Treating mixed hyperlipidemia and the atherogenic lipid phenotype for prevention of cardiovascular events.

Abstract

Statins reduce cardiovascular events and cardiovascular and total mortality in persons at risk for and with coronary disease, but there remains a significant residual event rate, particularly in those with the atherogenic lipid phenotype that is characterized by a low high-density lipoprotein (HDL) cholesterol and increase in non-HDL cholesterol. Large outcome trials designed to assess the value of combining statins with other agents to target HDL cholesterol and non-HDL cholesterol will not be completed for a few years, but there is ample evidence for the clinician to consider combination therapy. The choices for therapies to supplement statins include niacin, fibrates, and omega-3 fatty acids. We present the argument that after therapeutic lifestyle changes, the first priority should be the maximally tolerated effective dose of a potent statin. Evidence supports the addition of niacin as the second agent. In some situations, high-dose omega-3 fatty acid therapy could be the first agent added to statins. Although fibrate monotherapy alone or in combination with non-statin low-density lipoprotein cholesterol-lowering agents can be effective in mixed hyperlipidemia when statins are not tolerated, the combination of statin+fibrate should be considered second-line therapy until the efficacy and safety are established.

• Authors: Melvyn Rubenfire, Robert D Brook, Robert S Rosenson
• Journal: The American journal of medicine (Am J Med) Vol. 123 Issue 10 Pg. 892-8 (Oct 2010) ISSN: 1555-7162 [Electronic] United States
• PMID: 20920687 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2010 Elsevier Inc. All rights reserved.

Chemical References

• Cholesterol, LDL
• Fatty Acids, Omega-3
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Niacin
• Clofibric Acid

Topics

• Atherosclerosis (prevention & control)
• Cardiovascular Diseases (prevention & control)
• Cholesterol, LDL (blood)
• Clofibric Acid (therapeutic use)
• Drug Therapy, Combination
• Fatty Acids, Omega-3 (therapeutic use)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Hyperlipidemia, Familial Combined (drug therapy, therapy)
• Lipid Metabolism (drug effects, genetics)
• Niacin (therapeutic use)
• Phenotype
• Risk Factors
• Risk Reduction Behavior