Comparing Hyperlipidemia Control with Daily Versus

Hydroxymethylglutaryl coenzyme A reductase inhibitors(statins) are effective in lowering cholesterol levels and reducing all-cause mortality, nonfatal myocardial infarction or coronary death, and stroke in at-risk patients.1-3 The increase in the treatment of hyperlipidemia with statins has resulted in an increase in the costs of drug thera-py. Finding ways to reach the appropriate endpoints of treating hyperlipidemia and managing the costs is critical to all healthcare systems. One approach to balancing the increasing use and costs is finding alternative dosing strategies using higher tablet strengths at longer dosing in-tervals. If the same quality of disease management can oc-cur at a lower total cost, then that therapy should improve the cost-effectiveness of the specific treatment. Several trials were published assessing the effect of al-ternate-day therapy with statins to evaluate whether the low-density lipoprotein cholesterol (LDL-C) goals can be maintained by using lower doses.4-10 In the earliest studies, lovastatin was used in alternate-day dosing and found to reduce LDL-C by about 20%.4,5 Rindone et al.6 compared the LDL-C values in a group of patients taking fluvastatin 20 mg daily or 40 mg every other day. The 2 regimens lowered LDL-C by 24 % and 21%, respectively, a statisti-cally nonsignificant difference. Other studies reported effi-cacy using alternate-day dosing of atorvastatin, simvastatin, and the combination of simvastatin and fenofibrate.7-9 One trial compared weekly dosing of atorvastatin 20 mg wit