MARY J. MALLOY, M.D.; JOHN P. KANE, M.D., Ph.D.; STEVEN T. KUNITAKE, Ph.D.; PEGGY TUN, M.D.
Objective: To compare the effectiveness of the ternarydrug combination of colestipol, niacin, and lovastatin with binary combinations of those drugs in treating patients with familial hypercholesterolemia.
Design: An open sequential study of serum lipoprotein responses in patients receiving diet alone (mean duration, 4 months); colestipol and niacin with diet (mean duration, 9 months); and colestipol, niacin, and lovastatin with diet (mean duration, 15 months).
Setting: Metabolic ward and lipid clinic of a university medical center.
Patients: Twenty-two patients with clinical characteristics of familial hypercholesterolemia (low-density-lipoprotein cholesterol, > 8.48 mmol/L; 21 of 22 with tendon xanthomas).
Interventions: Diet: less than 200 mg/d of cholesterol and less than 8% of total calories from saturated fat; colestipol, 30 g/d; lovastatin, 40 to 60 mg/d; and niacin, 1.5 to 7.5 g/d.
Measurements and Main Results: Mean total serum cholesterol and low-density-lipoprotein cholesterol levels of 4.86 ± 0.62 mmol/L (188 ± 24 mg/dL SD) and 2.89 ± 0.54 mmol/L (112 ± 21 mg/dL SD), respectively, were significantly lower during ternary-drug treatment than during colestipol-niacin treatment (p < 0.003) or during treatment in which other possible binary combinations were given. The cholesterol content of very low-density-lipoproteins was lower and high-density-lipoprotein cholesterol levels higher during this phase than during the colestipol-niacin phase.
Conclusions: Colestipol, lovastatin, and niacin are mutually complementary in treating hypercholesterolemia. This regimen produces reductions in serum cholesterol levels similar to those associated with regression of atheromatous plaques in animal studies.
MARY J. MALLOY, JOHN P. KANE, STEVEN T. KUNITAKE, PEGGY TUN. Complementarity of Colestipol, Niacin, and Lovastatin in Treatment of Severe Familial Hypercholesterolemia. Ann Intern Med. 1987;107:616–623. doi: 10.7326/0003-4819-107-5-616
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Published: Ann Intern Med. 1987;107(5):616-623.
Cardiology, Coronary Risk Factors, Dyslipidemia.
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