Niacin-ER and Lovastatin Treatment of Hypercholesterolemia

Reduction of total cholesterol (TC) and low-densitylipoprotein cholesterol (LDL-C) is highly effective in reducing coronary events in the primary and secondary prevention of coronary artery disease (CAD).1-5 While the focus on drug therapy has been toward lowering LDL-C, it has recently been strongly recommended that high-density lipoprotein cholesterol (HDL-C) also be evaluated for ther-apeutic intervention. It is estimated that one-third of pa-tients with CAD who have concentrations of LDL-C <100 mg/dL or, at most, 130 mg/dL will not necessarily benefit from further reduction.6,7 However, results from the Heart Protection Study8 (n = 20 536) showed that those with LDL-C <100 mg/dL at baseline treated with a hydrox-ymethylglutaryl coenzyme A (HMG-CoA) reductase in-hibitor (statin) reduced the rate of myocardial infarction, stroke, and revascularization by 25 % (p < 0.001). As a re-sult, the clinical practice of aggressive LDL-C reduction and the benefits of ancillary effects of statins are becoming more accepted. However, not all individuals benefit from aggressive therapy in clinical practice. There are several reasons for these varied responses: differing dosing strategies and indi