Differential approaches for drug therapy in dyslipidemia

Dyslipidemias are complex disorders requiring different therapeutic approaches. In our outpatient clinic statins are used alone in the majority of patients, fibrates in a lower proportion, while fibrates and statins in combination have been used in a minority of patients in the past years. This combination was tested in a multicenter trial comparing fluvastatin and bezafibiate alone or in combination in 333 coronary patients. Combination therapy was more effective than single-drug therapy in reducing low density lipoprotein cholesterol (-24%) and triglycerides (-38%) and in increasing high-density lipoprotein cholesterol (HDL-C) (+22%). Another issue is the effect of different statins on HDL-C. In a multicenter trial involving 842 patients simvastatin proved more efficacious than equi-potent doses of atorvastatin in raising HDL-C. These examples underline the complexity of this therapy that needs often to be tailored to individual cases.