A study published in a recent issue of the Annals of Internal Medicine says that long-term therapy with a non-statin triple-drug regimen, combined with lifestyle and dietary changes, substantially increased HDL cholesterol levels and reduced cardiovascular endpoints.
The study, the Armed Forces Regression Study, enrolled 143 retired military personnel with low HDL cholesterol levels and proven coronary artery disease. They were randomized to receive either placebo or a 3-drug regimen consisting of gemfibrozil, niacin, and cholestyramine. All patients were enrolled in addition in a program of aggressive dietary management and other lifestyle changes. (For instance, 80% of enrollees were smokers at the beginning of the study, and only 10% were smokers at the end of the study.)
After 30 months, patients on the triple-drug regimen had a 36% increase in HDL cholesterol levels, a 26% reduction in LDL cholesterol levels, and a 50% reduction in triglyceride levels. A combined endpoint including heart attack, stroke, and the need for invasive therapy for their coronary artery disease was also significantly reduced. Further, on catheterization, treated patient showed evidence of a halting in the progression of coronary artery disease (whereas in the placebo group there was worsening of their coronary artery disease.)
This study adds substantially to the growing body of evidence that raising HDL levels is important. (While LDL levels were reduced in this study, the reduction was relatively small when compared to the degree of LDL lowering commonly seen with statin drugs.) The investigators speculate that the HDL increase was due primarily to niacin and gemfibrozil, since cholestyramine has very little HDL-raising effect.
This study should further spur the race now being run by several drug companies to come up with new, effective and well-tolerated drugs for increasing HDL.
