Lipid management for patients with CAD, Part 2: A guide to drug therapy

The primary goal of lipid therapy is to reduce serum levels of low- density lipoprotein (LDL). However, lipid-altering agents variously affect multiple lipoprotein species and should be chosen to treat specific patterns of dyslipidemia. Available agents include bile acid resins, niacin, fibric acid derivatives, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, fish oil, and estrogens. Overall, the HMG-CoA reductase inhibitors have reduced the need for combination drug therapy. Nevertheless, certain patients still require treatment with more than 1 drug to achieve a lipid profile that permits regression of atherosclerosis and reduces mortality. Using drugs with different and complementary modes of action may provide the most effective treatment for 'mixed' dyslipidemias. Some combinations may increase the frequency of certain adverse effects; monitoring, especially of creatine kinase levels, may be required. Often, however, using lower dosages of more than 1 drug lessens side effects.

Duke Scholars

Author Geoffrey Steven Ginsburg Medicine, Cardiology