Drug Combo Improves Cholesterol Levels
Improves LDL, HDL Cholesterol -- and Triglycerides
April 11, 2003 -- With too much "bad" LDL cholesterol often comes too little "good" HDL cholesterol -- not to mention high levels of triglyceride fats floating around in the blood. And getting all these different blood fats back in line can be tricky. But now researchers have discovered that combining two different drugs can significantly benefit those with this triple-whammy.
Researchers say that combining an LDL-lowering "statin" drug with a drug that raises HDL cholesterol and lowers triglyceride levels may be the way to go. This combination dropped triglyceride levels by 52% and LDL cholesterol by 28%. But it also raised HDL cholesterol by a dramatic 23%. While Zocor by itself produced a similar drop in their LDL cholesterol, it raised HDL cholesterol only by 6%.
In three 12-week periods, each of the 20 study participants received one of three daily treatments: Zocor 10 mg and Tricor 200 mg, Zocor plus a placebo, or two placebos. All the participants had high LDL cholesterol and triglyceride levels and low HDL cholesterol -- a condition called combined hyperlipidemia.
Drug treatment for combined hyperlipidemia presents a challenge because one drug rarely corrects all the abnormalities observed in this condition, says lead researcher Gloria Vega, PhD, professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas.
"The take-home message is that you should know your LDL cholesterol -- and know your other risk factors," Vega tells WebMD. While attention is often focused on lowering "bad" LDL cholesterol to help prevent heart attack, high triglyceride levels and low HDL cholesterol worsen the risk.
Her study appears in the April 15 issue of The American Journal of Cardiology. The study results are promising and should be tested in a larger group of patients, says one cardiologist.
"It's always hard to draw too many conclusions based on a study of only 20 people," says cardiologist Ira S. Nash, MD, of the Mount Sinai School of Medicine and a spokesman for the American Heart Association. "But it's an impressive movement in all parameters in a direction you want to see. This is a nice piece of work that sets the stage."
And other recent research has highlighted the importance of getting those HDL cholesterol levels up. Just last week, two studies were presented at the American College of Cardiology's annual meeting suggesting that high levels of heart-protecting HDL cholesterol may be as or even more important in preventing heart attacks than lowering LDL cholesterol.
Zocor, a popular member of the "statin" drugs used by millions of Americans, is used primarily to lower harmful LDL cholesterol levels; its typical starting dose is at least 20 milligrams -- twice as high as what was used in Vega's study. Tricor helps reduce triglycerides levels.
"We know that [cholesterol and triglycerides] are undertreated in general, and it's rare when a patient gets a second drug after the first," Nash tells WebMD. "But clearly, the vast majority of Zocor is directed at lowering LDL cholesterol rather than raising HDL cholesterol. And Tricor is primarily used to lower triglyceride levels."
But neither drug is specifically designed to raise HDL cholesterol -- although treating any LDL cholesterol or triglycerides level abnormality with medications or even lifestyle changes sometimes produces slight increases in HDL cholesterol. By lowering triglyceride levels, for instance, patients with high triglyceride levels often boost their HDL cholesterol, says Vega.
When giving Tricor to patients already taking Zocor, doctors are advised to prescribe lower doses of the statin -- the same 10-milligram dosage used in Vega's study -- to avoid toxicity. In Vega's study, no apparent serious side effects were noted from the dual therapy.