Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hypercholesterolemia 745

➣unclear whether any significant effects on cardiovascular or all

cause mortality

■Fibrates

➣clofibrate, gemfibrozil, fenofibrate, gemfibrozil and fenofibrate

preferred

➣can add to statin, bile acid sequestrant, or niacin

➣more effective for hypertriglyceridemia

➣10% reduction in total cholesterol, LDL cholesterol may increase,

not change or decrease, increase HDL cholesterol

➣20–30% reduction in cardiovascular events

➣unclear whether any significant effects on cardiovascular or all

cause mortality

Side Effects & Contraindications

■Statins

➣side effects: elevated AST, ALT, myositis

➣contraindications: pregnancy, breast feeding

■Cholesterol absorption inhibitor

➣side effects: none

➣contraindications: hypersensitivity

■Bile acid sequestrants

➣side effects: constipation, flatulence, abdominal discomfort, fat

malabsorption and fat soluble vitamin deficiency at highest

doses only

➣contraindications: marked hypertriglyceridemia

■Niacin

➣side effects: cutaneous flush, hepatic dysfunction, glucose intol-

erance, hyperuricemia, skin changes with hyperpigmentation

and acanthosis nigracans, increased risk of myositis when com-

bined with statins

➣contraindications:

➣relative: peptic ulcer disease, gout, diabetes mellitus

■Fibrates

➣side effects: abdominal pain, nausea, vomiting, cholelithiasis,

hepatic dysfunction, myositis (risk increased when combined

with statins), potentiate action of oral anticoagulants

➣contraindications:

➣relative: renal insufficiency, pregnancy, breast feeding

follow-up

■Well controlled, stable patients every 6 months

➣Obtain lipid panel, ALT, AST