In the treatment of hypercholesterolemia, medical evidence suggests that although combination therapy is safe and effective, compliance issues continue to prevent patients from achieving full benefit. This issue of Advanced Studies in Medicine, based on the proceedings of a roundtable symposium of national authorities on cholesterol management that took place in Baltimore, Maryland, on December 4, 200l, presents recent clinical evidence supporting the benefits of combination therapy in the treatment of hypercholesterolemia in addition to its potential as a prophylactic measure in delaying cardiac events for patients with normal lipid profiles. In an overview article, David G. Robertson, MD, an endocrinologist with Atlanta Diabetes Associates in Georgia, reviews findings from clinical trials of HMG-CoA reductase inhibitor (statin) and combination therapy and explores issues surrounding compliance.
Dr Robertson also explores clinical evidence supporting the use of combination therapy as a means of achieving even more significant reductions in low-density lipoprotein cholesterol (LDL-C) levels without the side effects associated with high-dose statin monotherapy. Dr Robertson suggests that in patients undergoing statin monotherapy, if the maximum achievable or tolerated dose does not reduce LDL-C levels to below 130 mg/dL, providers are obligated to add a second agent to therapy. Furthermore, he presents clinical evidence that suggests additional therapeutic benefits can be achieved by reducing LDL-C levels to an even lower goal of below 100 mg/dL, with or without combination therapy. He goes on to explore intriguing questions within the medical literature about the role of triglycerides, particle size, and particle numbers as predictors of medical benefit.
In the roundtable discussion and case study that follow, several authorities in the field of dyslipidemia further discuss current concepts and some of these key issues. Emergent findings from clinical evidence identifying opportunities to address multiple contributors to risk, beyond LDL-C, are discussed, pointing to even higher risk reduction with the use of combination therapy. A cost-benefit analysis puts these findings in even sharper perspective.
An additional article includes an interview with Bassem El-Masri, MD, Director of the Cardiac Prevention and Intervention Center at Cornell Medical Center. Dr El-Masri provides additional insights about aggressive approaches to interventions in patients of all ages.
*Associate Professor of Medicine, Johns Hopkins University School of Medicine; Director of Preventive Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
†Professor of Medicine and Pediatrics, Johns Hopkins University School of Medicine; Director, Johns Hopkins University Lipid Clinic; and Chief, Lipid Research, Johns Hopkins University Hospital, Baltimore, Maryland.