0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
776 Hypertriglyceridemia➣20–30% reduction in cardiovascular events
➣unclear whether any significant effects on cardiovascular or all
cause mortality
■Niacin
➣crystalline, time-released
➣start at low dose and titrate weekly up to therapeutic level
➣can combine with fibrate
➣20–80% reduction in triglycerides, 10–15% reduction in total and
LDL cholesterol, increase HDL cholesterol
➣20–25% reduction in cardiovascular events
➣unclear whether any significant effects on cardiovascular or all
cause mortality
■Statins
➣several available: lovastatin, pravastatin, simvastatin, fluvastatin,
atorvastatin, and rosuvastatin
➣more effective when cholesterol and apolipoprotein B elevated
➣10–30% reduction in triglycerides, 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
Side Effects & Contraindications
■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 (can be used), breast feed-
ing
■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
■Statins
➣side effects: elevated AST, ALT, myositis
➣contraindications: pregnancy, breast feeding
follow-up
■Well controlled, stable patients every 6 months
➣Obtain lipid panel, ALT, AST