Mode of action and adverse effects of lipid lowering drugs

Serum lipids, cholesterol and triglycerides are incorporated into hydrophil ic lipoproteins, which include chylomicrons, very low density lipoproteins (VLDL), intermediate density lipoproteins (IDL), low density lipoproteins ( LDL) and high density lipoproteins (HDL). An elevated level of these lipopr oteins, except for HDL, is the basis of all hyperlipidemias. However, only some of the lipoprotein fractions, particularly LDL and remnant particles, are potential risk factors for atherogenesis and subsequent cardiovascular disease. Several classes of pharmacological agents are currently available to increase the breakdown and reduce the synthesis of LDL and remnant facto rs. These include nicotinic acid and its analogs, fibric acid derivatives ( e.g., clofibrate, gemfibrozil, bezafibrate), bile acid resins (e.g., choles tyramine), HMG-CoA reductase inhibitors (e.g., lovastatin, simvastatin, pra vastatin) and probucol. Lipid lowering drugs of different classes have a sy nergistic effect on lipid metabolism and combination therapy is often used. Lipid lowering drugs are prescribed as long-term preventive therapy in app arently asymptomatic people. Several studies indicate that secondary preven tion with lipid lowering drugs is cost-effective, particularly in patients with symptomatic coronary artery disease. (C) 1998 Prous Science. All right s reserved.