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COMBINATION HYPERLIPIDEMIC THERAPY.

Some authorities recommend a target LDL cholesterol of 100 mg/dL for people with coronary artery disease (CAD). This trial evaluated whether combination antihyperlipidemic therapy can achieve target LDL levels in normolipidemic patients.

Researchers randomized 91 nonsmokers with known CAD to placebo or a stepped-care regimen targeted to total cholesterol levels less than 160 mg/dl and LDL to HDL cholesterol ratios less than 2. Stepped-care therapy consisted of pravastatin plus nicotinic acid, cholestyramine, and gemfibrozil as needed and tolerated. The patients' mean baseline lipid levels were total cholesterol, 214 mg/dl; LDL cholesterol, 140 mg/dl; and HDL cholesterol, 42 mg/dl.

During 2.5 years of follow-up, 41 patients in the stepped-care regimen (93 percent) and none in the control group reached treatment goals. Seventy percent of the stepped-care group needed combination therapies to achieve goals. Combinations of pravastatin with either nicotinic acid or gemfibrozil were the most successful.

Comment: This pragmatic trial shows that combination therapies are often necessary to achieve recommended lipid levels in patients with CAD.

— CD Mulrow

Published in Journal Watch General Medicine October 8, 1996

Citation(s):

Pasternak RC et al. Effect of combination therapy with lipid-reducing drugs in patients with coronary artery disease and "normal" cholesterol levels. Ann Intern Med 1996 Oct 1 125 529-540.

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