Divergent approaches to the treatment of dyslipidemia with low levels of high-density lipoprotein cholesterol

Further therapy should be considered for patients who have reached target low-density lipoprotein cholesterol (LDL-C) levels but have low plasma levels of high-density lipoprotein cholesterol (HDL-C) since rates of coronary artery disease continue to be high for a sizable proportion of this population. Lifestyle approaches include dietary changes, smoking cessation, moderate alcohol intake, concomitant drug reassessment, and specific coexistent conditions. Aggressive statin therapy still leaves a high residual rate of cardiac events. Other drug approaches include estrogen, fibrate, niacin therapy, and combinations of these agents. Recent results from an ongoing trial of combination extended-release prescription niacin plus lovastatin are very promising.