based on pre-existing conditions. The updated guidelines add the use of Framingham projections of a 10-year absolute CHD risk to identify patients for more intensive treatment. For subjects with 0 or 1 risk factors, an LDL-C of less than 160 mg/dL is recommended. For subjects with two or more risk factors and with a Framingham 10-year risk of less than 10 percent, an LDL-C of less than 130 mg/dL is recommended.
• CHD risk equivalents include other clinical forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease); diabetes; and the presence of multiple risk factors that confer a 10-year Framingham risk for CHD of ⁇ 20%.
• an LDL-C of less than 70 mg/dL is recommended.
• TJETF Third Joint European Task Force
• TJETF Third Joint European Task Force
• systolic blood pressure diastolic blood pressure
• 10-year risk score of a fatal cardiovascular event or preexisting atherosclerotic disease.
• Recommendations are also provided for patients having a combination of conditions, such as a known 10-year risk score of fatal cardiovascular disease plus elevated plasma total cholesterol or LDL cholesterol levels.
• the TJETF recommends reaching an LDL-C of less than 115mg/dL if a subject's 10-year risk of cardiovascular disease is less than 5 percent, or has a 10-year risk of cardiovascular disease of greater than or equal to 5 percent and also has an existing total cholesterol of greater than or equal to 190 mg/dL or an existing LDL-C of greater than or equal to 115 mg/dL.
• the TJETF guidelines recommends reaching an LDL-C of less than 100mg/dL if a subject has atherosclerotic disease, or Type 2 diabetes, or a total cholesterol greater than or equal to 320 mg/dL, or an LDL-C greater than or equal to 240 mg/dL, or has systolic blood pressure of greater than or equal to 180 mm Hg, or has diastolic blood pressure of greater than or equal to 110 mm Hg, or has a 10-year risk of cardiovascular disease of greater than or equal to 5 percent plus a total cholesterol of less than 190 mg/dL and an LDL-C less than 115 mg/dL.
• statins are drugs of choice to lower LDL-C, not all patients can tolerate statins or can tolerate a high statin dose. In addition, approximately half of all patients on stable statin doses do not reach recommended LDL-C lowering goals, (See, Centralized Pan-European Survey on the Undertreatment of Hypercholesterolemia in Patient Using Lipid Lowering Drugs, The Cepheus-Greece Survey, Angiology (2010), Vol. 61 (5), pp 465-474 and the 2004-updated NCEP ATPIII guidelines.).
• statins have a nonlinear dose-response relationship such that doubling the dose of a particular statin provides only an additional 6% further lowering of LDL-C
• the present invention relates to additional intervention in a patient group wherein despite being on a stable dose of a statin, the patients in the group have failed to achieve the relevant LDL cholesterol treatment goal or continue to have a high-risk for developing coronary heart disease or experiencing a recurrent cardiac event.
• the additional intervention comprises administering a compound of formula (I), formula (II), or formula (III) alone or in conjunction with another cholesterol lowering drug. These compounds are administered in conjunction with ongoing statin treatment.
• the addition of a compound of the invention to the ongoing statin treatment further reduces the LDL-C and results in a lowered risk for developing cardiovascular disease or having a recurrent cardiovascular event when compared to the level achieved in the absence of the compound of the invention.
• one embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a compound of formula (I):
• n, m , R 1 f R 2 , R 3 , R 4 , Yi, and Y 2 are as defined herein, or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof; wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of a compound of formula (I):
• n, m , R ⁇ R 2 , R 3 , R 4 , Y 1 t and Y 2 are as defined herein, or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof; wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Another embodiment of the invention is a method of lowering LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patient, an effective amount of a compound of formula (I): (I)
• n, m , R ⁇ R 2 , R 3 , R 4 , Yi, and Y 2 are as defined herein, or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof.
• FIG. 1 Shows the additional lowering of LDL-C levels in patients not reaching treatment goals on statin alone resulting from the addition of gemcabene .
• Bar A of the graph represents statin treatment alone; B represents statin + 300 mg gemcabene; and C represents statin + 900 mg gemcabene.
• carboxyalkylether includes the free acid, pharmaceutically acceptable salts and esters thereof, and prodrugs thereof that are converted to the free acid, or salt or hydrate thereof. Such compounds are known in the art, as well as their synthesis and formulation.
• treating or other forms of the word such as “treatment”, or “treat” is used herein to mean that administration of a compound of the present invention mitigates a disease or a disorder in a host and/or reduces, inhibits, or eliminates a particular characteristic or event associated with a disorder (e.g., reduced steroidogenesis).
• treatment includes, preventing a disorder from occurring in a host, particularly when the host is predisposed to acquiring the disorder; inhibiting the disorder; and/or alleviating or reversing the disorder.
• the term “prevent” does not require that the disease state be completely thwarted.
• the term preventing refers to the ability of the skilled artisan to identify a population that is susceptible to disorders, such that administration of the compounds of the present invention may occur prior to onset of a disease. The term does not imply that the disease state be completely avoided.
• HDL-C is an abbreviation for high density lipoprotein cholesterol.
• LDL-C is an abbreviation for low density lipoprotein cholesterol.
• LDL-C level is used interchangeably with “plasma LDL-C level”.
• VLDL-C is an abbreviation for very low density lipoprotein cholesterol.
• Between as used herein is inclusive, e.g., "between 1 mg and 5000 mg” includes 1 mg and 5000 mg.
• From as used herein is inclusive, e.g., "from 1 mg to 5000 mg” includes 1 mg and 5000 mg.
• Alkyl means a saturated aliphatic hydrocarbon containing 1-6 carbon atoms.
• An alkyl can be straight or branched.
• alkenyl means an aliphatic carbon that contains 2-6 carbon atoms and at least one double bond. Like an alkyl, an alkenyl can be straight or branched.
• Alkynyl means an aliphatic carbon that contains 2-6 carbon atoms and at least one triple bond. Like an alkyl, an alkynyl can be straight or branched.
• Carbocyclic ring encompasses cycloalkyl and cycloalkenyl rings. Carbocyclic rings can be optionally substituted with one or more substituents such as aliphatic (e.g., alkyl, alkenyl, or alkynyl).
• an "effective amount” is that amount of the compound, or pharmaceutically acceptable composition thereof, which is effective to lower plasma LDL-C levels and/or to reduce a patient's Framingham Risk Score.
• CHD is an abbreviation for Coronary Heart Disease.
• Reference to "a patient on a stable dose of a statin” means that the patient has been treated with a statin for a period sufficient for one of skill in the art to determine that the patient has reached a stable LDL-C level at a defined dose of a statin.
• Patients at high risk for CHD or a recurrent cardiac event include without limitation, persons with CHD (history of myocardial infarction, unstable angina, stable angina, coronary artery procedures, (such as angioplasty or bypass surgery, or evidence of clinically significant myocardial ischemia)) or CHD risk equivalents which include clinical manifestations of non-coronary forms of atherosclerotic disease, (such as peripheral arterial disease, abdominal aortic aneurysm, and carotid artery disease), diabetes, with 2 or more risk factors and a Framingham 10-year risk of developing CHD greater than 20%.
• CHD history of myocardial infarction, unstable angina, stable angina, coronary artery procedures, (such as angioplasty or bypass surgery, or evidence of clinically significant myocardial ischemia)
• CHD risk equivalents which include clinical manifestations of non-coronary forms of atherosclerotic disease, (such as peripheral arterial disease, abdominal aortic aneurysm,
• Patients at very high-risk for CHD or a recurrent cardiovascular event include patients that have had a recent heart attack, or those who have cardiovascular disease combined with either diabetes, or severe or poorly controlled risk factors (such as continued smoking), or metabolic syndrome.
• Cardiovascular diseases include, without limitation, coronary artery disease, cerebral vascular disease, such as stroke, peripheral vascular disease, or any diseases pertaining to an abnormal condition of the heart or circulatory system.
• Statins are drugs that inhibit 3-hydroxymethylglutaryl coenzyme A reductase (H G CoA reductase).
• NCEP National Cholesterol Education Program
• NCEP ATP III National Cholesterol Education Program
• NASH Publication No. 02-5215 the National Cholesterol Education Program
• NCEP ATP III National Cholesterol Education Program Adult Treatment Panel III
• Treatment goals as defined in the updated guidelines are based on a patient's estimated risk for developing CHD.
• the goal for high-risk patients having CHD or a CHD risk equivalent is an LDL-C level of less than 100 mg/dL.
• the goal for patients having two or more risk factors is an LDL-C level of less than 130 mg/dl.
• the goal for patients having zero or one risk factor is an LDL-C level of less than 160 mg/dL.
• the recommended goal is an LDL-C level of less than 70 mg/dL.
• Risk factors include smoking, hypertension (Blood pressure of > 140/90 mmHg or on antihypertensive medication), low HDL cholesterol ( ⁇ 40 mg/dL), family history of premature CHD (CHD in male first degree relative ⁇ 55 years; CHD in female first degree relative ⁇ 65 years), and age (men > 45 years; women ⁇ 55 years).
• Patients with very high-risk are those who have had a recent heart attack, or those who have cardiovascular disease combined with either diabetes, or severe or poorly controlled risk factors (such as continued smoking), or metabolic syndrome.
• a patient achieves an LDL cholesterol treatment goal when the patient's LDL-C level meets a recommended level as defined by the 2004-Updated NCEP ATPIII guidelines.
• Age-P-39 Ago 049 Age 5Q-59 Age6Q €9 Age 7Q-79
• the present invention relates to additional intervention in a patient group wherein despite being on a stable dose of a statin the patients in the group have failed to achieve the relevant LDL cholesterol treatment goal.
• the additional intervention comprises administering a compound of formula (I), formula (II), or formula (III) alone or in conjunction with another cholesterol lowering drug.
• These compounds of formula (I), formula (II), or formula (III) are referred to throughout the specification and claims as "compounds of the present invention” or “compounds useful in the present invention” .
• ABCA1 is a cell membrane protein responsible for the transfer of cholesterol to HDL and thus plays a function in the assembly of HDL.
• ABCA1 deficiency is the metabolic basis of Tangier's disease which is characterized by low levels of HDL cholesterol, accumulation of lipid in organs, and premature atherosclerosis. Increased expression of ABCA1 can result in elevation of HDL cholesterol and reduced cardiovascular disease progression.
• PCSK9 is an LDL receptor associated protein that allows the receptor to undergo degradation following endocytosis. Binding PCSK9 with specific monoclonal antibodies allows recycling of the LDL receptor leading to a more efficient removal of LDL cholesterol.
• PCSK9 inhibitors are known in the art, including but not limited to AMG 145 (Amgen), RN316 (Pfizer/Rlnat), RG7652 (Roche/Genentec), REGN727
• one embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patient, an effective amount of a compound of formula (I) in combination with a PCSK9 inhibitor.
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient an effective amount of a compound of formula (I) in combination with a PCSK9 inhibitor.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, comprising administering to a patient in need thereof, an effective amount of a compound of formula (I) in combination with a PCSK9 inhibitor.
• ABCA1 elevating compounds are known, see for example U.S. Patent No.
• Embodiments of the invention therefore include embodiments wherein a compound of the present disclosure is administered in combination with an agent that elevates ABCA1 levels.
• MicroRNAs play important roles in regulating cholesterol and fatty acid metabolism.
• MicroRNA are short non-coding RNAs that act as post- transcriptional regulators.
• a number of microRNAs have been identified.
• miR-33 has been shown to inhibit the expression of ABCA1.
• Targeted inhibition of microRNA-33 results in increased expression of ABCA1 , elevated HDL cholesterol, and inhibition of atherosclerosis in mice, (see Rayner et al., Science vol. 328, 2010)
• targeted inhibition of microRNA-33 results in elevated HDL-C and reduced LDL-C.
• Embodiments of the invention therefore include embodiments wherein a compound of the present disclosure is administered in combination with an agent that inhibits miR-33.
• Microsomal Transfer Protein-1 Another protein involved in cholesterol metabolism is Microsomal Transfer Protein-1
• MTP-1 is an intracellular protein that facilitates the transfer of triglycerides to chylomicrons
• abetalipoproteinemia The production of apolipoprotein B100 or apolipoprotein B-48, which are derived from a single gene via post transcriptional processing, are used in the assembly of VLDL and chylomicrons, respectively, and are constitutively produced and act as a surplus for use as a ready source to assemble these particles given delivery of triglycerides via MTP-1.
• MTP-1 The lack or reduction of MTP-1 markedly inhibits triglyceride delivery to the assembly process and forces the degradation of apolipoprotein B-100 or B-48 and leads to accumulation of intracellular triglycerides.
• MTP-1 activity leads to a fatty liver and intestinal enterocyte accumulation of triglyceride-rich lipid droplets.
• Embodiments of the invention therefore include embodiments wherein a compound of the present disclosure is administered in combination with an agent that inhibits MTP-1.
• the LDL-C level may be further lowered by at least 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%, 29%, 30%, 31 %, 32%, 33%, 34%, 35%, 36%, 37%, 38%, 39%, 40%, 41%, 42%, 43%, 44%, 45%, 46%, 47%, 48%, 49%, 50%, 51 %, 52%, 53%, 54%, 55%, 56%, 57%, 58%, 59%, 60%, 61%, 62%, 63%, 64%, 65%, 66%, 67%, 68%, 69%, or 70% or at least by about 15%, about 16%, about 17%, about 18%, about 19%, about 20%, about 21%, about 22%, about 23%, about 24%, about 25%, about 26%,
• the LDL-C level is further lowered by about 10% to about 20 %, or from about 10% to about 30%, or from about 20% to about 40%, or from about 20% to about 50%, or from about 20% to about 60%, or from about 20% to about 70%, or from about 30% to about 70%, or from about 30% to about 80%, or from about 30% to about 90%, with respect to the amount LDL-C was lowered by the statin.
• the LDL-C level is lowered to ⁇ 240 mg/dL. In another embodiment the LDL-C level is lowered to ⁇ 200 mg/dL. In yet another embodiment the LDL-C level is lowered to ⁇ 150 mg/dL. In still another embodiment the LDL-C level is lowered to ⁇ 140 mg/dL. In another embodiment the LDL-C level is lowered to ⁇ 130 mg/dL. In yet another embodiment the LDL-C level is lowered to ⁇ 115 mg/dL. In another embodiment the LDL-C level is lowered to ⁇ 70 mg/dL.
• One embodiment of the invention is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patient, an effective amount of a compound of the present invention.
• Another embodiment of the present invention is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patient, an effective amount of a compound of formula (I), formula (II) or formula (III), or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I), or the free acid, a salt, or a hydrate thereof.
• One embodiment of the invention is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patie
• n, and m independently are integers from 2 to 9; each occurrence of R 2 , R 3 , and R 4 is independently C C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl, or R-i and R 2 , taken together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons, or R 3 and R 4 together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons; Yi and Y 2 independently are -COOH, -CH 2 OH, tetrazole, and -COOR 5 ; R 5 is C C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl; or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a compound of the invention, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• the risk score is accessed using the Framingham Risk Score equation. In one embodiment the
• patient'sFramingham Risk Score is reduced by between about 1 and about 2 points when compared with treatment with statin alone. In another embodiment the patient's Framingham Risk Score is reduced by between about 2 and about 3 points when compared with treatment with statin alone. In another embodiment the patient's Framingham Risk Score is reduced by between about 3 and about 4 points when compared with treatment with statin alone. In yet another embodiment the patient's Framingham Risk Score is reduced by ⁇ 1 point. In still another embodiment the patient's Framingham Risk Score is reduced by >2 points. In another embodiment the patient's Framingham Risk Score is reduced by >3 points. In another embodiment the patient's Framingham Risk Score is reduced by >4 points.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a compound of formula (I), formula (II) or formula (III), or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a compound of formula (I), formula (II) or formula (III), or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof, wherein the
• n, and m independently are integers from 2 to 9; each occurrence of R 1 t R 2 , R 3 , and R 4 is independently d-C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl, or R-, and R 2 , taken together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons, or R 3 and R 4 together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons; and Y 2 independently are -COOH, -CH 2 OH, tetrazole, and -COOR 5 ; R 5 is C C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl; or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof; wherein
• Another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of a compound of the present invention, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to the patient, an effective amount of a compound of formula (I), formula (II) or formula (III), or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of a com ound of formula (I):
• n, and m independently are integers from 2 to 9; each occurrence of R 1 f R 2 , R 3 , and R 4 is independently C r C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl, or R, and R 2 , taken together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons, or R 3 and R 4 together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons; Yi and Y 2 independently are -COOH, -CH 2 OH, tetrazole, and -COOR 5 ; R 5 is C r C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl; or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof
• the compound of formula (I) is administered as a free acid.
• the compound administered is a pharmaceutically acceptable salt of a compound of formula (I).
• the compound administered is an ester of a compound of formula (I).
• the compound administered is a precursor (pro-drug) of formula (I) that metabolizes in vivo to the active carboxyalkylether acid or a salt of formula (I).
• the compound is a compound of formula I, wherein n is 2, or n is
• n is 4, or n is 5, or n is 6, or n is 7, or n is 8, or n is 9.
• m is 2, or n is 3, or m is
• n and m are both 2, or n and m are both 3, or n and m are both 4, or n and m are both 5, or n and m are both 6, or n and m are both 7, or n and m are both 8, or n and m are both 9.
• the compound is a compound of formula I, wherein R 1 t R 2 , R 3 , and R independently are C C 6 alkyl. In some embodiments R, , R 2 , R 3 , and R4 are all Ci-C 6 alkyl. In some embodiments R-i , R 2 , R 3 , and R, independently are C 2 -C 6 alkenyl. In some embodiments R R 2l R 3 , and R 4 independently are C 2 -C 6 alkynyl. In some embodiments R., , R 2 , R 3 , and R 4 are -CH 3 . In some embodiments R-,, R 2 , R 3 , and R4 are -CH 2 CH 3 .
• R 1 t R 2 , R 3 , and R4 are - CH 2 CH 2 CH 3 .
• R R 2 , R 3 , and R 4 are all C 2 -C 6 alkenyl.
• Ri, R 2 , R 3 , and R4 are all C 2 -C 6 alkynyl.
• R 2 taken together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons.
• R 3 and R 4 taken together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons.
• the compound is a compound of formula I, wherein Y ⁇ and Y 2 are both -COOH. In some embodiments Y ⁇ and Y 2 are both -CH 2 OH. In some embodiments Y ⁇ and Y 2 are both -tetrazole. In some embodiments Y and Y 2 are both -CH 2 (OH). In some embodiments Y-i and Y 2 are both -COOR5 and R 5 is C C 6 alkyl. In some embodiments Y, and Y 2 are both -COOR 5 and R 5 is C 2 -C 6 alkenyl. In some embodiments Y 1 and Y 2 are both -COOR5 and R 5 is C 2 -C 6 alkynyl.
• the compound is a compound of formula I, wherein n and m are the same integer, and Ri, R 2 , R 3 , and R 4 independently are C C 6 alkyl.
• the compound is a compound of formula I, wherein Yi and Y 2 are the same and are -COOH or -COOR5, and R5 is C r C 6 alkyl.
• the compound is a compound of formula I, wherein Y and Y 2 are COOH, Ri , R 2 , R 3 , and are methyl, and n and m are the same and are an integer selected from 2, 3, 4, or 5, preferably n and m are the same and are 4 or 5. Most preferably n and m are 4.
• the compound is a compound of formula I, wherein Yi and Y 2 are -COOH, and R,, R 2 , R 3 , and R 4 independently are Ci-C 6 alkyl, and n and m are 4.
• the compound is a compound of formula I, wherein Y ⁇ and Y 2 are -COOH, n and m are 4, R ⁇ R 2 , R 3 , and R4 are methyl.
• the compound is a compound of formula I, wherein Y-i and Y 2 are -COOH, n and m are 5, R,, R 2 , R 3 , and R4 are methyl.
• the compound is a compound of formula I, wherein Y ⁇ and Y 2 are -CH 2 OH, and n and m are 4. In another embodiment, the compound is a compound of formula I, wherein Y ⁇ and Y 2 are -CH 2 OH, n and m are 4 and R 1 t R 2 , R 3 , and R 4 are methyl.
• Carboxyalkylethers are a class of compounds described by Bisgaier et al. in U.S. Patent No. 5,648,387, and by Ando et al. in U.S. Patent No. 6,861 ,555, both patents are incorporated herein by reference. These compounds are described as having a number of biological activities, including raising levels of high density lipoproteins (HDL), and are said to be useful for treating cardiovascular disorders, diabetes, and other medical conditions.
• the compounds can be used alone or in combination with other agents such as statins, for example as described by Bisgaier et al. in U.S. Patent Publication No. 2002/0103252, which is incorporated herein by reference.
• the compound of formula (I) is a compound known as "CI-1027”, as “gemcabene”, and as "PD 72953” (Bays et. al., Am. J. Cardiol. (2003); Vol. 92, pp 538- 543, incorporated herein by reference).
• the chemical name of this compound is 6,6'-oxybis-(2,2'- dimethylhexanoic acid) or alternately 6-(5-carboxy-5-methyl-hexyloxy)-2,2-dimethylhexanoic acid.
• gemcabene is administered as a pharmaceutical salt. In yet another embodiment, gemcabene is administered as a calcium salt.
• gemcabene is administered as the anhydrous monocalcium salt.
• gemcabene is administered as a hydrate.
• gemcabene is administered as the hydrate of the monocalcium salt, as described in U.S. Patent No. 6,861 ,555.
• the structure of the h drate of the monocalcium salt of gemcabene is:
• gemcabene is administered in a crystalline form.
• Another embodiment of the invention is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patient, an effective amount of gemcabene.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of gemcabene, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of gemcabene, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Another embodiment of the invention is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patient, an effective amount of a calcium salt of gemcabene.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a calcium salt of gemcabene, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of a calcium salt of gemcabene, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Another embodiment of the invention is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, the patient having an LDL-C level above treatment goal, comprising administering to the patient, an effective amount of gemcabene-monocalcium salt.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of gemcabene-monocalcium salt, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of gemcabene-monocalcium salt, wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Another embodiment of the invention is a method of lowering the plasma LDL-
• C level in a patient on a stable dose of statin comprising administering to the patient, an effective amount of gemcabene or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound, or the free acid, a salt, or a hydrate thereof.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of gemcabene or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof; wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of gemcabene or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (I) or the free acid, a salt, or a hydrate thereof; wherein the patient is on a stable dose of statin and the patient has an LDL-C level above treatment goal.
• ESP 55016 Another compound useful in the methods of the present invention is a compound known as ESP 55016 and alternately as ETC 1002.
• ESP 55016 which is described in Cramer, C.T., et al. J. Lipid Res. 2004, 45:1289-1301.
• the structure of ESP 55016 is:
• ESP 55016 was shown to be effective in lowering non-HDL-C, raising HDL-C, and decreasing triglyceride levels in obese female Zucker rats. Also useful in the present invention are pharmaceutically acceptable salts or an ester of ESP 55016.
• Another embodiment of the invention is a method of lowering the plasma LDL-
• C level in a patient on a stable dose of statin comprising administering to the patient, an effective amount of the compound: or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound, or the free acid, a salt, or a hydrate thereof.
• Another embodiment of the invention is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of the compound:
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event comprising administering to a patient in need thereof, an effective amount of the compound:
• n and m are an integer from 3-5; each of R 1 p R 2 , R3, and R 4 is independently methyl, phenyl, 4- methyl-phenyl, and 4-butyl-phenyl; Y, and Y 2 independently are -COOH, -CH 2 OH, tetrazole, and -COOR 5 ; R 5 is C C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl; or an ester or a salt thereof.
• n, and m independently are integers from 4 to 7; each occurrence of Ri, R 2 , R3, and R 4 is independently C,-C 6 alkyl, C 2 -C 6 alkenyl, C 2 -C 6 alkynyl, or R-i and R 2 taken together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 6 carbons, or R 3 and R 4 together with the carbon to which they are attached, form a carbocyclic ring having from 3 to 5 carbons; R is H or C C 6 alkyl; or an ester or a salt thereof, or a precursor thereof that metabolizes in vivo to the compound of formula (III) or the free acid, a salt, or a hydrate thereof.
• Compounds useful in the methods of the invention also include precursors or pro-drugs of the compounds of the present disclosure, namely compounds that when administered to a subject are metabolized or otherwise converted in vivo to the free acid, salt, or hydrate thereof. See Goel, U.S. Patent No. 7,345,190 "Carnitine conjugates as dual prodrugs and uses thereof, incorporated herein by reference.
• Other compounds that are metabolized in situ include those described in U.S. Patent Nos. 6,410,802, 6,459,003, 6,645,170, 6,713,507, 6,790,953 and 7,192,940, all of which are incorporated herein by reference.
• patients may be or may become intolerant or resistant to statin therapy.
• the patient experience adverse events, for example, muscle pain, myopathy or
• statin use may be contraindicated. It is contemplated that for these patients, monotherapy with the compounds of the invention can be administered and LDL-C lowering achieved. In general, adverse events associated with statins increase in frequency and severity with increasing dose of statin.
• a patient receiving a statin may not achieve goal because the patient is being treated at the maximum dose of statin tolerated by that patient which is insufficient to obtain the desired result.
• the compounds of the invention are contemplated for use in such patients.
• One of skill in the art would understand that combination treatment of a statin and a compound of the invention could be useful in further lowering LDL-C while the patient is treated at the maximum tolerated dose of statin even where that dose is lower than the maximum allowed dose.
• any of the foregoing method can be used to treat a patient with one or more of the following conditions: coronary heart disease or a coronary heart risk equivalent, or has had a previous primary cardiovascular event, or a previous cerebral vascular event.
• the patient is being treated by any of the methods of the disclosure has as a risk factor, smokes, has hypertension, is undergoing treatment with an antihypertensive medication, has an HDL cholesterol level less than 40 mg/dL, has a family history of premature coronary heart disease, is a male ⁇ 45 years or a female ⁇ 55 years of age.
• One embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, wherein the patient has a 10-year risk for coronary heart disease of ⁇ 10%, or >20%, or >25%, or ⁇ 30%, comprising administering to the patient, an effective amount of a compound of formula (I).
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, wherein the patient has a 0-year risk for coronary heart disease of ⁇ 1 0%, or >20%, or >25%, or >30%, comprising administering to the patient an effective amount of a compound of formula (I).
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, wherein the patient has a 10-year risk for coronary heart disease of >10%, or >20%, or >25%, or >30%, comprising administering to the patient an effective amount of a compound of formula (I).
• One embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, wherein the patient has an LDL-C level of ⁇ 70 mg/dL, or ⁇ 100 mg/dL, or ⁇ 1 15 mg/dL, or > 130 mg/dL, or > 160 mg/dL, or > 240 mg/dL, comprising administering to the patient, an effective amount of a compound of formula (I).
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, wherein the patient has an LDL-C level of > 70 mg/dL, or > 100 mg/dL, or ⁇ 115 mg/dL, or ⁇ 130 mg/dL, or > 160 mg/dL, or ⁇ 240 mg/dL, comprising administering to the patient an effective amount of a compound of formula (I).
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, wherein the patient has an LDL-C level of ⁇ 70 mg/dL, or > 100 mg/dL, or ⁇ 115 mg/dL, or ⁇ 130 mg/dL, or > 160 mg/dL, or ⁇ 240 mg/dL, comprising administering to the patient an effective amount of a compound of formula (I).
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, wherein the patient has an LDL-C level between about 70 mg/dL and about 100 mg/dL, or between about 70 mg/dL and about 115 mg/dL, or between about 115 mg/dL and about 130 mg/dL, or between about 130 mg/dL and about 160 mg/dL, or between about 160 mg/dL and about 240 mg/dL, comprising administering to the patient, an effective amount of a compound of formula(l) .
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, wherein the patient has LDL-C level between about 70 mg/dL and about 100 mg/dL, or between about 70 mg/dL and about 115 mg/dL, or between about 115 mg/dL and about 130 mg/dL, or between about 130 mg/dL and about 160 mg/dL, or between about 160 mg/dL and about 240 mg/dL, comprising administering to the patient an effective amount of a compound of formula (I).
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, wherein the patient has an LDL-C level between about 70 mg/dL and about 100 mg/dL, or between about 70 mg/dL and about 115 mg/dL, or between about 115 mg/dL and about 130 mg/dL, or between about 130 mg/dL and about 160 mg/dL, or between about 160 mg/dL and about 240 mg/dL, comprising administering to the patient an effective amount of a compound of formula (I).
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, wherein the patient is diabetic, comprising administering to the patient, an effective amount of a compound of formula (I).
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, wherein the patient is diabetic, comprising administering to the patient an effective amount of a compound of formula (I).
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, wherein the patient is diabetic, comprising administering to the patient an effective amount of a compound of formula (I).
• Another embodiment is one embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, wherein the patient has an HDL cholesterol level less than 40 mg/dL and blood triglycerides levels ⁇ 150 mg/dL, comprising administering to the patient, an effective amount of a compound of formula (I).
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, wherein the patient has an HDL cholesterol level less than 40 mg/dL and blood triglycerides levels ⁇ 150 mg/dL, comprising administering to the patient an effective amount of a compound of formula (I).
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, wherein the patient has an HDL cholesterol level less than 40 mg/dL and blood triglycerides levels > 150 mg/dL, comprising administering to the patient an effective amount of a compound of formula (I).
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, wherein the patient has metabolic syndrome, comprising administering to the patient, an effective amount of a compound of formula (I).
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, wherein the patient has metabolic syndrome, comprising administering to the patient an effective amount of a compound of formula (I).
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, wherein the patient has metabolic syndrome, comprising administering to the patient an effective amount of a compound of formula (I).
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, wherein the patient is administered one or more additional cholesterol lowering drugs independently selected from a cholesterol absorption inhibitor, a bile acid sequestrant, a cholesteryl ester transfer protein inhibitor, a microsomal triglyceride transfer protein inhibitor, a miR-33 inhibitor, a PCSK9 inhibitor, a squalene synthase inhibitor and an apoB synthesis inhibitor, comprising administering to the patient, an effective amount of a compound of formula (I).
• additional cholesterol lowering drugs independently selected from a cholesterol absorption inhibitor, a bile acid sequestrant, a cholesteryl ester transfer protein inhibitor, a microsomal triglyceride transfer protein inhibitor, a miR-33 inhibitor, a PCSK9 inhibitor, a squalene synthase inhibitor and an apoB synthesis inhibitor, comprising administering to the patient, an effective amount of a compound of formula (
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, wherein the patient is administered one or more additional cholesterol lowering drugs independently selected from a cholesterol absorption inhibitor, a bile acid sequestrant, a cholesteryl ester transfer protein inhibitor, a microsomal triglyceride transfer protein inhibitor, a miR-33 inhibitor, a PCSK9 inhibitor, a squalene synthase inhibitor and an apoB synthesis inhibitor, comprising administering to the patient an effective amount of a compound of formula (I).
• additional cholesterol lowering drugs independently selected from a cholesterol absorption inhibitor, a bile acid sequestrant, a cholesteryl ester transfer protein inhibitor, a microsomal triglyceride transfer protein inhibitor, a miR-33 inhibitor, a PCSK9 inhibitor, a squalene synthase inhibitor and an apoB synthesis inhibitor
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, wherein the patient is administered one or more additional cholesterol lowering drugs independently selected from a cholesterol absorption inhibitor, a bile acid sequestrant, a cholesteryl ester transfer protein inhibitor, a microsomal triglyceride transfer protein inhibitor, a miR-33 inhibitor, a PCSK9 inhibitor, a squalene synthase inhibitor, and an apoB synthesis inhibitor, comprising administering to the patient an effective amount of a compound of formula (I).
• additional cholesterol lowering drugs independently selected from a cholesterol absorption inhibitor, a bile acid sequestrant, a cholesteryl ester transfer protein inhibitor, a microsomal triglyceride transfer protein inhibitor, a miR-33 inhibitor, a PCSK9 inhibitor, a squalene synthase inhibitor, and an apoB synthesis inhibitor
• the additional cholesterol lowering drug is ezetimibe, cholestryamine, or Vytorin.
• the effective daily dose of a compound of the present invention is typically from about 0.1 mg/kg to about 100 mg/kg.
• the daily dose typically utilized for administration to a human subject is between about 25 and about 1200 mg, or between about 50 and about 1000 mg, or between about 50 and about 900 mg, or between about 100 and about 900 mg, or between about 100 and about 600 mg, or between about 150 and about 600 mg, or about 150 mg, or about 300 mg, or about 600 mg, or about 900 mg, or between 10 and 1500 mg, or between 25 and 1200 mg, or between 50 and 1000 mg, or between 50 and 900 mg, or between 100 and 900 mg, or between 100 and 600 mg, or between 150 and 600 mg, or 150 mg, or 300 mg, or 600 mg, or 900 mg.
• the daily dose can be by non-limiting example, 25 mg, or 30 mg, or 35 mg, or 40 mg, or 45 mg, or 50 mg, or 55 mg, or 60 mg, or 65 mg, or 70 mg, or 75 mg, or 80 mg, or 85 mg, or 90 mg, or 95 mg, or 100 mg, 125 mg, or 150 mg, or 175 mg, or 200 mg, or 225 mg, or 250 mg, or 275 mg, or 300 mg, or 325 mg, or 350 mg, or 375 mg, or 400 mg, or 425 mg, or 450 mg, or 475 mg, or 500 mg, or 525 mg, or 550 mg, or 575 mg, or 600 mg, or 625 mg, or 650 mg, or 675 mg, or 700 mg, or 725 mg, or 750 mg, or 775 mg, or 800 mg, or 825 mg, or 850 mg, or 875 mg, or 900 mg, or 925 mg, or 975 mg, or 1000 mg, or 1025 mg, or 1050 mg, or 1075 mg, or 1
• the preferred daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• the compounds of the present disclosure may be administered 1 , 2, 3, 4 or 5 times per day. Preferably the compounds are administered 1 or 2 times a day. More preferably the compounds are administered 1 time per day.
• the statin is atorvastatin, lovastatin, simvastatin, pravastatin, rosuvastatin, fluvastatin, pitavastatin or any combination thereof.
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, comprising administering to the patient, an effective amount of a gemcabene.
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene.
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a calcium salt.
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a calcium salt.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a calcium salt.
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a monocalcium salt.
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a monocalcium salt.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a monocalcium salt.
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, comprising administering to the patient, an effective amount of a gemcabene and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a calcium salt and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a calcium salt and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a calcium salt and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Another embodiment is a method of lowering the plasma LDL-C level in a patient on a stable dose of statin, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a monocalcium salt and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Another embodiment is a method of decreasing a patient's risk for developing coronary heart disease or having a recurrent cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a monocalcium salt and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• Yet another embodiment is a method of preventing, delaying the onset of, or reducing the severity of a secondary cardiovascular event, comprising administering to the patient, an effective amount of a gemcabene, wherein the gemcabene is administered as a monocalcium salt and the daily dose is 150 mg, or 300 mg, 600 mg or 900 mg.
• a specific dosage and treatment regimen for any particular patient will depend upon a variety of factors, including the activity of the specific compound employed, the age, body weight, general health, sex, diet, time of administration, rate of excretion, drug combination and the judgment of the treating physician, and the severity of the particular disease being treated.
• the amount of the compound administered will also depend upon the particular compound in the composition.
• preferred embodiments include where the compound of formula (I) is gemcabene, or the compound of formula (I) is the calcium salt of gemcabene, or the compound of formula (I) is the monocalcium salt of gemcabene.
• Compounds useful in the present invention can be formulated as pharmaceutical compositions and administered to a subject, such as a human subject in a variety of forms adapted to the chosen route of administration, i.e., orally, transdermal, and parenterally, by intravenous, intramuscular, or subcutaneous routes.
• a subject such as a human subject
• Such compositions and methods for their preparation are well known and may be found, for example, in Remington's Pharmaceutical Sciences, 19th Edition (Mack Publishing Company, 1995).
• typical formulations for gemcabene are described in U. S. Patent No. 5,648,387.
• gemcabene is formulated with common excipients and carriers such as starch, binders, diluents and the like, and molded into tablets, or encapsulated into gelatin capsules, all for convenient oral administration.
• Gemcabene has excellent physical properties that enable formulation as syrups, elixirs, slow release lozenges and other common oral formulation types.
• Gemcabene can additionally be formulated with saline and other common excipients for administration by the intravenous route, intraperitoneal and similar parenteral routes.
• Transdermal patches can be made with binders and common adjuvants, and rectal formulations using pharmaceutically acceptable waxes can be made utilizing common formulation technologies that are well known to those skilled in the art of pharmaceutical formulations.
• a total of 66 hypercholesterolemia patients were treated in this study: 22 randomized to gemcabene 900 mg, 20 randomized to gemcabene 300 mg, and 24 randomized to placebo.
• Patients were excluded for any of the following reasons: women with childbearing potential; ages > 65 and ⁇ 18 years; triglycerides >400 mg/dL; creatinine phosphokinase levels >3 times the upper limit of normal (ULN); body mass index >35; any of the following within 1 month of enrolling into the study: myocardial infarction, severe or unstable angina pectoris, coronary angioplasty, coronary artery bypass graft, or any other major cardiovascular event resulting in hospitalization; uncontrolled diabetes mellitus (HbA c >10%), renal dysfunction, hepatic dysfunction, history of gall stones or gall bladder disease; known hypersensitivity to a lipid-altering agent; participation in another clinical study concurrently or within 30 days prior to the screening visit; taking excluded medications/supplements, abnormalities investigator feels may compromise the patient's safety or successful participation in the study.
• HbA c uncontrolled diabetes mellitus
• HbA c uncontrolled diabetes mellitus
• renal dysfunction hepatic
• Baseline values were defined as the mean of the 2 lipid measurements obtained at screening and Week 0. Final lipid values were obtained at week 8.
• the patients' Framingham Risk Score was calculated at baseline. The Framingham risk score calculation takes into account: age, gender, systolic blood pressure level (+/- treatment), HDL cholesterol level, and smoker status. After eight weeks, the Framingham Risk Score was reassessed and showed significant improvement in both statin plus gemcabene groups but not in the statin plus placebo group. Significance was determined using the SAS Proc Univariate which provides p values from the student's paired t-test and the Wilcoxon Signed Rank test.

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