The 1988 US National Cholesterol Education Program Expert Panel Report recommended initial treatment with niacin or bile acid sequestrants, followed by other agents if needed, to lower low-density lipoprotein cholesterol (LDL-C) levels in hypercholesterolemic patients who require drug therapy.
It is unknown how the effectiveness and costs of such an approach ( « stepped care ») compare in typical clinical practice to those of initial therapy with lovastatin.
We randomly assigned 612 patients, aged 20 to 70 years, who met 1988 National Cholesterol Education Program guidelines for drug treatment of elevated LDL-C level and had not previously used cholesterol-lowering medication, to either a stepped-care regimen or initial therapy with lovastatin (both n=306).
The study, conducted at Southern California Kaiser Permanente, was designed to approximate typical practice : provider compliance with treatment plans was encouraged but not enforced, and patients paid for medication as they customarily would.
At 1 year, the decline in mean LDL-C level was significantly greater among patients assigned to initial treatment with lovastatin (22% vs 15% for stepped care ; P<. 001), as was the number who attained goal LDL-C level (¾4.14 mmol/L [¾160 mg/dL], or ¾3.36 mmol/L [¾130 mg/dL] if coronary heart disease or two or more risk factors were present) (40% vs 24% ; P<. 001).
The increase in mean high-density lipoprotein cholesterol...
Mots-clés Pascal : Hypercholestérolémie, Homme, Traitement, Nicotinique acide, Chimiothérapie, Efficacité traitement, Coût, Etude comparative, Lovastatine, Randomisation, Lipide, Métabolisme pathologie, Hyperlipoprotéinémie, Hypolipémiant
Mots-clés Pascal anglais : Hypercholesterolemia, Human, Treatment, Nicotinic acid, Chemotherapy, Treatment efficiency, Costs, Comparative study, Randomization, Lipids, Metabolic diseases, Hyperlipoproteinemia, Antilipemic agent
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0216370
Code Inist : 002B02N. Création : 199608.