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Am Fam Physician. 1998;57(2):358-359

Black patients have almost twice the age-adjusted risk of dying from coronary heart disease as do white patients. Lipid-lowering drugs are known to have a beneficial effect on risk factors such as hypercholesterolemia. However, few studies have evaluated the efficacy of the use of lipid-lowering drugs in this population. Fong and Ward conducted a double-blind controlled trial to evaluate the efficacy of lovastatin in black patients with primary hypercholesterolemia.

Patients were included in the study if they had a diagnosis of hypercholesterolemia and met National Cholesterol Education Program (NCEP II) guidelines for the use of medication to treat elevated cholesterol levels. Patients with diabetes mellitus, hypothy-roidism and liver or renal disease were excluded from the study. Recent myocardial infarction and coronary artery bypass surgery were also exclusion criteria. A total of 41 patients completed the study. Lipid profiles and other blood chemistries were performed for each patient. Patients were then randomized to receive either placebo or 20 mg of lovastatin daily. All of the patients were counseled about the American Heart Association Step One Diet for lowering serum cholesterol.

Total cholesterol was reduced by 14.7 percent in the lovastatin group, compared with no reduction in cholesterol in the placebo group. Low-density lipoprotein levels decreased by 20 percent in the treatment group, and triglyceride levels decreased 10.5 percent in the treatment group. Several patients in the treatment group reached their target low-density lipoprotein levels (as established by the NCEP II guidelines), but none of the placebo-treated group reached the NCEP II goal. Neither group experienced any serious side effects, although four patients in the treatment group discontinued their medication for various reasons, including gastrointestinal upset. Previous studies have shown that black patients are less likely than white patients to be treated for hypercholesterolemia (odds ratio: 0.81).

The authors conclude that lovastatin and probably other HMG-CoA reductase inhibitors are efficacious in the treatment of hyper-cholesterolemia, and should be used more frequently in the black population when indicated for the treatment of hypercholesterolemia.

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Copyright © 1998 by the American Academy of Family Physicians.

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