What are the Comparative Risks versus Benefits for Bile Acid Sequestrants, HMG Co-A Reductase Inhibitors, Nicotinic Acid, Probucol, and Fibric Acid Derivatives?
Abundant evidence recently confirmed by several clinical trials in man, now indicates that lowering elevated levels of LDL cholesterol is beneficial (1–3). Morphologic studies, animal experiments with non-human primates as well as genetic metabolic, and epidemiologic studies in man have strongly linked plasma cholesterol levels (especially LDL cholesterol excess) to coronary artery disease risk. Lowering LDL cholesterol levels with several different medications has prevented coronary artery disease morbidity and mortality. In the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT), a double-blind, randomized multicenter primary prevention trial that compared cholestyramine 24 gms/day to placebo a 19% fall in the seven-year incidence of myocardial infarction and coronary heart disease (CHD) death attended a 12.5% reduction of LDL cholesterol and a 3% increase in HDL cholesterol in the treatment group (4,5). In the Helsinki Heart Study (6) another double-blind randomized primary prevention trial treatment with gemfibrozil 600 mgs B.I.D. led to a 11% fall in LDL cholesterol, a 11% increase in HDL cholesterol, and a 34% reduction in definite CHD events over a five-year period.
KeywordsAcanthosis Nigricans Bile Acid Sequestrant Fibric Acid Derivative Helsinki Heart Study Coronary Drug Project
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