DIET AND EXERCISE AND GEMFIBROZIL THERAPY FOR THE MANAGEMENT OF DYSLIPIDEMIA - A CEN-ASTERISK STUDY

Background. Dyslipidemia constitutes a serious health problem that sho uld be diagnosed and treated by the family physician. Little is known about the efficacy of typical dietary therapy for patients with abnorm al cholesterol levels. This study was the first large prospective fami ly practice evaluation of the effectiveness of diet-and-exercise thera py followed by a pharmacologic intervention for those patients who rem ained dyshpidemic. Methods. Patients who met standard criteria for car diovascular disease risk based on lipid analysis were enrolled in a ty pical 6-week physician-directed diet-and-exercise program. Those patie nts who were still dyslipidemic after that period were started on 12 w eeks of pharmacologic treatment with gemfibrozil. Results. Of the 2992 patients screened, 1193 were eligible for participation in the study. The diet-and-exercise program led to a modest change in lipid values (average decrease in total cholesterol of 4.1%). Only 2% of the patien ts achieved desirable levels of all lipid values. Seven hundred thirty -nine subjects qualified for further therapy and were treated with gem fibrozil. Seventy patients discontinued drug therapy because of advers e effects. Those who completed 12 weeks of pharmacologic therapy had a n additional 5.4% reduction in total cholesterol, 3.9% reduction in lo w-density lipoprotein cholesterol, 30.6% reduction in triglycerides, a nd a 17.2% increase in high-density lipoprotein cholesterol. Conclusio ns. These findings suggest that in a typical clinical setting, a nonph armacologic intervention of diet and exercise may not produce the desi red overall lipid changes in the majority of dyslipidemic patients.