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AHRQ Releases New Clinician, Consumer Guides on Treating Hypercholesterolemia, Reducing Breast Cancer Risk
By News Staff
Cholesterol Treatment With Combination Therapy
The systematic review on which the guide is based compared the following medication combinations with statin monotherapy:
- a statin plus a bile acid sequestrant;
- a statin plus ezetimibe, which is marketed as Zetia;
- a statin plus a fibrate;
- a statin plus niacin; and
- a statin plus omega-3 fatty acids.
- The evidence is insufficient to conclude that combination therapy leads to lower rates of clinical events and death (all-cause mortality and vascular death) than statin monotherapy. In these studies, clinical events included myocardial infarctions, strokes and the need for invasive vascular procedures.
- The evidence is insufficient to assess whether any combination regimen provides greater reduction in LDL cholesterol than statin monotherapy. Evidence is also insufficient for other intermediate outcomes, including total cholesterol, HDL cholesterol, and coronary artery and carotid intima thickening.
- The evidence is insufficient to draw conclusions about the rates of adverse events of combination therapy compared with statin monotherapy. The adverse events assessed in these studies included elevation of liver enzymes, myalgia, rhabdomyolysis and cancer.
Medications to Reduce Women's Primary Breast Cancer Risk
According to the guide, tamoxifen, which is marketed as Nolvadex, is widely used to treat early and advanced hormone-receptor positive breast cancer; raloxifene, which is marketed as Evista, is used primarily to treat osteoporosis. Although both medications are approved by the FDA to reduce the risk of primary breast cancer, they are rarely used for this purpose in the United States.
Regarding the effectiveness of tamoxifen and raloxifene for this use, the guide offers the following findings:
- Tamoxifen and raloxifene are both effective at reducing the risk of primary invasive breast cancer in women ages 35-70.
- Raloxifene and tamoxifen reduce the likelihood of a woman developing breast cancer by a similar amount.
Obtaining the Guides
Free print copies can be obtained by calling the AHRQ Publications Clearinghouse at (800) 358-9295. Reference AHRQ publication No. 09(10)-EHC024-3 for the clinician's guide on treating high cholesterol and publication No. 09(10)-EHC023-3 for the clinician's guide on preventing breast cancer. Print copies of the consumer guide on cholesterol therapy can be ordered using publication No. 09(10)-EHC024-A; the breast cancer prevention guide for women is available as publication No. 09(10)-EHC028-A.