What is the best initial treatment for elevated LDL-C ?
Edward M. Gardner 5/16/97
Routine Screening in a 45 y.o. female detects an elevated LDL-C of 205. She has no other CAD risk factors.
Clinical Bottom Lines:
1. Lovastatin is more effective initial treatment
than a stepped care regimen (SC)
of cholesterol lowering agents.
2. SC saves money and may be appropriate for the patient who pays out of pocket for prescriptions.
An open label, intention to treat, RCT of 612
patients with increased cholesterol who received initial
tovastatin or a stepped care medical treatment plan for 1 year.
SC medications included niacin, bile acid sequestrants, and
|% ach goal||40||24||<0.001||40%||16%||6|
|% dec LDL||22||15||<0.001|
1. SC increased HDL by 8% vs 1% increase for
lovastatin at 1 year.(p<0.001)
2. A subgroup analysis showed that in patients who paid for their prescriptions, decrease in LDL was 19% for SC and 16% for lovastatin.
3. More patients in SC were bothered by side effects, 30%, vs 16% for the lovastatin group.
4. The study tried to approximate conditions of a typical out-patient clinicalpractice.
5. The study was open label.
6. The study was funded by Merck & Co., the makers of lovastatin.
Oster G. Borok GM, Menzin J. et al. Cholesterol-Reduction Intervention Study
(CRIS). A randomized trial to assess effectiveness and costs in clinical practice.
Arch Int Med. 1996;156:731-9.