Treating mixed hyperlipidemia and the atherogenic lipid phenotype for prevention of cardiovascular events

Melvyn Rubenfire, Robert D. Brook, Robert S. Rosenson

Research output: Contribution to journalReview articlepeer-review

36 Scopus citations


Statins reduce cardiovascular events and cardiovascular and total mortality in persons at risk for and with coronary disease, but there remains a significant residual event rate, particularly in those with the atherogenic lipid phenotype that is characterized by a low high-density lipoprotein (HDL) cholesterol and increase in non-HDL cholesterol. Large outcome trials designed to assess the value of combining statins with other agents to target HDL cholesterol and non-HDL cholesterol will not be completed for a few years, but there is ample evidence for the clinician to consider combination therapy. The choices for therapies to supplement statins include niacin, fibrates, and omega-3 fatty acids. We present the argument that after therapeutic lifestyle changes, the first priority should be the maximally tolerated effective dose of a potent statin. Evidence supports the addition of niacin as the second agent. In some situations, high-dose omega-3 fatty acid therapy could be the first agent added to statins. Although fibrate monotherapy alone or in combination with non-statin low-density lipoprotein cholesterol-lowering agents can be effective in mixed hyperlipidemia when statins are not tolerated, the combination of statin + fibrate should be considered second-line therapy until the efficacy and safety are established.

Original languageEnglish
Pages (from-to)892-898
Number of pages7
JournalAmerican Journal of Medicine
Issue number10
StatePublished - Oct 2010


  • Atherogenic lipid phenotype
  • Coronary disease prevention
  • Mixed hyperlipidemia


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