EFFICACY OF LOW-DOSE CHOLESTEROL-LOWERING DRUG-THERAPY IN MEN WITH MODERATE HYPERCHOLESTEROLEMIA

Objective: To test the potency of low-dose cholesterol-lowering drug t herapy in patients with moderate hypercholesterolemia and to evaluate the effectiveness for cholesterol lowering of a safe regimen to be use d in primary prevention of coronary heart disease. Design: The efficac y of three drug regimens (cholestyramine resin, 8 g/d; cholestyramine resin, 8 g/d, plus lovastatin, 5 mg/d; and lovastatin, 20 mg/d) was te sted in 26 men aged 31 to 70 years with moderate hypercholesterolemia after a Step-One cholesterol-lowering diet. Each drug period was 3 mon ths in duration, interspersed by a I-month period of the Step-One diet only. Blood for lipid and lipoprotein measurements was obtained on 5 different days during the last 2 weeks of each drug and diet only peri od. Results: Cholestyramine resin therapy at 8 g/d achieved a signific ant reduction in low-density lipoprotein cholesterol levels from 4.47 mmol/L (173 mg/dL) to 3.90 mmol/L (151 mg/dL) (P<.005). The addition o f 5 mg of lovastatin to cholestyramine therapy achieved even lower lev els, averaging 3.39 mmol/L (131 mg/dL) (P<.005). Lovastatin therapy at 20 mg/d produced lowering of low-density lipoprotein cholesterol leve ls similar to that of the low-dose combination. Conclusions: Low-dose combination drug therapy for the management of hypercholesterolemia ap pears to be an effective means of lowering cholesterol levels that rem ain persistently elevated after dietary therapy; at the same time, it should carry a low risk of toxic effects.