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Besides therapeutic lifestyle change, what treatment do you recommend for a patient at high risk for CAD but unable to take or tolerate a statin?
APOLLO User
For patients who cannot tolerate statins, ezetimibe and the bile acid sequestrant colesevelam are good options. For patients with low high-density lipoprotein cholesterol and high triglyceride levels, niacin or a fibrate should be considered. If possible, however, a low dose of a statin should be given. Although the evidence is anecdotal, a low dose of rosuvastatin (2.5 or 5 g) given every other day, alternating with ezetimibe 10 mg, can often be tolerated by statin-intolerant patients and provide good low-density lipoprotein cholesterol–lowering efficacy. Dietary measures to consider include supplementation with plant sterols, water-soluble fiber, and soy protein.
Michael H. Davidson, MD, FACC, FACP
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Steering Committee
- Antonio M. Gotto, Jr., MD, DPhil
Steering Committee Chair
- Christie M. Ballantyne, MD
- Michael B. Clearfield, DO, FACOI
- Michael H. Davidson, MD, FACC, FACP
- Keith C. Ferdinand, MD, FACC
- Robert M. Guthrie, MD
- D. Roger Illingworth, MD, PhD
- Pamela Kushner, MA, MD, FAAFP
- Peter Libby, MD
- Joseph A. Lieberman III, MD, MPH
- MacRae F. Linton, MD
- Carol M. Mason, ARNP, FAHA
- Dervilla M. McCann, MD, FACC
- James M. McKenney, PharmD
- Paul M. Ridker, MD, MPH, FACC, FAHA
- Jeffrey G. Shanes, MD, FACC, FACP, FSCA, FAHA
- Paul D. Thompson, MD
- Peter P. Tóth, MD, PhD, FAAFP, FAHA, FACC
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