Divergent approaches to the treatment of dyslipidemia with low levels of high-density lipoprotein cholesterol

  • Thomas A Pearson
    Address for reprints: Thomas A. Pearson, MD, PhD, Department of Community and Preventive Medicine, 601 Elmwood Avenue, Box 644, Rochester, NY 14642
    Department of Community and Preventive Medicine, University of Rochester, Preventive Cardiology Clinic, Strong Memorial Hospital, Rochester, New York, USA
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      Further therapy should be considered for patients who have reached target low-density lipoprotein cholesterol (LDL-C) levels but have low plasma levels of high-density lipoprotein cholesterol (HDL-C) since rates of coronary artery disease continue to be high for a sizable proportion of this population. Lifestyle approaches include dietary changes, smoking cessation, moderate alcohol intake, concomitant drug reassessment, and specific coexistent conditions. Aggressive statin therapy still leaves a high residual rate of cardiac events. Other drug approaches include estrogen, fibrate, niacin therapy, and combinations of these agents. Recent results from an ongoing trial of combination extended-release prescription niacin plus lovastatin are very promising.
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