Various herbal medicines are thought to be useful in the management of cardiometabolic disease and its risk factors. Ganoderma lucidum (Curtis) P. Karst. (Ganodermataceae), also known as Lingzhi, h...

Type 2 diabetes (T2D) is increasingly prevalent and associated with increased risk for cardiovascular and renal disease. After lifestyle modification, metformin is usually the first-line pharmacoth...

Introduction: The prevalence of obesity is increasing worldwide and associated conditions, particularly type 2 diabetes mellitus (T2DM), also show increasing prevalence. Lifestyle intervention should be the first line of management for obesity but additional pharmacotherapy is often required and bariatric surgery is appropriate in more severe cases. Drugs acting as glucagon-like peptide-1 receptor agonists (GLP-1RAs) developed for the management of T2DM reduce body weight and liraglutide is the first GLP-1RA to be approved for the treatment of obesity in patients with and without T2DM. Areas covered: In this review of relevant published material, the authors summarize the pharmacokinetics, pharmacodynamics, clinical efficacy and safety of liraglutide for the treatment of obesity. Expert opinion: Liraglutide effectively reduces body weight and body fat through mechanisms involving reduced appetite and lowered energy intake, independent of its glucose-lowering effects. Like most of the other medications currently available for obesity, liraglutide has some common adverse effects, although generally not serious ones. Liraglutide has additional benefits in reducing cardiovascular events in patients with T2DM but the cost and the need for daily injections may limit its use in obesity. Newer GLP-1RAs, such as semaglutide, or other drugs in development for obesity may have advantages over liraglutide.

Systemic exposure in treating Asian patients not adequately controlled on doses up to 20 mg/day. Considering that the 80-mg rosuvastatin dose was never developed because the risk of severe myopathy was too high in pre-approval studies in Western countries 3) and that based on the doubling of the systemic exposure to rosuvastatin in Chinese subjects compared to Caucasians 2) and that the systemic exposure to rosuvastatin is dose proportional over the dose range of 10 to 80-mg 4) , the 40-mg dose in Chinese subjects would be expected to result in the same average systemic exposure as the 80-mg dose in Caucasians.. We therefore believe that the 40-mg dose of rosuvastatin should not be used in Chinese patients, although the advice in the prescribing information leaves this to the prescriber's discretion. There is also evidence that systemic exposure to atorvastatin and to simvastatin acid, the active metabolite of simvastatin, is greater in healthy Chinese and Japanese subjects than in Caucasians in the United States 5). Another analysis comparing single-dose pharmacokinetic studies with atorvastatin from different countries concluded that there were no differences in the systemic exposure to atorvastatin between Asian subjects from Japan, China, Singapore, and the United Kingdom and the Caucasian subjects 6). The studies compared used different doses of atorvastatin and were likely to be different in other respects, and the systemic exposure to atorvastatin from the dosenormalized area under the concentration-time curve was actually 14% higher in the Asians than in the Caucasians before adjusting for body weight. Body weight usually has a small but significant effect on statin pharmacokinetics, 7) and this may contribute to the ethnic differences as East Asian patients typically have lower body weight than Caucasians.

Introduction: Alirocumab is a human monoclonal antibody inhibiting proprotein convertase subtilisin/kexin type 9 (PCSK9) that is administered by subcutaneous injection every 2 weeks. Area covered: Herein, the authors discuss the background to inhibition of PCSK9 and the pharmacodynamics, pharmacokinetics and clinical trials with alirocumab. Alirocumab produces substantial reductions in low density lipoprotein cholesterol (LDL-C) in patients with and without background statin treatment. The safety profile appears very promising from the relatively short term studies that have been completed but there are some remaining concerns about long term risks of neurocognitive events and developing diabetes. Expert opinion: The profound reduction in LDL-C with alirocumab is most likely to translate into cardiovascular benefits in the ODYSSEY OUTCOMES trial and is unlikely in itself to result in any major adverse effects. The high cost and the current lack of long-term safety and efficacy data will restrict the use of alirocumab to patients who have high cardiovascular risk from established atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia and who are unable to achieve LDL-C targets with maximally tolerated dose of statins with or without other lipid-lowering drugs. When further data become available, these indications are likely to be expanded.