Best Alternatives to Statins for Treating Hyperlipidemia
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Most alternatives to statin therapy reduce cholesterol levels but do not consistently demonstrate a reduction in cardiac-related and all-cause mortality in patients with or without coronary heart disease (CHD). Fibrates and niacin decrease the risk of major coronary events; however, no statistically significant reductions in mortality have been shown. (Strength of Recommendation [SOR]: A, based on systematic review of randomized controlled trials [RCTs]). Resins decrease cardiovascular mortality but not total mortality. (SOR: A, based on review of RCTs). The effects of ezetimibe (Zetia) on cardiovascular outcomes and mortality are unknown. (SOR: C, based on a single RCT with disease-oriented evidence). Omega-3 fatty acid supplementation does not clearly demonstrate reductions in mortality. (SOR: A, based on two meta-analyses of RCTs). There is insufficient evidence to recommend the use of herbal therapy for the treatment of hyperlipidemia. (SOR: A, based on a systematic review of RCTs).
Clinical Inquiries, 2007 (MU)
American Family Physician, 76(7) 2007: 1027-1029.