Selecting a Treatment Regimen
Table 8. Pharmacologic Approach to Achieving LDL Particle Number, and Triglyceride Goals2, 5-8 LDL Particle Number (measured Apo B or NMR LDL-P) At Goal
Not at Goal
LDL-C and Non-HDL-C Near or
at goal No further therapya
Statin Therapy (expected LDL particle number decrease) Less Potent Statin (< 35%) (fluvastatin, lovastatin, pravastatin)
More Potent Statin (35-55%) (atorvastatin, pitavastatin, rosuvastatin, simvastatin)
Bile Acid Sequestrant Therapy (expected LDL particle number decrease) colestipol, cholestyramine, colesevelam (15-30%)
Cholesterol Absorption Inhibitor Therapy (expected LDL particle number decrease) ezetimibe (15-25%)
Combination Therapies (expected LDL particle number decrease) Statin + ezetimibe/bile acid sequestrants (50-70%) Statin + Niacin (50-70%) Statin + ezetimibe/bile acid sequestrant + niacin (> 60%)
Triglyceride (TG)
< 500 mg/dL May consider TG
lowering therapy based on clinical judgment
> 500 mg/dL TG lowering
3. Omega-3 (Fish Oil) (20-45%)
therapy (expected TG decrease) 1. Niacin (20-45%) 2. Fibrateb
LDL Lowering Therapy (see above) (20-50%)
Priority 1 – LDL lowering Priority 2 – TG lowering Consider additional therapy (expected LDL particle number decrease) Niacin (5-25%) Fibrateb
Omega-3 (Fish Oil) DHA + EPA (Neutral to 3-5%—not significant in multiple trials) EPA only (4-15%)
(5-20%)
a More aggressive therapy may be needed based on clinical judgment. b
Fenofibrate of fenofibric acid preferred over gemfibrozil for combination therapy due to increased risk of rhabdomyolysis from gemfibrozil.
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