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Drug therapy should be initiated for the treatment of dyslipidemia only after an adequate trial of diabetic control, diet, weight loss, and exercise (Table 6). The £

initial presentation of the patient, the severity of the dyslipidemia, and the presence of other risk factors for CHD or CHD itself determine how long nonpharma-cological approaches should be tried. It is clear that lipid-lowering agents will be less efficacious, or actually ineffective, if these related factors are not optimally J

approached first. On the other hand, severely dyslipidemic patients, and those

Table 6 Effects of Lipid-Altering Drugs

Drug Triglycerides LDL cholesterol HDL cholesterol

Table 6 Effects of Lipid-Altering Drugs

Drug Triglycerides LDL cholesterol HDL cholesterol

Statins

Depending on patient initial triglyceride and degree of LDL lowering: triglycerides i 10-30%

Depending on which statin used and dose: l 20-55%

In general: T 5-10%

Fibrates

i 25-45%

Variable depending on patient initial LDL level and degree of triglyceride lowering: Î 10-30%, no change, or l 10-20%

Depending on patient initial triglyceride level and degree of triglyceride drop; T 10-25%

Niacin

i 20-35%

l 10-20%

T 10-20%

Resins

T 0-20% (may be higher if initial triglyceride >300

l 15-25%

Variable; T 0-5%

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