title: Maintenance of low-density lipoprotein goal with step-down pravastatin therapy.
abstract: OBJECTIVE
  To determine whether patients who had achieved their National Cholesterol Education Program (NCEP)-derived goals for low-density lipoprotein (LDL) cholesterol with pravastatin would benefit from step-down therapy.
  
  
  METHODS
  Prospective, randomized, open-label study
  
  
  METHODS
  Kansas City Veterans Affairs Medical Center.
  
  
  METHODS
  One hundred four men who were taking pravastatin once/day and had maintained their NCEP-defined LDL goal for at least 3 months.
  
  
  METHODS
  Fifty-three patients were randomized to group 1, for which the dosing frequency was changed from daily to every other day, and 51 patients were randomized to group 2, for which the daily dose was halved.
  
  
  RESULTS
  Fasting lipid profiles and hepatic transaminase levels were analyzed at baseline, 2 months, and 4 months. Lifestyle, concomitant drug therapy, adverse events, weight, and compliance were noted at baseline and month 4. Thirty-one patients (58%) from group 1 and 22 patients (43%) from group 2 did not remain at their LDL goal after step-down pravastatin therapy Mean LDL at study end was 113 mg/dl for group 1 and 104 mg/dl for group 2 (p=0.04).
  
  
  CONCLUSIONS
  More than half (51%) of the patients enrolled did not remain at their LDL goal with step-down pravastatin therapy Therefore, we do not recommend a step-down approach for patients who have achieved their LDL goals. If a clinician decides, however, to attempt dosage reduction, the preferred regimen appears to be to halve the current dose once/day (vs administering the current dose every other day). A fasting lipid profile should be evaluated at 2 months and 4 months after step-down therapy begins to ensure that desired outcomes are achieved.
authors.affiliation: Department of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City, USA. maqual.infranca@med.va.gov
authors.forename: Maqual R
authors.initials: MR
authors.lastname: Graham
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Lindsey
authors.forename: James A
authors.initials: JA
authors.lastname: Kennedy
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D008078:Cholesterol, LDL / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D017035:Pravastatin