Effect of Combination Therapy with Lipid-Reducing Drugs in Patients with Coronary Heart Disease and “Normal” Cholesterol Levels

Abstract

To reach current goals for LDL cholesterol levels, most normolipidemic patients with coronary heart disease in this study needed combination therapy. Pravastatin with nicotinic acid and pravastatin with gemfibrozil are well-tolerated combinations that can maintain target LDL cholesterol levels, decrease triglyceride levels, and increase HDL cholesterol levels. Adding resin to these combinations produced no further benefit.

The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in dyslipidaemic patients

“…183 Niacin also has a number of anti-atherothrombotic effects that improve endothelial function, reduce inflammation, increase plaque stability and diminish thrombosis. 184 Niacin has additive effects to statins that improve LDL and HDL cholesterol and TG (table 5), 185,186 in line with its effects when used as monotherapy.…”

Niacin dosing: Relationship to benefits and adverse effects

“…Pasternak et al [39] in a comparison of usual care with stepped care therapy with pravastatin 40 mg/d, SR niacin (Endurance Products) 1.5 to 3 g/d, cholestyramine (4 to 24 g/d), and gemfibrozil (600 to 1200 mg/d) to reduce total cholesterol to below 160 mg/dL and LDL-C/HDL-C ratios to below 2.0 in patients with CHD, found only an 8% to 14% rise in HDL-C in 38 patients given SR niacin. Twelve patients who reached the total goal of a combination of all four medications had an overall decrease of 34% in LDL-C and in serum triglyceride levels, and a 17% increase in HDL-C.…”

High-density lipoprotein cholesterol increase and non-cardiovascular mortality: a meta-analysis

“…In the niacin trials group (N=785), none of the studies used niacin as a monotherapy, all of them used drug combinations. HARP (Harvard Atherosclerosis Reversibility Project),25 ARBITER 2 (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol)26 and HATS (HDL-Atherosclerosis Treatment Study)27 used niacin combined with statins, the Armed Forces Regression Study28 used niacin, gemfibrozil and cholestyramine, and CLAS (Cholesterol Lowering Atherosclerosis Study)29 and FATS (Familial Atherosclerosis Treatment Study)30 used niacin and colestipol. Six hormone replacement trials were included in the meta-analysis (N=5270).…”