title: Prolonged combination lipid therapy is associated with reduced carotid intima-media thickness: a case-control study of the 20-year Familial Atherosclerosis Treatment - Observational Study (FATS-OS).
abstract: BACKGROUND
  Studies have documented the short-term vascular benefits of combination lipid therapy.
  
  
  OBJECTIVE
  Our objective was to evaluate the long-term effects of combination lipid therapy on carotid intima-media thickness (CIMT) in patients with coronary artery disease.
  
  
  METHODS
  We performed a case-control study in patients who had finished the Familial Atherosclerosis Treatment Study (FATS) and returned to usual care with statin therapy alone or had elected to participate in the 20-year FATS-Observational Study (FATS-OS) and received combination therapy with lovastatin (40 mg/day), niacin (2-3 g/day), and colestipol (20 gm/day) for 11 years, then continued with simvastatin (10-80 mg/day) or lovastatin (40-80 mg/day) plus niacin (2-4 g/day). After 17.8 ± 0.8 years with combination therapy and 19.0 ± 0.8 years with usual care, cholesterol levels and CIMT were collected in 43 FATS-OS patients and 26 usual care patients.
  
  
  RESULTS
  Combination therapy group had a greater decrease in total cholesterol (-42 ± 14% vs -31 ± 17%, P = .008) and low-density lipoprotein cholesterol (LDL-C) (-57 ± 13% vs -38 ± 25%, P < .001) and greater increase in high-density lipoprotein cholesterol (HDL-C) (38 ± 43% vs 15 ± 23%, P = .02) as compared with usual care. CIMT (0.902 ± 0.164 vs 1.056 ± 0.169 mm, P < .001) on intensive therapy was significantly less compared with usual care. Multivariate regression analysis (coefficient, 95% CI) showed that combination therapy (-0.13; -0.21 to -0.04, P = .003) and on-therapy LDL-C (0.15; 0.02 to 0.28, P = .03) were significant independent predictors of CIMT.
  
  
  CONCLUSIONS
  Prolonged combination lipid therapy is associated with greater improvements in LDL-C and HDL-C levels and less atherosclerotic burden as compared with statin therapy alone.
authors.affiliation: Division of Cardiology, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA. Electronic address: binhan.phan@ucsf.edu.
authors.forename: Binh An P
authors.initials: BA
authors.lastname: Phan
authors.affiliation: Cardiovascular Atherosclerosis Research Laboratory, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Moore
authors.affiliation: Cardiovascular Atherosclerosis Research Laboratory, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Davis
authors.affiliation: Cardiovascular Atherosclerosis Research Laboratory, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Pollan
authors.affiliation: Whisper Light Mountain Statistical Consulting, Seattle, WA, USA.
authors.forename: Blazej
authors.initials: B
authors.lastname: Neradilek
authors.affiliation: Cardiovascular Atherosclerosis Research Laboratory, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: B Greg
authors.initials: BG
authors.lastname: Brown
authors.affiliation: Cardiovascular Atherosclerosis Research Laboratory, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Xue-Qiao
authors.initials: XQ
authors.lastname: Zhao
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents
keywords: Atherosclerosis; Carotid intima-media thickness; Colestipol; Hypercholesterolemia; Niacin; Statin