Effective use of combination lipid therapy |
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Authors: | Abu R Vasudevan MBBS MD MRCP Peter H Jones MD |
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Institution: | (1) Center for Cardiovascular Disease Prevention, Lipid and Atherosclerosis Section, Baylor College of Medicine, 6565 Fannin, Suite B160A, MS A601, 77030 Houston, TX, USA |
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Abstract: | Despite the benefits of statin therapy, low-density lipoprotein (LDL) cholesterol management remains suboptimal and many patients
do not achieve their recommended target goals. The aim of combination lipid drug therapy in high-risk patients is to achieve
LDL cholesterol and non-high-density lipoprotein (HDL) cholesterol goals with a minimum of serious adverse effects. Although
statins are the drug of first choice, statin monotherapy may be limited by intolerance of dose escalation or failure to attain
non-HDL cholesterol goals in those with mixed hyperlipidemia. Statins plus bile acid resins or ezetimibe can achieve greater
than 50% reduction in LDL cholesterol, with little or no increase in adverse effects. Fibrates, niacin, and omega-3 fatty
acids, when added to statins, can reduce triglycerides, increase HDL cholesterol, and reduce non-HDL cholesterol to a greater
extent than statin monotherapy. The safety profile of combination lipid therapy is acceptable if the global coronary heart
disease risk of the patient is high, thus producing a favorable risk to benefit ratio. Careful surveillance of hepatic transaminases,
avoidance of gemfibrozil in statin-fibrate combinations, and awareness of statin-concomitant drug interactions is key to safe
and efficacious use of combination lipid drug therapy. |
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