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Management of Primary Mixed Hyperlipidemia With Lovastatin

Management of Primary Mixed Hyperlipidemia With Lovastatin Abstract • Many patients with high levels of serum total cholesterol have a concomitant elevation of serum triglyceride levels and thus have mixed hyperlipidemia. In this study, 13 patients with mixed hyperlipidemia were treated with the cholesterol-lowering drug lovastatin to determine its effectiveness. In 9 of these patients, lovastatin therapy used alone was compared with the drug combination of lovastatin and gemfibrozil. In the 13 patients, lovastatin therapy produced a 31% reduction in total cholesterol level and a 32% decrease in triglyceride levels compared with placebo. It lowered very-low-density plus intermediate-density lipoprotein cholesterol levels by 40%, low-density lipoprotein cholesterol levels by 36%, and total apolipoprotein B levels by 28%. Concentrations of high-density lipoprotein cholesterol and apolipoprotein A-I were unchanged, but total cholesterol (and low-density lipoprotein cholesterol)/high-density lipoprotein cholesterol ratios were markedly reduced. Compared with lovastatin alone, lovastatin plus gemfibrozil produced greater decreases in very-low-density plus intermediate-density lipoprotein cholesterol levels and an increase in high-density lipoprotein cholesterol levels, but, in view of the higher risk for severe myopathy with this combination, lovastatin used alone may be adequate therapy for many patients with mixed hyperlipidemia. (Arch Intern Med. 1990;150:1313-1319) References 1. National Center for Health Statistics: Total serum cholesterol levels of adults 20 to 74 years of age: United States, 1976-1980 . Washington, DC: Dept of Health and Human Services; May 1986. Publication (DHS) 86-1686. Vital and Health Statistics, Series II, No. (236) . 2. Lipid Research Clinics Program Epidemiological Committee: Plasma lipid distributions in selected North American populations: the Lipid Research Clinics Program Prevalence Study . Circulation . 1979;60:427-439.Crossref 3. Heiss G, Tamir I, Davis C, et al. The Lipid Research Clinic Study: lipoprotein-cholesterol distributions in selected North American populations . Circulation . 1980;60:302-315.Crossref 4. Castelli WP. The triglyceride issue: a view from Framingham . Am Heart J . 1986;112:432-437.Crossref 5. Gordon T, Castelli WP, Hjortland MC, et al. High density lipoprotein as a protective factor against coronary heart disease: the Framingham Study . Am J Med . 1977;62:707-714.Crossref 6. Goldstein JL, Hazzard WR, Schrott HG, Bierman EL, Motulsky AG. Hyperlipidemia in coronary heart disease, I: lipid levels in 500 survivors of myocardial infarction . J Clin Invest . 1973;52:1533-1543.Crossref 7. Goldstein JL, Schrott HG, Hazzard WR, Bierman EL, Motulsky AG. Hyperlipidemia in coronary heart disease, II: genetic analysis of the lipid levels in 176 families and delineation of a new inherited disorder, combined hyperlipidemia . J Clin Invest. 1973;52:1544-1568.Crossref 8. Grundy SM, Chait A, Brunzell JD. Familial combined hyperlipidemia workshop . Arteriosclerosis . 1987;7:203-207. 9. Brunzell JD. Obesity and risk for cardiovascular disease . In: Greenwood MRC, ed. Contemporary Issues in Clinical Nutrition: Obesity . New York, NY: Churchill Livingstone; 1983;4:3-16. 10. The Expert Panel. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med . 1988;148:36-69.Crossref 11. Beil U, Crouse JR, Einarsson K, Grundy SM. Effects of interruption of the enterohepatic circulation of bile acids on the transport of very low density lipoprotein-triglycerides . Metabolism . 1982;31:438-444.Crossref 12. Vega GL, Grundy SM. Gemfibrozil therapy in primary hypertriglyceridemia associated with coronary heart disease . JAMA . 1985;253:2398-2403.Crossref 13. East C, Bilheimer DW, Grundy SM. Combination drug therapy for treatment of familial combined hyperlipidemia, types IIB and IV . Ann Intern Med . 1988;109:25-32.Crossref 14. Lipid and Lipoprotein Analysis in Manuals of Laboratory Operations , Lipid Research Clinic Program . Washington, DC: Dept of Health, Education, and Welfare; 1974. Publication NIH/75-628. 15. Grundy SM, Vega GL. Influence of mevinolin on metabolism of low density lipoproteins in primary moderate hypercholesterolemia . J Lipid Res . 1985;26:1464-1475. 16. Vega GL, Grundy SM. Treatment of primary moderate hypercholesterolemia with mevinolin and colestipol . JAMA . 1987;257:33-38.Crossref 17. Vega GL, Grundy SM. Lovastatin therapy in nephrotic hyperlipidemia: effects on lipoprotein metabolism . Kidney Int . 1988;33:1160-1168.Crossref 18. Illingworth DR, Sexton GJ. Hypocholesterolemic effects of mevinolin in patients with heterozygous familial hypercholesterolemia . J Clin Invest . 1984;74:1972-1978.Crossref 19. Mabuchi H, Haba T, Tatami R, et al. Effects of an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase on serum lipoproteins and ubiquinone-10-levels in patients with familial hypercholesterolemia . N Engl J Med . 1981;305:478-482.Crossref 20. Blane GF, Bogaievsky Y. Bonnefous F. Fenofibrate: influence on circulating lipids and side effects in medium and long-term clinical use . In: Fears R, ed. Pharmacological Control of Hyperlipidemia . Barcelona, Spain: JR Prous Science Publishers; 1986:187-216. 21. Grundy SM, Mok HY. Colestipol, clofibrate, and phytosterols in combined therapy of hyperlipidemia . J Lab Clin Med . 1977;89:354-366. 22. Roeschlau P, Bernt E, Gruber W. Enzymatic determination of total cholesterol in serum . Z Klin Chem Klin Biochem . 1974;12:226-227. 23. McGowan MW, Artis JD, Strandbergh DR, Zak B. A peroxidase-coupled method for the colorimetric determination of serum triglycerides . Clin Chem . 1983;29:538-542. 24. Grundy SM. Comparison of monosaturated fatty acids and carbohydrates for plasma cholesterol lowering . N Engl J Med . 1986;314:745-748.Crossref 25. Lindgren FT, Jensen LC, Hatch FT. The isolation and quantitative analysis of serum lipoproteins in blood lipids and lipoproteins . In: Nelson GS, ed. Quantitation, Composition and Metabolism . New York, NY: Wiley Interscience; 1972:181-274. 26. Markwell MAK, Haas SM, Tolbert NE, Bieber LL. Protein determination in membrane and lipoprotein samples: manual and automated procedures . Methods Enzymol . 1981;72:296-303. 27. Lowry OH, Rosebrough NJ, Farr AL, Randall RJ. Protein measurement with the Folin phenol reagent . J Biol Chem . 1951;193:265-275. 28. Vega GL, Grundy SM. Comparison of apolipoprotein B to cholesterol in low density lipoproteins of patients with coronary heart disease . J Lipid Res . 1984;25:580-592. 29. Vega GL, Groszek E, Wolf R, Grundy SM. Influence of polyunsaturated fats on plasma lipoprotein composition and apolipoprotein . J Lipid Res . 1982;23:811-822. 30. Weisgraber KH, Rall SC, Mahley RW. Cysteamine modification as an aid in apolipoprotein E phenotyping . In: Lippel K, ed. Proceedings of the Workshop on Lipoprotein Quantifications . Washington, DC: Dept of Health and Human Services; 1983:404-407. Publication 83-1266. 31. Rall SC Jr, Weisgraber KH, Mahley RW. Isolation and characterization of apolipoprotein E . Methods Enzymol . 1986;128:273-287. 32. The Consensus Development Conference on the Treatment of Hypertriglyceridemia, National Institutes of Health . JAMA . 1984;251:1196-1200.Crossref 33. Grundy SM, Vega GL, Bilheimer DW. Kinetic mechanisms determining variability in low density lipoprotein levels and their rise with age . Arteriosclerosis . 1985;5:623-630.Crossref 34. Grundy SM. HMG-CoA reductase inhibitors for treatment of hypercholesterolemia . N Engl J Med . 1988;319:24-33.Crossref 35. Uauy R, Vega GL, Grundy SM, Bilheimer DW. Lovastatin therapy in receptor-negative homozygous familial hypercholesterolemia: lack of effect on low density lipoprotein concentrations or turnover . J Pediatr . 1988;113:387-392.Crossref 36. Vega GL, East C, Grundy SM. Lovastatin therapy in familial dysbetalipoproteinemia: effects on kinetics of apolipoprotein B . Atherosclerosis . 1988;70:131-143.Crossref 37. Garg A, Grundy SM. Lovastatin for lowering cholesterol levels in non-insulin-dependent diabetes mellitus . N Engl J Med . 1988;318:81-86.Crossref 38. Ginsberg HN, Le N-A, Short MP, Ramakrishnan R, Desnick RJ. Suppression of apolipoprotein B production during treatment of cholesterol ester storage disease with lovastatin: implication for regulation of apolipoprotein B . J Clin Invest . 1987;80:1692-1698.Crossref 39. Brunzell JD, Sniderman AD, Albers JJ, Kwiterovich PO Jr. Apoproteins B and AI and coronary artery disease in humans . Arteriosclerosis . 1984;4:79-83.Crossref 40. Tatami R, Mabuchi H, Ueda K, et al. Intermediate-density lipoprotein and cholesterol-rich very low density lipoprotein in angiographically determined coronary artery disease . Circulation . 1981;64:1174-1184.Crossref 41. Reardon MF, Nestel PJ, Craig IH, Harper RW. Lipoprotein predictors of the severity of coronary artery disease in men and women . Circulation . 1985;71:881-888.Crossref 42. Krauss RM, Williams PT, Brensike J, et al. Intermediate-density lipoproteins and progression of coronary artery disease in hypercholesterolemic men . Lancet . 1987;2:62-66.Crossref 43. Carlson LA, Olsson AG, Oro L, et al. Effects of hyperlipidemia regimes on serum lipoproteins . In: Schettler G, ed. Atherosclerosis III . New York, NY: A Weizel-Springer-Verlag; 1974:768-781. 44. Sniderman A, Shapiro S, Marpole D, Skinner B, Teng B, Kwiterovich PO Jr. Association of coronary atherosclerosis with hyperapobetalipoproteinemia (increased protein but normal cholesterol levels in human plasma low density (B) lipoproteins) . Proc Natl Acad Sci USA . 1980;77:604-608.Crossref 45. Sniderman A, Wolfson C, Teng B, Franklin FA, Bachorik PS, Kwiterovich PO. Association of hyperapobetalipoproteinemia with endogenous hypertriglyceridemia and atherosclerosis . Ann Intern Med . 1982;97:833-839.Crossref 46. Avogaro P, Holo B, Bon G, Cazzolato G, Quinci GB, Belussi F. Plasma levels of apolipoprotein A-I and apolipoprotein B in human atherosclerosis . Artery . 1978;4:385-394. 47. DeBacker G, Rosseneu M, Deslypise JP. Discriminative value of lipids and apoproteins in coronary heart disease . Atherosclerosis . 1982;42:197-203.Crossref 48. Grundy SM, Goodman DW, Rifkind BM, Cleeman JI. The place of HDL in cholesterol management: a perspective from the National Cholesterol Education Program . Arch Intern Med . 1989;149:505-510.Crossref 49. Grundy SM, Vega GL. Fibric acids: effects on lipids and lipoprotein metabolism . Am J Med . 1987;83:9-20.Crossref 50. Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primaryprevention trial with gemfibrozil in middle-aged men with dyslipidemia: safety of treatment, changes in risk factors, and incidence of coronary heart disease . N Engl J Med . 1987;317:1237-1245.Crossref 51. Manninen V, Elo MO, Frick MH, et al. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study . JAMA . 1988;260:641-651.Crossref 52. Coronary Drug Project Research Group. Clofibrate and niacin in coronary heart disease . JAMA . 1975;231:360-381.Crossref 53. Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin . J Am Coll Cardiol . 1986;8:1245-1255.Crossref 54. Kane JP, Malloy MJ, Tun P, et al. Normalization of low-density-lipoprotein levels in heterozygous familial hypercholesterolemia with a combined drug regimen . N Engl J Med . 1981;304:251-258.Crossref 55. Blankenhorn DH, Nessin SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA . 1987;257:3233-3240.Crossref 56. Tobert JA. Efficacy and long-term adverse effect pattern of lovastatin . Am J Cardiol . 1988;62:28J-34J.Crossref 57. East C, Alvivizatos PA, Grundy SM, Jones PH, Farmer JA. Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation . N Engl J Med . 1988;318:47-48.Crossref 58. Corpier CL, Jones PH, Suki WN, et al. Rhabdomyolysis and renal injury with lovastatin use: report of two cases in cardiac transplant recipients . JAMA . 1988;260:239-241.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Management of Primary Mixed Hyperlipidemia With Lovastatin

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American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390180119022
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Abstract

Abstract • Many patients with high levels of serum total cholesterol have a concomitant elevation of serum triglyceride levels and thus have mixed hyperlipidemia. In this study, 13 patients with mixed hyperlipidemia were treated with the cholesterol-lowering drug lovastatin to determine its effectiveness. In 9 of these patients, lovastatin therapy used alone was compared with the drug combination of lovastatin and gemfibrozil. In the 13 patients, lovastatin therapy produced a 31% reduction in total cholesterol level and a 32% decrease in triglyceride levels compared with placebo. It lowered very-low-density plus intermediate-density lipoprotein cholesterol levels by 40%, low-density lipoprotein cholesterol levels by 36%, and total apolipoprotein B levels by 28%. Concentrations of high-density lipoprotein cholesterol and apolipoprotein A-I were unchanged, but total cholesterol (and low-density lipoprotein cholesterol)/high-density lipoprotein cholesterol ratios were markedly reduced. Compared with lovastatin alone, lovastatin plus gemfibrozil produced greater decreases in very-low-density plus intermediate-density lipoprotein cholesterol levels and an increase in high-density lipoprotein cholesterol levels, but, in view of the higher risk for severe myopathy with this combination, lovastatin used alone may be adequate therapy for many patients with mixed hyperlipidemia. (Arch Intern Med. 1990;150:1313-1319) References 1. National Center for Health Statistics: Total serum cholesterol levels of adults 20 to 74 years of age: United States, 1976-1980 . Washington, DC: Dept of Health and Human Services; May 1986. Publication (DHS) 86-1686. Vital and Health Statistics, Series II, No. (236) . 2. Lipid Research Clinics Program Epidemiological Committee: Plasma lipid distributions in selected North American populations: the Lipid Research Clinics Program Prevalence Study . Circulation . 1979;60:427-439.Crossref 3. Heiss G, Tamir I, Davis C, et al. The Lipid Research Clinic Study: lipoprotein-cholesterol distributions in selected North American populations . Circulation . 1980;60:302-315.Crossref 4. Castelli WP. The triglyceride issue: a view from Framingham . Am Heart J . 1986;112:432-437.Crossref 5. Gordon T, Castelli WP, Hjortland MC, et al. High density lipoprotein as a protective factor against coronary heart disease: the Framingham Study . Am J Med . 1977;62:707-714.Crossref 6. Goldstein JL, Hazzard WR, Schrott HG, Bierman EL, Motulsky AG. Hyperlipidemia in coronary heart disease, I: lipid levels in 500 survivors of myocardial infarction . J Clin Invest . 1973;52:1533-1543.Crossref 7. Goldstein JL, Schrott HG, Hazzard WR, Bierman EL, Motulsky AG. Hyperlipidemia in coronary heart disease, II: genetic analysis of the lipid levels in 176 families and delineation of a new inherited disorder, combined hyperlipidemia . J Clin Invest. 1973;52:1544-1568.Crossref 8. Grundy SM, Chait A, Brunzell JD. Familial combined hyperlipidemia workshop . Arteriosclerosis . 1987;7:203-207. 9. Brunzell JD. Obesity and risk for cardiovascular disease . In: Greenwood MRC, ed. Contemporary Issues in Clinical Nutrition: Obesity . New York, NY: Churchill Livingstone; 1983;4:3-16. 10. The Expert Panel. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med . 1988;148:36-69.Crossref 11. Beil U, Crouse JR, Einarsson K, Grundy SM. Effects of interruption of the enterohepatic circulation of bile acids on the transport of very low density lipoprotein-triglycerides . Metabolism . 1982;31:438-444.Crossref 12. Vega GL, Grundy SM. Gemfibrozil therapy in primary hypertriglyceridemia associated with coronary heart disease . JAMA . 1985;253:2398-2403.Crossref 13. East C, Bilheimer DW, Grundy SM. Combination drug therapy for treatment of familial combined hyperlipidemia, types IIB and IV . Ann Intern Med . 1988;109:25-32.Crossref 14. Lipid and Lipoprotein Analysis in Manuals of Laboratory Operations , Lipid Research Clinic Program . Washington, DC: Dept of Health, Education, and Welfare; 1974. Publication NIH/75-628. 15. Grundy SM, Vega GL. Influence of mevinolin on metabolism of low density lipoproteins in primary moderate hypercholesterolemia . J Lipid Res . 1985;26:1464-1475. 16. Vega GL, Grundy SM. Treatment of primary moderate hypercholesterolemia with mevinolin and colestipol . JAMA . 1987;257:33-38.Crossref 17. Vega GL, Grundy SM. Lovastatin therapy in nephrotic hyperlipidemia: effects on lipoprotein metabolism . Kidney Int . 1988;33:1160-1168.Crossref 18. Illingworth DR, Sexton GJ. Hypocholesterolemic effects of mevinolin in patients with heterozygous familial hypercholesterolemia . J Clin Invest . 1984;74:1972-1978.Crossref 19. Mabuchi H, Haba T, Tatami R, et al. Effects of an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase on serum lipoproteins and ubiquinone-10-levels in patients with familial hypercholesterolemia . N Engl J Med . 1981;305:478-482.Crossref 20. Blane GF, Bogaievsky Y. Bonnefous F. Fenofibrate: influence on circulating lipids and side effects in medium and long-term clinical use . In: Fears R, ed. Pharmacological Control of Hyperlipidemia . Barcelona, Spain: JR Prous Science Publishers; 1986:187-216. 21. Grundy SM, Mok HY. Colestipol, clofibrate, and phytosterols in combined therapy of hyperlipidemia . J Lab Clin Med . 1977;89:354-366. 22. Roeschlau P, Bernt E, Gruber W. Enzymatic determination of total cholesterol in serum . Z Klin Chem Klin Biochem . 1974;12:226-227. 23. McGowan MW, Artis JD, Strandbergh DR, Zak B. A peroxidase-coupled method for the colorimetric determination of serum triglycerides . Clin Chem . 1983;29:538-542. 24. Grundy SM. Comparison of monosaturated fatty acids and carbohydrates for plasma cholesterol lowering . N Engl J Med . 1986;314:745-748.Crossref 25. Lindgren FT, Jensen LC, Hatch FT. The isolation and quantitative analysis of serum lipoproteins in blood lipids and lipoproteins . In: Nelson GS, ed. Quantitation, Composition and Metabolism . New York, NY: Wiley Interscience; 1972:181-274. 26. Markwell MAK, Haas SM, Tolbert NE, Bieber LL. Protein determination in membrane and lipoprotein samples: manual and automated procedures . Methods Enzymol . 1981;72:296-303. 27. Lowry OH, Rosebrough NJ, Farr AL, Randall RJ. Protein measurement with the Folin phenol reagent . J Biol Chem . 1951;193:265-275. 28. Vega GL, Grundy SM. Comparison of apolipoprotein B to cholesterol in low density lipoproteins of patients with coronary heart disease . J Lipid Res . 1984;25:580-592. 29. Vega GL, Groszek E, Wolf R, Grundy SM. Influence of polyunsaturated fats on plasma lipoprotein composition and apolipoprotein . J Lipid Res . 1982;23:811-822. 30. Weisgraber KH, Rall SC, Mahley RW. Cysteamine modification as an aid in apolipoprotein E phenotyping . In: Lippel K, ed. Proceedings of the Workshop on Lipoprotein Quantifications . Washington, DC: Dept of Health and Human Services; 1983:404-407. Publication 83-1266. 31. Rall SC Jr, Weisgraber KH, Mahley RW. Isolation and characterization of apolipoprotein E . Methods Enzymol . 1986;128:273-287. 32. The Consensus Development Conference on the Treatment of Hypertriglyceridemia, National Institutes of Health . JAMA . 1984;251:1196-1200.Crossref 33. Grundy SM, Vega GL, Bilheimer DW. Kinetic mechanisms determining variability in low density lipoprotein levels and their rise with age . Arteriosclerosis . 1985;5:623-630.Crossref 34. Grundy SM. HMG-CoA reductase inhibitors for treatment of hypercholesterolemia . N Engl J Med . 1988;319:24-33.Crossref 35. Uauy R, Vega GL, Grundy SM, Bilheimer DW. Lovastatin therapy in receptor-negative homozygous familial hypercholesterolemia: lack of effect on low density lipoprotein concentrations or turnover . J Pediatr . 1988;113:387-392.Crossref 36. Vega GL, East C, Grundy SM. Lovastatin therapy in familial dysbetalipoproteinemia: effects on kinetics of apolipoprotein B . Atherosclerosis . 1988;70:131-143.Crossref 37. Garg A, Grundy SM. Lovastatin for lowering cholesterol levels in non-insulin-dependent diabetes mellitus . N Engl J Med . 1988;318:81-86.Crossref 38. Ginsberg HN, Le N-A, Short MP, Ramakrishnan R, Desnick RJ. Suppression of apolipoprotein B production during treatment of cholesterol ester storage disease with lovastatin: implication for regulation of apolipoprotein B . J Clin Invest . 1987;80:1692-1698.Crossref 39. Brunzell JD, Sniderman AD, Albers JJ, Kwiterovich PO Jr. Apoproteins B and AI and coronary artery disease in humans . Arteriosclerosis . 1984;4:79-83.Crossref 40. Tatami R, Mabuchi H, Ueda K, et al. Intermediate-density lipoprotein and cholesterol-rich very low density lipoprotein in angiographically determined coronary artery disease . Circulation . 1981;64:1174-1184.Crossref 41. Reardon MF, Nestel PJ, Craig IH, Harper RW. Lipoprotein predictors of the severity of coronary artery disease in men and women . Circulation . 1985;71:881-888.Crossref 42. Krauss RM, Williams PT, Brensike J, et al. Intermediate-density lipoproteins and progression of coronary artery disease in hypercholesterolemic men . Lancet . 1987;2:62-66.Crossref 43. Carlson LA, Olsson AG, Oro L, et al. Effects of hyperlipidemia regimes on serum lipoproteins . In: Schettler G, ed. Atherosclerosis III . New York, NY: A Weizel-Springer-Verlag; 1974:768-781. 44. Sniderman A, Shapiro S, Marpole D, Skinner B, Teng B, Kwiterovich PO Jr. Association of coronary atherosclerosis with hyperapobetalipoproteinemia (increased protein but normal cholesterol levels in human plasma low density (B) lipoproteins) . Proc Natl Acad Sci USA . 1980;77:604-608.Crossref 45. Sniderman A, Wolfson C, Teng B, Franklin FA, Bachorik PS, Kwiterovich PO. Association of hyperapobetalipoproteinemia with endogenous hypertriglyceridemia and atherosclerosis . Ann Intern Med . 1982;97:833-839.Crossref 46. Avogaro P, Holo B, Bon G, Cazzolato G, Quinci GB, Belussi F. Plasma levels of apolipoprotein A-I and apolipoprotein B in human atherosclerosis . Artery . 1978;4:385-394. 47. DeBacker G, Rosseneu M, Deslypise JP. Discriminative value of lipids and apoproteins in coronary heart disease . Atherosclerosis . 1982;42:197-203.Crossref 48. Grundy SM, Goodman DW, Rifkind BM, Cleeman JI. The place of HDL in cholesterol management: a perspective from the National Cholesterol Education Program . Arch Intern Med . 1989;149:505-510.Crossref 49. Grundy SM, Vega GL. Fibric acids: effects on lipids and lipoprotein metabolism . Am J Med . 1987;83:9-20.Crossref 50. Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primaryprevention trial with gemfibrozil in middle-aged men with dyslipidemia: safety of treatment, changes in risk factors, and incidence of coronary heart disease . N Engl J Med . 1987;317:1237-1245.Crossref 51. Manninen V, Elo MO, Frick MH, et al. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study . JAMA . 1988;260:641-651.Crossref 52. Coronary Drug Project Research Group. Clofibrate and niacin in coronary heart disease . JAMA . 1975;231:360-381.Crossref 53. Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin . J Am Coll Cardiol . 1986;8:1245-1255.Crossref 54. Kane JP, Malloy MJ, Tun P, et al. Normalization of low-density-lipoprotein levels in heterozygous familial hypercholesterolemia with a combined drug regimen . N Engl J Med . 1981;304:251-258.Crossref 55. Blankenhorn DH, Nessin SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA . 1987;257:3233-3240.Crossref 56. Tobert JA. Efficacy and long-term adverse effect pattern of lovastatin . Am J Cardiol . 1988;62:28J-34J.Crossref 57. East C, Alvivizatos PA, Grundy SM, Jones PH, Farmer JA. Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation . N Engl J Med . 1988;318:47-48.Crossref 58. Corpier CL, Jones PH, Suki WN, et al. Rhabdomyolysis and renal injury with lovastatin use: report of two cases in cardiac transplant recipients . JAMA . 1988;260:239-241.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1990

References