[Pharmacologic treatment of dyslipidemias: Analysis of initiation recommendations and drug selection].

According to the NCEP resins and nicotinic acid were selected as drugs of choice to treat hypercholesterolemia. Gemfibrozil and nicotinic acid were recommended for patients with HDL cholesterol below 35 mg/dl. Current concepts of efficacy and side effects lead to the following recommendations. a) type IIa severe hypercholesterolemia (LDL > 220 mg/dl): HGMC inhibitors or combined therapy with resins and nicotinic acid, fenofibrate, or bezafibrate. b) Moderate hypercholesterolemia (LDL < 220 mg/dl): bezafibrate and/or acipimox if HDL is < 35 mg/dl; fenofibrate, bezafibrate and/or acipimox if HDL > 35 mg/dl. As second line drugs, the HGMC inhibitors. c) Type IIb hyperlipidemia: first line, acipimox; second line, fibrates associated to acipimox. d) Type III hyperlipidemia: first line, fibrates; second line, an association of HGMC inhibitors and fibrates or acipimox. e) Type IV moderate hyperlipidemia (TG < 500 mg/dl): first line, acipimox, second line, fibrates alone or in association with acipimox. As general remarks, lovastatin has been effective and well tolerated in 98% of cases. Pravastatin seems to have very little side effects. Acipimox, a nicotinic acid derivative is especially effective in elevating HDL2b levels and decreasing LDL III. Given its adequate tolerance, acipimox has replaced nicotinic acid.