Management Of Hyperlipidemia Research Articles

Effects of Gongronema latifolium Benth and Celosia argentea Linn supplemented diet on the hepatic and cardiac functions of high-fat diet-induced hyperlipidemic rats

PurposeThe purpose of this study is to assess the effects of two green leafy vegetables (Gongronema latifolium and Celosia argentea) on the hepatic biomarkers [Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST)], cardiac biomarkers [Creatine Kinase (CK) and Lactate Dehydrogenase (LDH)] and histopathology of the heart of high-fat diet-induced hyperlipidemic rats, with the aim of evaluating the vegetables as functional foods.Design/methodology/approachExperimental diets consisted of Control Diet (CD), High-Fat Diet (HFD), High-Fat Diet with Blanched Celosia argentea (HCB), High-Fat Diet with Unblanched Celosia argentea (HCU), High-Fat diet with Blanched Gongronema latifolium (HGB) and High-Fat Diet with Unblanched Gongronema latifolium (HGU). Seventy-five albino male rats (weighing 180–200 g) were used. The animals were divided into 15 groups of five albino rats each. Animals in Groups 1, 2 and 3 were fed with CD, HFD only and HFD with Atorvastin (5 mg/kg b.w), respectively. Animals in Groups 4, 5 and 6 were fed with 5, 10 and 15% HCB, respectively. Animals in Groups 7, 8 and 9 were fed with 5, 10 and 15% HCU, respectively, whereas animals in Groups 10, 11 and 12 were fed with 5, 10 and 15% HGB, respectively, and animals in Groups 13, 14 and 15 were fed with 5, 10 and 15% diet-inclusion of HGU, respectively.FindingsThe incorporation of the vegetal matter into the diet brought about a significant reduction (p = 0.05) in the activities of ALT, AST, CK and LDH when compared with HFD. However, the histological examination showed no pathological lesion, only at 15% inclusion of the vegetables.Originality/valueThe paper established that the incorporation of Celosia argentea and Gongronema latifolium into diet, most especially at 15% inclusion, may serve as functional food in the management of hyperlipidemia and associated complications.

English

Medicinal plants contain natural bio-active constituents in various parts called photochemical that are of therapeutic importance. This research was undertaken to determine the phytochemical constituents and in-vitro antioxidant activities of ethyl acetate extract of Dryopteris dilatata leaves (DDL). Phytochemical analysis was determined on the plant samples following established protocols. The antioxidant property of Dryopteris dilatata leaves was evaluated using ferric reducing antioxidant power (FRAP), superoxide scavenging radical activity (SSRA) and hydroxyl radical activity (OH) assay. The results of the phytochemical analysis revealed the presence of the following phenols, terpenoid, alkaloids, flavonoids, tannins, cardiac glycosides and saponins, while steroids, carbohydrates, proteins, amino acids and phlobotannins were below detectable levels. DDL leaves produced significant (P<0.05) levels of ferric reducing antioxidant power (FRAP), superoxide scavenging radical activity (SSRA) and hydroxyl radical activity (OH) in a concentration dependent manner compared to the reference antioxidants, ascorbic acid and manitol; therefore, the extract could serve as free radical scavenger, acting as primary antioxidants. Based on the phytoconstituents and antioxidant activities, it could be concluded that D. dilatata could be of great value in the management of hyperglycemia, hyperlipidemia, and cancer, among other diseases that could be caused as a result of oxidative stress. This calls for further exploration of its bioactive compound.   Key words: Phytochemicals, Dryopteris dilatata, in-vitro antioxidant and, oxidative stress.

Liposorber® LA-15 system for LDL apheresis in resistant nephrotic syndrome patients.

Steroid-resistant nephrotic syndrome (SRNS) is a major cause of stage 5 chronic kidney disease (CKD 5) in children. LDL apheresis (LDL-A) is now FDA approved for the treatment of pediatric focal segmental glomerulosclerosis (FSGS). Effective management of hyperlipidemia with LDL-A in SRNS patients may prevent progression of kidney disease and lead to remission. We report a case series of patients who received LDL-A for treatment of SRNS METHODS: We describe five children with SRNS who were treated with 12 sessions of LDL-A. Partial remission (PR) is defined as urine protein to creatinine ratio (UPC) of 0.2-2 (g/g) or decrease in UPC ≥ 50%, and complete remission (CR) is defined asUPC < 0.2 (g/g). One patient achieved CR and three achieved PR. One patient did not respond to therapy. The earliest that a patient achieved PR was at treatment #10 and some did not respond until after LDL-A was completed. Those who responded stayed in either CR or PR for extended periods of time. LDL-A was successful at significantly reducing LDL (p < 0.001), total cholesterol (p < 0.001), and triglyceride (p < 0.001). LDL-A was able to significantly decrease the lipid levels in these patients and induce CR and PR in the majority. The current study confirms previous studies showing those with a higher glomerular sclerosis burden were less likely to respond. LDL-A should be considered in patients with treatment-resistant SRNS and should be considered before there is a high burden of glomerular sclerosis to provide the best chance of success.

Influences of antidepressant medications on the risk of developing hyperlipidemia in patients with depression by a population-based cohort study and on in vitro hepatic lipogenic-related gene expression

BackgroundDepression increases the risk of cardiovascular disease (CVD). The association between antidepressant medications (ADMs) and CVD remains controversial. Hyperlipidemia is a risk factor for CVD. We conducted a nationwide population-based retrospective cohort study to examine depression and ADM use on the risk of developing hyperlipidemia. The effects of ADMs on the expression of lipogenesis-related hepatic genes were also evaluated. MethodsWe obtained data from the Longitudinal Health Insurance Database of Taiwan on patients with new-onset depression and a comparison cohort without depression. A Cox proportional hazards regression model was used to analyze the differences in the risk of developing hyperlipidemia between these two cohorts. We also examined the influence of ADMs on the expression of lipogenesis-related hepatic genes. ResultsAfter adjustment for comorbidities and confounding factors, the case group (N = 38,322) had a higher risk for hyperlipidemia than that of the control cohort (N = 38,322) [adjusted hazards ratio (aHR) =1.16]. Patients with depression who did not receive ADM therapy exhibited a significantly higher risk of hyperlipidemia (aHR = 1.61). However, in patients with depression treated with ADMs, the risk of developing hyperlipidemia was significantly lowered compared to the patients without ADMs (all aHR < 0.81). Gene expression analysis indicated that ADMs downregulated the expression of lipogenesis-related hepatic genes. LimitationsUnmeasured confounding risk factors for hyperlipidemia might not have been included in the study. ConclusionsADMs reduced hyperlipidemia risk in patients with depression, partly by downregulating the expression of lipogenesis-related genes and improving the patients’ lipid profiles. Early diagnosis and management of hyperlipidemia would further facilitate the prevention of CVD.

Use of Lipid-Modifying Agents for the Treatment of Glomerular Diseases

Although dyslipidemia is associated with chronic kidney disease (CKD), it is more common in nephrotic syndrome (NS), and guidelines for the management of hyperlipidemia in NS are largely opinion-based. In addition to the role of circulating lipids, an increasing number of studies suggest that intrarenal lipids contribute to the progression of glomerular diseases, indicating that proteinuric kidney diseases may be a form of “fatty kidney disease” and that reducing intracellular lipids could represent a new therapeutic approach to slow the progression of CKD. In this review, we summarize recent progress made in the utilization of lipid-modifying agents to lower renal parenchymal lipid accumulation and to prevent or reduce kidney injury. The agents mentioned in this review are categorized according to their specific targets, but they may also regulate other lipid-relevant pathways.

Impact of Gut Microbiota and Microbiota-Related Metabolites on Hyperlipidemia.

Hyperlipidemia, defined as the presence of excess fat or lipids in the blood, has been considered as a high-risk factor and key indicator of many metabolic diseases. The gut microbiota has been reported playing a vital role in regulating host lipid metabolism. The pathogenic role of gut microbiota in the development of hyperlipidemia has been revealed through fecal microbiota transplantation experiment to germ-free mice. The effector mechanism of microbiota-related metabolites such as bile acids, lipopolysaccharide, and short-chain fatty acids in the regulation of hyperlipidemia has been partially unveiled. Moreover, studies on gut-microbiota-targeted hyperlipidemia interventions, including the use of prebiotics, probiotics, fecal microbiota transplantation, and natural herbal medicines, also have shown their efficacy in the treatment of hyperlipidemia. In this review, we summarize the relationship between gut microbiota and hyperlipidemia, the impact of gut microbiota and microbiota-related metabolites on the development and progression of hyperlipidemia, and the potential therapeutic management of hyperlipidemia targeted at gut microbiota.

The scientific basis and future of lipoprotein apheresis.

Lipoprotein apheresis plays a vital role in the management of the severe hyperlipidemias that predispose to atherosclerosis. Determinants of efficacy are the acute reduction in lipoproteins achieved by each apheresis procedure, their frequency, and the fractional catabolic rates and hence pool sizes of low-density lipoprotein (LDL) or lipoprotein (a) (Lp(a)) of the patient being treated. A useful criterion of the efficacy of apheresis plus lipid-lowering drug therapy is the decrease in the interval (time-averaged) mean of serum total or LDL cholesterol or Lp(a) between procedures, expressed as the percent decrease in the interval means below the maximal levels of these lipoproteins when off all treatment. Recent advances in lipid-lowering drug therapy may diminish the use of lipoprotein apheresis but will not abolish its unique role as a therapeutic "last chance saloon," especially for children and pregnant women with homozygous familial hypercholesterolemia.

Anti dyslipidemic effect of Ficus Carica Fruit (Fig) on Lipid Profile of Diet Induced Hyperlipidemic Rats

Back ground: Hyperlipidaemia, characterized by elevation of one or more lipid types in blood, is a major risk factor for cardiovascular diseases and stroke. Management of hyperlipidaemia is helpful to control the fatal outcome of cardiovascular diseases. This experimental study was done to observe the effects of pulp of Ficus carica fruit on lipid profile in induced hyperlipidemic rats in comparison to atorvastatin. Methodology: The duration of study was 12 weeks. In this study forty male rats were taken and divided into four groups. One group was normal control which was given normal diet throughout study period of 12 weeks. The second group was positive control which was given high fat diet for 12 weeks. The remaining two groups were experimental groups which were given high fat diet for 12 weeks. Hyperlipidaemia was induced after giving high fat diet for first four weeks to the experimental groups. The pulp of Ficus carica fruit and atorvastatin was then added to diet of two experimental groups respectively in addition to high fat diet for the next 8 weeks. Body weight, fasting lipid profile, LDL/HDL ratio and AIP were measured at baseline, 4th, 8th, and 12th week of study. Results: Pulp of Ficus carica fruit significantly improved fasting lipid profile, AIP and LDL/HDL ratio. HDL was also significantly increased. However there was no change in body weight. Conclusion: Ficus carica fruit has marked antihyperlipidemic properties comparable to standard drug atorvastatin. Key words: Hyperlipidaemia, ethanolic extract, pulp, Ficus carica

The effect of nurse case coordination on management of chronic conditions

A clinical decision report using: Ishani A, Greer N, Taylor BC, et al. Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial. Diabetes Care. 2011;34(8):1689-1694. https://doi.org/10.2337/dc10-2121 for a patient requiring care coordination for management of hypertension, diabetes, and hyperlipidemia.

Ganoderma applanatum mushroom provides new insights into the management of diabetes mellitus, hyperlipidemia, and hepatic degeneration: A comprehensive analysis.

This study was undertaken to evaluate the antidiabetic, hypolipidemic, and hepatoprotective effects of methanol and aqueous extracts of Ganoderma applanatum (MEGA, AEGA) in alloxan‐induced diabetic rats. The antidiabetic study was implemented by the induction of alloxan to the rats. The analysis of the hypolipidemic and liver‐protective effects of fungus extracts was studied by estimating the lipid profile and the liver marker enzymes. Besides, in silico screening of the compounds of Ganoderma applanatum has been incorporated thus to check the binding affinity of compounds and enzymes affinity. The Discovery Studio 2020, UCSF Chimera, and PyRx AutoDock Vina have been used to implement the docking analysis. Nine days of oral feeding of MEGA and AEGA of Ganoderma applanatum resulted in a significant (p < .001) reduction in blood glucose, lipid profile, and liver marker enzymes. Besides, Myrocin C scored the highest score in the docking study. The biological and computational approaches suggested the MEGA and AEGA could be a potential source for antidiabetic, hypolipidemic, and hepatoprotective effects.

Ficus asperifolia Miq‐enriched biscuit diet protects against L‐NAME induced hyperlipidemia and hypertension in rats

AbstractDietary sources of functional foods and nutraceutical have shown strong potentials in the management of hypertension and its complications. Sandpaper leaves, Ficus asperifolia Miq (FA), particularly found in Africa has a rich folkloric history in the management of diabetes and hypertension. This study produced biscuits supplemented with blends of FA at 2.5% and 5% fed to Nw (G)‐nitro‐l‐arginine‐methyl‐ester (L‐NAME, 40 mg/kg/day) induced‐hypertensive rats for 14 days followed by the assessment of blood pressure, lipid profile, and atherogenic index in hypertensive rats. The phenolic constituents of FA blends were analyzed using high‐performance liquid chromatography diode‐anode (HPLC‐DAD). Thereafter, the mean arterial blood pressure (MABP) and systolic blood pressure (SBP) was measured using the tail‐cuff method after which the heart and lungs of rats were collected, weighed, and the antioxidant status and lipid cholesterol profile were assessed. We realized that recorded phenolic constituents in extracts of FA was at a high level and FA enriched biscuit‐diet caused a significant decrease in SBP and MABP in L‐NAME‐induced hypertensive rats, body weight, atherogenic index and cholesterol profile in treated rats. However, FA enriched biscuit resulted in increased activities of catalase (CAT), superoxide dismutase (SOD), and glutathione‐S‐transferase (GST) antioxidant enzymes in the heart and lungs of hypertensive rats. This study revealed that FA enriched biscuit‐diet does not only have antihypertensive and antioxidant potential in L‐NAME‐induced hypertensive rats but also plays a protective role in the management of hyperlipidemia.

Efficacy of a micronized, nanocrystal fenofibrate formulation in treatment of hyperlipidemia in dogs.

BackgroundSafe, effective, and readily available drug therapies are required for the management of hyperlipidemia and its associated complications in dogs.ObjectivesTo investigate the efficacy of a micronized, nanocrystal formulation of fenofibrate (Tricor) in the treatment of hyperlipidemia in dogs.AnimalsTen client‐owned dogs with primary (n = 7) and secondary (n = 3) hyperlipidemia. All dogs had hypertriglyceridemia at baseline; 3 dogs also had hypercholesterolemia.MethodsProspective dose‐escalation study. Dogs were treated with fenofibrate orally once daily in up to 3 cycles of 21 days each. Fenofibrate dose was increased at the end of each cycle if hypertriglyceridemia persisted and adverse effects were not documented. Complete blood count, biochemistry, and urine protein:creatinine ratio were collected serially. Baseline (T0) parameters were compared to time of maximal reduction in serum triglyceride concentrations (T1) and reported as median (range).ResultsTriglycerides normalized in all dogs (T0 = 662 mg/dL [189‐2391]; T1 = 113 mg/dL [81‐132]; P = .002). Fenofibrate dose at T1 = 6.4 mg/kg PO q24h (range, 2.2‐13.5). T1 was achieved at 3 (n = 4), 6 (n = 4), and 9 (n = 2) weeks. Serum cholesterol concentrations decreased in 9 of 10 dogs. Quiet demeanor and firm stools in 1 dog were the only reported adverse reactions. Fenofibrate administration resulted in a significant reduction in median alkaline phosphatase activity (P = .049).Conclusions and Clinical ImportanceOver 21 to 63 days, TriCor was effective in the management of primary and secondary hyperlipidemia in dogs.

Pharmacological Management of Hyperlipidemia in Older individuals.

To provide an up-to-date review of current hyperlipidemia guidelines and discuss pharmacotherapeutic management of hyperlipidemia in older individuals. A PubMed search of articles published through October 2020 was performed using a combination of the following words: older adults, hyperlipidemia, statin, ezetimibe, fibrate, fish oil, niacin, bile acid sequestrant, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor. Relevant original research, review articles, and guidelines were assessed for the management of hyperlipidemia in the older individuals. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. Hyperlipidemia is a common chronic disease state in the elderly population, though there is limited evidence for clinical outcomes in older people when compared withwith the general adult population. Statins have the most evidence for primary and secondary prevention of cardiovascular disease in older people, though ezetimibe and PCSK9 inhibitors have a role as add-on or monotherapy in patients who do not tolerate statins. Optimal management of hyperlipidemia in older people is important in order to avoid further complications and improve outcomes. Pharmacists can help improve management in the elderly by incorporating up-to-date evidence from guidelines and providing medication education specifically for this population.

Therapeutic Potential of Ethyl Acetate Fraction of Methanolic Extract of Camellia Sinensis (Green Tea) in Diabetes and Hyperlipidaemia Management in Streptozotocin induced Diabetic Male Albino Rat

This study investigates the therapeutic potential of the ethyl acetate fraction derived from the methanolic extract of Camellia sinensis (green tea) in managing diabetes and hyperlipidemia using a streptozotocin-induced diabetic male albino rat model. Diabetes and hyperlipidemia pose significant health challenges globally, with limited effective treatments available. Green tea, known for its rich polyphenolic content and antioxidant properties, has shown promising therapeutic effects in various metabolic disorders. In this research, streptozotocin-induced diabetic male albino rats were treated with the ethyl acetate fraction of green tea extract. Parameters such as blood glucose levels, lipid profile, and antioxidant enzymes activity were assessed. The findings reveal that treatment with the ethyl acetate fraction of methanolic extract of Camellia sinensis (green tea) resulted in significant (p&lt;0.05) reductions in blood glucose levels and improvement in lipid profile parameters compared to the diabetic control group. Furthermore, histopathological examination indicated amelioration of pancreatic tissue damage in treated rats. These results suggest that the ethyl acetate fraction of green tea extract holds promise as a therapeutic agent for managing diabetes and hyperlipidemia. Further research elucidating the underlying mechanisms and clinical trials are warranted to validate its efficacy and safety for human use

Management of Hyperlipidaemia through Ayurvedic Intervention

The potential of hyperlipidemia to engage in the pathology of atherosclerotic diseases such as coronary heart disease, which dominates the scenario of diseases causing morbidity and mortality in the world. Hyperlipidemia is defined as elevated serum levels of cholesterol, triglycerides, or both. It is characterized by abnormally elevated lipid concentrations in blood caused by impaired lipid and lipoprotein metabolism and has the potential to cause a variety of complications such as cardiovascular disease, diabetes, obesity, hypertension, atherosclerosis, and so on. Hyperlipidemia is classified as Medoroga in Ayurveda. The results obtained for the lipid profile parameter demonstrated a significant change. The difference in total serum cholesterol is 36 mg/dl, serum triglycerides is 32 mg/dl, serum LDL is 40 mg/dl, serum VLDL is 15 mg/dl and serum HDL is -3 mg/dl.

Mechanisms and primary prevention of atherosclerotic cardiovascular disease among people living with HIV.

To highlight mechanisms of elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLWH), discuss therapeutic strategies, and opportunities for primary prevention. HIV-associated ASCVD risk is likely multifactorial and due to HIV-specific factors and traditional risk factors even in the setting of treated and suppressed HIV disease. Although a growing body of evidence suggests that inflammation and immune activation are key drivers of atherogenesis, therapies designed to lower inflammation including colchicine and low-dose methotrexate have not improved secondary cardiovascular endpoints among PLWH. Statins continue to be the mainstay of management of hyperlipidemia in HIV, but the impact of newer lipid therapies including proprotein convertase subtilisin/kexin type 9 inhibitors on ASCVD risk among PLWH is under investigation. Aside from the factors mentioned above, healthcare disparities are particularly prominent among PLWH and thus likely contribute to increased ASCVD risk. Our understanding of mechanisms of elevated ASCVD risk in HIV continues to evolve, and the optimal treatment for CVD in HIV aside from targeting traditional risk factors remains unknown. Future studies including novel therapies to lower inflammation, control of risk factors, and implementation science are needed to ascertain optimal ways to treat and prevent ASCVD among PLWH.

The management of foot infections

Limb preservation can involve both established and emerging strategies to identify, prevent and surgically manage foot infections in patients living with peripheral arterial disease (PAD), chronic limb-threatening ischemia, and diabetes. If a person with diabetes needs treatment, a multidisciplinary approach is recommended that combines antiplatelet agents, a statin, glucose management, exercise therapy, hypertension management and hyperlipidemia management.

Rosuvastatin and Fenofibrate Combination in The Treatment of Mixed Hyperlipidemia: A Narrative Review

Introduction: Patients with mixed dyslipidemia are presented with high levels of low-density lipid cholesterol (LDL-C), triglycerides (TG), and reduced high-density lipid cholesterol (HDL-C). Though useful in lowering LDL-C, therapy with rosuvastatin is insufficient in optimizing the overall lipid profile, thus putting the patient at risk of residual cardiovascular risk. A combination of statin with other lipid-modifying agents has been used with more efficient lipid control and cardiovascular risk prevention. Of these, fenofibric acid is the most frequently used, along with rosuvastatin.&#x0D; Methods: Authors conducted a literature search of published literature to assess the use of rosuvastatin and fenofibrate combination in the management of mixed hyperlipidaemia.&#x0D; Results and discussion: The authors selected a total of 46 articles to be included in the review. Due to the small number of articles and heterogeneity on the combination of rosuvastatin and fenofibrate combination in mixed hyperlipidemia, the findings herein are presented using narrative summaries. Based on the thorough assessment of the selected literature, the essential themes that emerged from the review include safety and efficacy of rosuvastatin and fenofibrate combination, place of therapy of rosuvastatin, and fenofibrate combination, and potential cardiovascular risk reduction with rosuvastatin and fenofibrate combination. &#x0D; Conclusion: Based on the review, the authors suggested that the combination therapy with fenofibric acid was beneficial, well-tolerated with a similar safety profile compared with statin monotherapy. The combination therapy of moderate dose rosuvastatin and fenofibric acid led to a reduction of cardiovascular risk factors via several pathways.

Hyperlipidemia management during the COVID-19 pandemic: PCSK9 inhibitors to enhance the antiviral action of interferon.

Hyperlipidemia management during the COVID-19 pandemic: PCSK9 inhibitors to enhance the antiviral action of interferon.

Plausible influence of atorvastatin and dietary legumes (horsegram and groundnut) in dyslipidemia in experimental rodents

BackgroundDyslipidemia a common pathology in metabolic syndrome results due to various factors. Although statins are proven for its beneficial role in the management of hyperlipidemia, plant-based foods and their ingredients are still a cornerstone of health care and medical prescriptions. Legumes are important constituents of a balanced diet. They are rich in fiber and provide health benefits and are used to treat disease related pathologies. PurposeThe present study intended to identify the influence of two legumes, horsegram and groundnut individually and with atorvastatin in high fat diet induced hyperlipidemic rats and trace if there is any adverse effect due to food drug interactions. MethodsHyperlipidemia in Sprague Dawley rats were induced by feeding high fat diet for 12 weeks. Subsequently, supplementation of horsegram and groundnut with and without atorvastatin was given for 4 weeks. The physiological indicators (body weight, feed intake, fat index), biochemical parameters (cholesterol, triglyceride, glucose, urea and creatinine) including markers of oxidative stress (catalase, GST, SOD, TBARS and GSH), mRNA expression markers of lipid metabolism and inflammation markers (SREBP-1, ACC, FABP, HMG-CoAR, NF-kB and IL-6) and the protein expression of HO-1 and NF-kB followed by histopathological analysis of the heart, liver and kidney tissues were checked to study the influence of the legumes with and without atrovastatin. ResultsResults showed that administration of the legumes individually and their combination with atorvastatin significantly reduced the body weight, feed intake, fat index, biochemical metabolites and enzymatic markers in comparison to the HFD group. In addition, it also decreased the enzymatic and non-enzymatic antioxidant levels. Likewise, the legumes individually as well as in combination with atorvastatin significantly decreased the protein expression of HO-1 and NF-kB. Further, histopathological analysis confirmed the influence of the legumes and its combination to overcome hyperlipidemia as evidenced by the pathological changes in the treated rats. ConclusionThe results of the present work confirm that the legumes individually as well as its combination with atorvastatin are helpful to manage hyperlipidemia. On comparison, horsegram with atorvastatin possess a better therapeutic efficacy when compared to groundnut with atorvastatin and there is no evidence of food drug interactions.