Current and new therapy for hypercholesterolemia

Abstract

Until recently, the mainstays of pharmacotherapy for hypercholesterolemia were the bile-acid sequestrants and nicotinic acid. Although effective, they are difficult to administer and patient compliance is poor, especially with the higher dosage regimens. With the arrival of the first of the HMG CoA reductase inhibitors, physicians treating patients with elevated cholesterol levels have access to well-tolerated, effective medications for lowering serum low density lipoprotein cholesterol and the attendant risks of coronary heart disease. These drugs are new, however, and their long-term safety has not been established. Extended safety data are available for gemfibrozil, which recently has been shown to reduce significantly coronary heart disease end-points. Such information is not yet available for probucol. Diet should remain the first choice of therapy for hypercholesterolemia. Diet alone should be shown to be insufficient before pharmacotherapy is contemplated, and the diet should be continued even when drugs are added to the therapeutic regimen.