David Rind wrote:
> Ed Mathes wrote:
> > So, Dr. Harris, what do you propose then for patients who don't tolerate
> > statins? Remember, although primarily triglyceride drugs, fibrates also
> > have effects on other cholesterol parameters.
> >
> > Ed
>
> Dr. Harris can give his own answer, but my take on this is that in
> patients who don't tolerate statins we're in the same situation we were
> before the statins were available: there is no evidence that any of the
> other cholesterol-lowering medications are of benefit in primary
> prevention, and several studies suggest these drugs cause harm.
>
> In secondary prevention, using a fibrate or niacin is a reasonable
> option (though one that doesn't get you enormous benefits). In primary
> prevention, you mostly need to accept that we don't have any medications
> other than statins that have been show to work.
>
> --
> David Rind
>
Yes, David, you are correct that the story concerning the benefit of using
non-statin lipid lowering medications for primary prevention is not complete.
However, fenofibrate either singly or in combination with statins will likely
to have a role in primary prevention of atherosclerosis in folks with
Metabolic Syndrome (MetS) who have insulin resistance and secondary prevention
of atherosclerosis in folks with Type 2 Diabetes.
This is suggested by DAIS as cited by Ed Mathes. There is a case to be made
for being proactive here and not wait for "definitive" trials because these
folks are at high risk for cardiovascular events. I would commend Ed for his
position which is one of concern for his patients.
The PDF file for the full-text of a relevant paper underscoring the importance
of the findings of DAIS can be found he
http://makeashorterlink.com/?P2CD158C9
Enjoy :-)
Servant to the humblest person in the universe,
Andrew
--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
**
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