Combined drug therapy for familial hypercholesterolemia.

Six familial hypercholesterolemic subjects were treated with a combination of cholestyramine (16 g/day) and nicotinic acid (3 g/day). This therapy consistently lowered plasma cholesterol and triglyceride by, on average, 41% and 37% respectively. Very low density and low density lipoprotein cholesterol fell, while high density lipoprotein cholesterol rose significantly. Plasma apolipoprotein levels were also affected by treatment. Apolipoprotein A-I rose 26% and apolipoprotein B fell 31%. In addition, there was a fourfold increase in plasma high density lipoprotein subfraction2 (HDL2), although HDL3 remained unaltered. These favorable changes in a number of atherosclerotic risk indices commend the use of this drug combination in the treatment of heterozygous familial hypercholesterolemia.