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Complementarity of Colestipol, Niacin, and Lovastatin in Treatment of Severe Familial Hypercholesterolemia

[+] Article, Author, and Disclosure Information

Colestipol was provided by Dr. Nicholas Andreadis of the Upjohn Company, Kalamazoo, Michigan; and lovastatin by Dr. Jonathan Tolbert of Merck and Company, Inc., Rahway, New Jersey.

▸Requests for reprints should be addressed to Mary J. Malloy, M.D.; Cardiovascular Research Institute, University of California; San Francisco, CA 94143-0130.

San Francisco, California

©1987 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1987;107(5):616-623. doi:10.7326/0003-4819-107-5-616
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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.





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