USE OF NIACIN, STATINS, AND RESINS IN PATIENTS WITH COMBINED HYPERLIPIDEMIA

Patients in the original Familial Atherosclerosis Treatment Study (FAT S) cohort were subgrouped into those with triglyceride levels less tha n or equal to 120 mg/dl (n = 26) and those with triglyceride levels gr eater than or equal to 190 mg/dl (n = 40). Their therapeutic responses to niacin plus colestipol, lovastatin plus colestipol, colestipol alo ne, or placebo were determined. Therapeutic response was also determin ed in the same 2 triglyceride subgroups (n = 12 and n = 27, respective ly) of patients selected for low levels of high-density lipoprotein (H DL) cholesterol and coronary artery disease. These triglyceride criter ia were chosen to identify patient subgroups with high likelihood of ' 'pattern A'' (normal-size low-density lipoprotein [LDL] particles and triglyceride less than or equal to 120 mg/dl) or ''pattern B'' (small dense LDL and triglyceride greater than or equal to 190 mg/dl). Our fi ndings in these small patient subgroups are consistent with the emergi ng understanding that coronary artery disease patients presenting with high triglyceride levels have lower HDL-C, smaller less buoyant LDL-C , and greater very low-density lipoprotein (VLDL) cholesterol and VLDL apolipoprotein B, and are more responsive to therapy as assessed by a n increase in HDL-C and reduction in triglycerides, VLDL-C, and VLDL a polipoprotein B. In the FATS high-triglyceride subgroup with these cha racteristics, a tendency toward greater therapeutic improvement in cor onary stenosis severity was observed among those treated with either o f the 2 forms of intensive cholesterol-lowering therapy. This improvem ent is associated with therapeutic reduction of LDL-C and elevation of HDL-C, but also appears to be associated with drug-induced improvemen t in LDL buoyancy. (C) 1998 by Excerpta Medica, Inc.