Comparing hyperlipidemia control with daily versus twice-weekly simvastatin.

BACKGROUND: Costs associated with the use of hydroxymethylglutaryl coenzyme A reductase inhibitors are increasing. Finding ways to manage hyperlipidemia at lower costs is critical to all healthcare systems. OBJECTIVE: To assess effectiveness, safety, cost, and patients' satisfaction when converting hyperlipemic patients taking simvastatin daily to simvastatin twice weekly. METHODS: This nonrandomized, open-label, proof-of-concept study converted patients treated with simvastatin 10 or 20 mg daily to 40 or 80 mg twice weekly, respectively, for 12 weeks. The lipid profiles at enrollment, week 6, and week 12 were compared using repeated-measures ANOVA. The percentage of patients attaining the appropriate low-density lipoprotein cholesterol (LDL-C) goal was determined. RESULTS: Thirty-one patients completed the study. The proportion of patients at the LDL-C goal was not statistically different between enrollment and week 12 (87% vs 68%; p = 0.068). The mean LDL-C value +/- SD at weeks 6 and 12 increased compared with enrollment (112 +/-20, 111 +/-17, and 97 +/- 17 mg/dL, respectively; p < 0.001). Three (10%) patients reported nonadherence to the twice-weekly regimen. Seventeen (55%) patients reported that both regimens were equally convenient or preferred the twice-weekly regimen. Estimated cost-savings at our institution associated with this regimen would be $32 000 per 1000 patients per year. CONCLUSIONS: The twice-weekly regimen safely maintained most of the patients at their LDL-C goal level, and over half the patients found this regimen to be the same or easier to follow than a daily regimen. Large outcome studies evaluating this approach are needed.

Low-Dose Aspirin and Ibuprofen Reduce the Cutaneous Reactions Following Niacin Administration.

BACKGROUND: Moderate doses of prostaglandin inhibitors may reduce the cutaneous reactions from niacin administration. We undertook this study to determine if low doses of either ibuprofen or aspirin reduces cutaneous reactions from niacin in healthy volunteers. METHODS: Twenty-two subjects were randomized to received crystalline niacine 500 mg preceded by either placebo, aspirin 165 mg, aspirin 325 mg, or ibuprofen 200 mg. The study was crossover and double blinded, and treatment arms were separated by 2 days. Subjects were asked to rate the severity of flushing, itching, and tingling after niacin on a visual analog scale (0---no symptoms; 10---severe symptoms). Statistical analysis was performed using repeated measures of analysis of variance. RESULTS: Nineteen of the 22 subjects completed the protocol. Overall, aspirin 325 mg statistically reduced flushing after niacin administration. No statistical difference was observed for the other treatment arms for either flushing, itching, or tingling. When subjects experiencing the worse symptoms were analyzed separately, all treatment arms statistically reduced the flushing, itching, or tingling from niacin. Aspirin 325 mg was the most efficacious, followed by aspirin 165 mg and ibuprofen 200 mg. CONCLUSION: These data demonstrate that pretreatment with low doses of aspirin or ibuprofen are effective in reducing cutaneous reactions from niacin administration.