Friday, June 15, 2012

LDL cholesterol and the Pre-Statin era

The pre- Statin era
 I have had the privilege of practicing medicine before before Statins became available . I can tell you , the treatment results were not that good and patients had problems tolerating the  available medications.

Bile acid resins( Questran and colestid ) had problems with causing gastrointestinal distress especially constipation , they interfered with the absorption of other medications and increased triglyceride levels.

Niacin was not well tolerated because of itching and flushing and an underlying concern of liver toxicity and increasing blood glucose levels at higher doses . Most of my patients never stayed on niacin for very long. The recent AIM-HIGH study did not help the niacin cause. This study, as I recall , was designed to demonstrate the benefits of using Niacin in reducing the residual risk of cardiovascular disease in patients with well controlled LDL of 70 mg/dl . Niacin failed to show any added benefit and the study was stopped early because of increased deaths in the treatment group. There are older studies combining Niacin with bile acid resins that were effective in reducing the risk of cardiovascular disease.

Fibric acids( Lopid [gemfibrozil] , Tricor [ fenofibrate] )  This class of drugs  are better tolerated and have been effective in reducing triglycerides and raising HDL . Combining this class of drugs with Statins does increase the risk of muscle problems and should be used with caution.

In general I would not want to go back to the pre-Statin era.

The chart below is a summery published in a good review article . I suggest reading the article for more details.

Have Fun, Be Smart and take advantage of the wonderful advances in medicine
David Calder,MD


From Journal of the American Pharmacists Association

New Guidelines for Managing Hypercholesterolemia

James M. McKenney
Posted: 07/01/2001; J Am Pharm Assoc. 2001;41(4) © 2001 American Pharmaceutical Association

Drug Class, Agents, and Daily DosesAverage Lipid/Lipoprotein EffectsAdverse EffectsContraindicationsClinical Trial Results
Bile acid resins[a]LDL-C ↓15%-30%
HDL-C ↑ 3%-5%
TG -- no change or increase
GI distress, constipation, decreased absorption of other drugsAbsolute:
G > 400 mg/dL
TG > 200 mg/dL
Reduced major
coronary events and CHD death
HMG-CoA reductase inhibitors (statins)[b]LDL-C ↓18%-55%
HDL-C ↑5%-15%
TG ↓7%-30%
Myopathy, increased liver enzymesAbsolute:
Active or chronic liver disease
Concomitant use with certain drugs[c]
Reduced major coronary events, CHD deaths, and total mortality
Nicotinic acid[d]LDL-C ↓5%-25%
HDL-C ↑15%-35%
TG ↓20%-50%
Flushing, hyperglycemia (or gout), upper GI distress, hepatotoxicityAbsolute:
Chronic liver disease
Severe gout
Reduced major coronary events, and possibly total mortality
Fibric acids[e]LDL-C ↓5%-20%
(may be increased in patients with high TG)
HDL-C ↑10%-20%
TG ↓10%-50%
Dyspepsia, gallstones, myopathyAbsolute:
Severe renal disease
Severe hepatic disease
Reduced major coronary events, increased non-CHD mortality (2 of 5 clinical trials)

1 comment:

  1. This blog is great source for Medium Chain Triglycerides information which is very useful for me. Thank you very much.

    To reduce triglycerides


Your comments and questions are appreciated. David Calder,MD