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Margo A. Denke, MD; Scott M. Grundy, MD, PhD

Arch Intern Med. 1995;155(4):393-399.

Abstract
Objective
To test the potency of low-dose cholesterol-lowering drug therapy in patients with moderate hypercholesterolemia and to evaluate the effectiveness for cholesterol lowering of a safe regimen to be used in primary prevention of coronary heart disease.

Design
The efficacy of three drug regimens (cholestyramine resin, 8 g/d; cholestyramine resin, 8 g/d, plus lovastatin, 5 mg/d; and lovastatin, 20 mg/d) was tested in 26 men aged 31 to 70 years with moderate hypercholesterolemia after a Step-One cholesterol-lowering diet. Each drug period was 3 months in duration, interspersed by a 1-month period of the Step-One diet only. Blood for lipid and lipoprotein measurements was obtained on 5 different days during the last 2 weeks of each drug and diet-only period.

Results
Cholestyramine resin therapy at 8 g/d achieved a significant reduction in low-density lipoprotein cholesterol levels from 4.47 mmol/L (173 mg/dL) to 3.90 mmol/L (151 mg/dL) (P<.005). The addition of 5 mg of lovastatin to cholestyramine therapy achieved even lower levels, averaging 3.39 mmol/L (131 mg/dL) (P<.005). Lovastatin therapy at 20 mg/d produced lowering of low-density lipoprotein cholesterol levels similar to that of the low-dose combination.

Conclusions
Low-dose combination drug therapy for the management of hypercholesterolemia appears to be an effective means of lowering cholesterol levels that remain persistently elevated after dietary therapy; at the same time, it should carry a low risk of toxic effects.

(Arch Intern Med. 1995;155:393-399)

Author Affiliations
From the Center for Human Nutrition (Drs Denke and Grundy) and Departments of Internal Medicine (Drs Denke and Grundy), Biochemistry (Dr Grundy), and Clinical Nutrition (Dr Grundy), The University of Texas Southwestern Medical Center at Dallas and Veterans Affairs Medical Center, Dallas.

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