0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
744 Hypercholesterolemia
Men <35 and premenopausal women:
LDL cholesterol <190 mg/dl
Men > 35 and women >45 with <2 other cardiovascular risk
factors:
LDL cholesterol <160 mg/dl
Adults with≥2 other cardiovascular risk factors:
LDL cholesterol <130 mg/dl
Diabetes mellitus or family history of early cardiovascular
disease:
LDL cholesterol <100 mg/dl
Secondary prevention:
LDL cholesterol <100 mg/dlspecific therapy
■Statins
➣currently first line agents
➣several available: lovastatin, pravastatin, simvastatin, fluvastatin,
atorvastatin, and rosuvastatin
➣15–45% reduction in total cholesterol, 20–60% reduction in LDL
cholesterol
➣25–40% reduction in cardiovascular mortality
➣20–30% reduction in all cause mortality
■Cholesterol absorption inhibitor
➣ezetimibe
➣add to statin or use if statin not tolerated
➣15–20% reduction in total and LDL cholesterol
➣no outcomes studies yet
■Bile acid sequestrants
➣colestipol, cholestyramine
➣should be given with meals
➣add to statin or use if statin not tolerated
➣15–25% reduction in total and LDL cholesterol
➣up to 20% reduction in cardiovascular events
➣no significant effects on cardiovascular or all cause mortality
■Niacin
➣crystalline, time-released
➣start at low dose and titrate weekly up to therapeutic level
➣can add to statin or bile acid sequestrant
➣more effective for hypertriglyceridemia
➣10–15% reduction in total and LDL cholesterol, increase HDL
cholesterol
➣20–25% reduction in cardiovascular events