PHARMACIST's LETTER / PRESCRIBER's LETTER Non-Statin Lipid-Lowering Agents

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PL Detail-Document #310703 −This PL Detail-Document gives subscribers additional insight related to the Recommendations published in− PHARMACIST’S LETTER / PRESCRIBER’S LETTER July 2015

Non-Statin Lipid-Lowering Agents

Statins are the lipid-lowering agents of choice because they have by far the most, and most robust, evidence for reducing cardiovascular events, including death.25,49 Non-statins are no longer recommended for routine use.25,49 When deciding to start or continue a non-statin, consider the following: The addition of a non-statin to a statin has not been proven to further reduce cardiovascular mortality.1,25,30,49,61 Despite IMPROVE-IT, the FDA denied the expanded indication for morbidity and mortality benefits for ezetimibe.65 Adding a fibrate or niacin to achieve a specific LDL goal could result in reduction of the statin to a suboptimal dose.49 Reinforce statin adherence and lifestyle changes, and check for secondary causes of LDL elevation before adding a non-statin.25,49 For patients who cannot tolerate the recommended statin dose or who do not achieve the expected statin response (e.g., 50% LDL reduction with high-intensity statin) and are high-risk at baseline, consider adding a non-statin.25,49 Consider adding ezetimibe to a statin in high-risk patients, especially those with a recent ACS.30 There’s no proof that adding other non-statins (fibrates, etc) to a statin improves outcomes, and niacin worsens glycemic control.1,32 Consider PCSK9 inhibitors as add-on therapy for HoFH (evolocumab); with maximally tolerated statin for HeFH or clinical CVD requiring additional LDL lowering (evolocumab, alirocumab); and for statin-treated CVD patients with a CV event or multiple risk factors (evolocumab).52-54,61,67 Consider a bile acid sequestrant, gemfibrozil, or niacin for patients who cannot tolerate a statin.1,7,21,24 Do not add gemfibrozil to a statin due to myopathy risk.49 Consider omega-3 fatty acids, fenofibrate, or niacin if TG ≥500 mg/dL (about 5 mmol/L), or even approaching 1000 mg/dL (about 10 mmol/L).38,39 However, there’s no good evidence that lowering triglycerides reduces CV events or prevents pancreatitis.

The chart below provides lipid effects, outcomes, and cost information for the non-statins. (Information in the chart may differ from product labeling). For specifics on lowering triglycerides see our PL Detail-Document, Strategies for Lowering Triglycerides; for more information on the lipid-lowering potential of individual statins in our PL Chart, Characteristics of the Various Statins.

Abbreviations: ACS = acute coronary syndrome; CV = cardiovascular; CVD = cardiovascular disease; ER = extended-release; GI = gastrointestinal; HDL = high- density lipoprotein; HeFH = heterozygous familial hypercholesterolemia; HoFH = homozygous familial hypercholesterolemia; IR = immediate release; LDL = low- density lipoprotein; PCSK9 = proprotein convertase subtilisin/kexin type 9; SR = sustained release; SubQ = subcutaneous; TG = triglycerides

Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Alirocumabd LDL ↓: 40% to See Lipid Effects Post-hoc analysis Very expensive. U.S.: $1120 (Praluent) 60%.52,56,63 column. suggests Consider with (75 mg/two (Regardless of statin alirocumab in maximally tolerated weeks). Continued… use.) combination with statin for HeFH or More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com (PL Detail-Document #310703: Page 2 of11)

Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Alirocumab, maximally clinical CVD requiring continued tolerated statin additional LDL doses may reduce lowering.52,67 (PCSK9 inhibitor) major CV events in No adjustment needed high-risk patients. with mild to moderate Further data are renal or hepatic needed to confirm impairment. No safety [Level B].55 data available with severe renal or hepatic impairment.52,67 Administer via SubQ injection (allow to reach room temperature before injecting).52,67 No long-term safety data.

Bezafibrate LDL ↓: 6% to 21% Further LDL ↓: 1.1% Secondary First-line option for Canada: $75.43 (Bezalip SR, generic (400 mg).35,36 (400 mg).36 prevention: TG >10 mmol/L.39 (Bezalip SR) bezafibrate SR, prevents composite Option for TG (400 mg/day). generic immediate- HDL ↑: 15% to 25% Further HDL ↑: endpoint of MI and 5 to 10 mmol/L.39 35,36 36 release bezafibrate); (400 mg). 21.6% (400 mg). sudden death in a Option for low HDL.39 (Canada only) subgroup with TG Reversible increase in TG ↓: 25.1% to 42% Further TG ↓: 200 mg/dL or serum creatinine.33 35,36 36 (Fibric acid) (400 mg). 31.7% (400 mg). higher. No Requires renal dose increase in non-CV adjustment.33,b 37 death. Limited data with statins.

More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

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Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Cholestyramine LDL ↓: Further LDL ↓: Primary prevention, Can be difficult to U.S.: $246.06 (Questran, Questran 9% (4 g to 8 g/day);1 about 10% (8 g) to men: reduces need tolerate due to GI side (generic packets) Light [U.S.; brands no 21% (16 g to about 20% (24 g).4,5 for bypass, and effects such as (16 g/day). longer available], 20 g/day);1 combined endpoint constipation and gas.1 Olestyr [Canada] 23% to 28% Further HDL ↑: of coronary heart Canada: $203.04 (>20 g/day).1 0% to 10%.3,4 disease, death, and (Olestyr) (Bile acid sequestrant) nonfatal MI (NNT = (16 g/day). 59 for 7 years) HDL ↑: 4% to 8% 6,14 (16 to 24 g/day).1 [Level A]. Secondary TG ↑: 11% to 28% prevention, men: (4 g to 24 g/day).1 with diet, reduces cardiac events vs usual care (not placebo-controlled; events not a primary outcome)[Level B].7 Slows progression and increases regression of atherosclerosis.7,34

Colesevelam LDL ↓: 15% to 19.1% Further LDL ↓: None. Limited data with U.S.: $565.20 (WelChol [U.S.], (3.8 g/day).2,8 10% to 16% statins. (3.8 g/day). Lodalis [Canada]) (3.8 g/day).2 Studied in combination HDL ↑: 3% to 8.1% with atorvastatin, Canada: $216.84 (Bile acid sequestrant) (3.8 g/day).2,8 Further HDL ↑: lovastatin, pravastatin, (3.8 g/day). 3% to 7% and simvastatin.2,10 2 (FDA-approved for TG ↑: 10% (3.8 g/day; (3.8 g/day). Potential lower risk of glycemic control in about 20% when used GI side effects 2 type 2 diabetes). with insulin or compared to 2 sulfonylureas). cholestyramine and

colestipol.8,64

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Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Colestipol LDL ↓: 5% (2 g/day) Further LDL ↓: Reduces Can be difficult to U.S.: $188.66 (Colestid, generic to 26% (16 g/day).1 10% (5 g/day) to progression of tolerate due to GI side (generic) [U.S.]) 12% (10 g/day).11 atherosclerosis and effects such as (10 g/day). HDL: no effect.1 events when constipation and gas.8 (Bile acid sequestrant) combined with Canada: $71.52 TG ↑: 10% to 15% niacin or lovastatin (10 g/day). (2 to 16 g/day).1 (events not a primary outcome).50

Evolocumabd LDL ↓: 42% to See Lipid Effects Lowered LDL 34% Very expensive. U.S.: $1054.62 (Repatha) 65%.58,59,61,63 column. to 38.5% more Consider as add-on (140 mg every two (Regardless of statin compared to therapy for HoFH; weeks). (PCSK9 inhibitor) use.) ezetimibe.58,60 with maximally Added to a high- or tolerated statin for Canada: $603.42 moderate-dose HeFH or clinical CVD (140 mg every two statin, prevents one requiring additional weeks). CV death, MI, or LDL lowering; and for stroke for every 74 statin-treated CVD high-risk CVD patients with a CV patients treated for event or multiple risk about two years factors.53,54,61 (FOURIER study). Administer by SubQ CV death as a stand- injection (allow to alone outcome not reach room affected. Most temperature before patients had a prior injecting).53,54 MI, and about one No dosage adjustment third had diabetes needed with mild to and/or smoked.61 moderate renal or hepatic impairment. No safety data Continued… available for patients More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

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Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Evolocumab, with severe renal or continued hepatic impairment.53,54 No long-term safety data. Ezetimibe LDL ↓: 18% Further LDL ↓: With simvastatin Consider ezetimibe as U.S.: $259.96 (Zetia [U.S.], (10 mg/day).12,13 25%.13 20 mg, reduces first a moderate-dose statin (10 mg/day). Ezetrol, generics major add-on for high-risk [Canada]) HDL ↑: 1% Further HDL ↑: atherosclerotic secondary prevention Canada: $50.81 (10 mg/day).12,13 3%.13 event in chronic patients who can’t (generic) (Cholesterol renal disease [Level tolerate a high- (10 mg/day). absorption inhibitor) TG ↓: 8%.12,13 Further TG ↓: A].29 intensity statin, or who 14%.13 Adding ezetimibe don’t get the expected (Vytorin [U.S.]: (In U.S., available in to simvastatin 40 50% LDL reduction $257.58 [10 mg/ combination with mg post-ACS with a high-intensity 20 mg/day]). simvastatin [Vytorin] prevents one CV statin.49 and atorvastatin event for every 50 (Liptruzet [U.S.]: [Liptruzet]). patients treated for $165.00 7 yrs vs simvastatin [10mg/20mg/day]). alone [Level A].30

Fenofibrate LDL ↓: 20.6% Further LDL ↓: Prevention of CV First-line option for U.S.: $27.92 (Tricor, Lofibra, (145 mg).15 0% to 6% events in type 2 TG >10 mmol/L39 (generic) Trilipix, Antara [U.S.], (200 mg).16-18 diabetes: did not (about (48 mg/day). Lipidil EZ [Canada], HDL ↑: 11% reduce primary 1000 mg/dL). others, generics) (145 mg).15 Further HDL ↑: composite outcome Option for TG U.S.: $15.29 13% to 17% (non-fatal MI or >500 mg/dL38 or (generic) (Fibric acid) TG ↓: 23.5% to 54.5% (200 mg).16-18 CV death). 5 to 10 mmol/L.39 (145 mg/day). (greatest drop in Improved outcomes Option for low HDL.39 patients with highest Further TG ↓: included non-fatal Requires renal dose Canada: $29.53 triglycerides) 20% to 32% MI (24%↓), adjustment.33,b (generic) 15 16-18 (145 mg). (200 mg). coronary Associated with (145 mg/day). Continued… revascularization More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

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Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Fenofibrate, (21%↓), reversible increase in Canada: $8.82 continued progression to serum creatinine.33 (generic) albuminuria, and Unclear risk of (200 mg/day). reduced laser cholelithiasis.51 treatments for In the U.S., FDA retinopathy. Non- indication for significant increase fenofibric acid 31 in CV death. (Trilipix) use with As statin add-on, statins revoked in did not lower risk April 2016 due to lack of non-fatal MI, of CV benefit.57 non-fatal stroke, or Fenofibrate is still CV death more indicated as than statin alone in monotherapy for lipid patients with type 2 lowering.66 diabetes at high Preferred over risk for CV gemfibrozil for use 32 disease. with statins for safety.33

Gemfibrozil LDL: No effect.21 Further TG ↓: 41%.19 Primary prevention, First-line option for U.S.: $6.85 (Lopid [U.S.], men: reduced TG >10 mmol/L39 (generic) generics) HDL ↑: 6% Further HDL ↑: sudden cardiac (about 1000 mg/dL). (1200 mg/day). (1200 mg/day).21 9%.19 death plus Option for TG >500 (Fibric acid) fatal/nonfatal MI mg/dL38 or Canada: $33.42 TG ↓: 33% to 50% (NNT = 71 over 5 5 to 10 mmol/L.39 (generic) (greatest drop in years)[Level A].20 Option for low HDL.39 (1200 mg/day). patients with highest Secondary Requires renal dose triglycerides) prevention of adjustment.33,b 21,41 (1200 mg/day). nonfatal MI plus Avoid with statin.33,39 cardiac death in No mortality men with low HDL benefit.20,21 Continued… More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

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Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Gemfibrozil, (NNT = 23 over 5 Unclear risk of continued years)[Level A].21 cholelithiasis.51

Icosapent ethyl LDL: No effect.46 Further TG ↓: A study is Option for TG U.S.: $234.48 (Vascepa) 21.5% (4 g/day), underway to look at 500 mg/dL.46 (4 g/day). 46 47 (U.S. only) HDL: No effect. 10.1% (2 g/day). reduction in Safe for use with cardiovascular statin.47 46 (EPA; about 1 g TG : 27%. Further LDL ↓: events with Use caution with fish 47 omega-3s/capsule) 6.2% (4 g/day). icosapent in or shellfish allergy.46 patients taking a statin.48

Niacin LDL ↓: 14% to 17% Further LDL ↓: 8% As statin add-on, Option for TG U.S.: $19.48 (Niacor [IR; U.S. (Niaspan 2 g/day);22-24 (Niaspan reduces carotid >500 mg/dL38 (about (Niacor only], Niaspan [ER], 12% (niacin IR 1.5 1 g/day); 31% intima-media 5 mmol/L). 1 g/day). Niaspan FCT g/day and Niaspan 1.5 (Niaspan thickness Raises HDL more than [Canada]) g/day).28 2 g/day).9 (surrogate marker) any other agent. U.S.: $274.22

as compared to Dose-dependent risk of (Niaspan In the U.S., niacin was HDL ↑: 22% to 26% Further HDL ↑: 23% ezetimibe as statin hyperglycemia 1 g/day). 22-24 available as a combo (2 g/day Niaspan); (Niaspan add-on in patients (especially in patients with lovastatin 17% (niacin IR 1.5 1 g/day); 27% with lower HDL.29 with type 2 diabetes) Canada: $39.57 28 (Advicor) and g/day); (Niaspan Secondary MI and liver toxicity.24 (Niaspan 9 simvastatin (Simcor). 20% to 22% (Niaspan 2 g/day). prevention: one No mortality benefit.24 1 g/day). 22-24 Both products 1.5 g/day). less MI for every May increase risk of voluntarily withdrawn Further TG ↓: 24% 30 patients treated statin myopathy.24 Canada: $43.53 from the market in TG ↓: 20% to 50%.25 (Niaspan 1 g/day); for five years (Niaspan FCT 62 FDA indication for December 2015. 27% (Niaspan (Coronary Drug niacin ER use with 1 g/day). 2 g/day).9 Project)[Level B].24 statins revoked in No CV event April 2016 due to lack benefit from combo of CV benefit/safety.57

of niacin + statin vs In Canada, niacin is statin alone in still indicated as Continued… patients with well- More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com

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Lipid Effects in Outcomes Data Approx Cost for Drug Lipid Effectsc Combination with (monotherapy unless Comments 30-day Supplya Statin otherwise specified) Niacin, continued controlled LDL, monotherapy for low HDL, and high dyslipidemia.22,23 TG.40 In the U.S., niacin IR and ER are approved for monotherapy or for use with bile acid sequestrants.24

Omega-3 ethyl esters LDL ↑: 44.5% LDL ↑: 0.7% Secondary Option for TG U.S.: $290.63 (Lovaza) (4 g/day).27 (4 g/day).27 prevention: reduces >500 mg/dL (about (4 g/day). (U.S. only) cardiovascular 5 mmol/L).38 HDL ↑: 9.1% Further HDL ↑: death, sudden Safe for use with (EPA/DHA; about 1 g (4 g/day).27 3.4% (4 g/day).27 death, and statin.39 omega-3s/capsule). combined endpoint Associated with an TG ↓: 45% Further TG ↓: 29.5% of death, non-fatal increase in risk for 27 27 (4 g/day). (4 g/day). MI, and non-fatal recurrence of 26 stroke [Level B]. symptomatic atrial Secondary fibrillation or flutter prevention in within first three patients with, or at months of therapy.27 risk for, type 2 Use with caution with diabetes: did not fish or shellfish reduce CV events. allergy.27 About half of patients were taking a statin.42

a. U.S. cost is wholesale acquisition cost (WAC) b. Maximum daily dose if CrCl <60 mL/min: bezafibrate 200 mg, gemfibrozil 600 mg, and fenofibrate 67 mg. Avoid if CrCl <15 mL/min.33 c. TG-lowering effects of niacin, omega-3-ethyl esters, and fibrates is greatest in patients with higher baseline TG levels.43-45 d. Lipid levels off statin therapy may be required for prior authorization.

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Users of this PL Detail-Document are cautioned to use 6. Rifkind BM. Lipid Research Clinics Coronary their own professional judgment and consult any other Primary Prevention Trial: results and implications. necessary or appropriate sources prior to making Am J Cardiol 1984;54:30C-34C. clinical judgments based on the content of this document. 7. Watts GF, Lewis B, Brunt JN, et al. Effects on coronary artery disease of lipid-lowering diet, or diet Our editors have researched the information with input plus cholestyramine, in the St. Thomas’ from experts, government agencies, and national Atherosclerosis Regression Study (STARS). Lancet organizations. Information and internet links in this 1992;339:563-9. article were current as of the date of publication. 8. Davidson MH, Dillon MA, Gordon B, et al. Colesevelam hydrochloride (cholestagel): a new, Levels of Evidence potent bile acid sequestrant associated with a low In accordance with the trend towards Evidence-Based incidence of gastrointestinal side effects. Arch Intern Med 1999;159:1893-900. Medicine, we are citing the LEVEL OF EVIDENCE 9. Wolfe ML, Vartanian SF, Ross JL, et al. Safety and for the statements we publish. effectiveness of Niaspan when added sequentially to Level Definition a statin for treatment of dyslipidemia. Am J Cardiol A High-quality randomized controlled trial (RCT) 2001;87:476-9. High-quality meta-analysis (quantitative 10. Bays HE, Davidson M, Jones MR, Abby SL. Effects systematic review) of colesevelam hydrochloride on low-density B Nonrandomized clinical trial lipoprotein cholesterol and high-sensitivity C-reactive Nonquantitative systematic review protein when added to statins in patients with Lower quality RCT hypercholesterolemia. Am J Cardiol 2006;97:1198- Clinical cohort study 205. Case-control study 11. Simons LA, Simons J, Parfitt A. Successful Historical control management of primary hypercholesterolaemia with Epidemiologic study simvastatin and low-dose colestipol. Med J Aust C Consensus 1992;157:455-9. Expert opinion 12. Product monograph for Ezetrol. Merck Canada Inc. D Anecdotal evidence Kirkland, QC H9H 4M7. March 2012. In vitro or animal study 13. Product information for Zetia. Merck/Schering- Adapted from Siwek J, et al. How to write an evidence-based clinical Plough Pharmaceuticals. North Wales, PA 19454. review article. Am Fam Physician 2002;65:251-8. August 2013. 14. Probstfield JL, Rifkind BM. The Lipid Research Clinics Coronary Primary Prevention Trial: design, Project Leaders in preparation of this PL Detail- results, and implications. Eur J Clin Pharmacol Document (310703): Melanie Cupp, Pharm.D., 1991;40(Suppl 1):S69-75. BCPS (Original July 2015), Beth Bryant, Pharm.D., 15. Product information for Tricor. AbbVie Inc. North BCPS, Assistant Editor (May 2016 update), (last Chicago, IL 60064. February 2016. modified April 2017). 16. Koh KK, Quon MJ, Han SH, et al. Additive beneficial effects of fenofibrate combined with atorvastatin in the treatment of combined hyperlipidemia. J Am Coll References Cardiol 2005;45:1649-53 1. PL Detail Document, Ezetimibe’s Role in 17. Vega GL, Ma PT, Cater NB, et al. Effects of adding Cardiovascular Risk Reduction. Pharmacist’s fenofibrate (200 mg/day) to simvastatin (10 mg/day) Letter/Prescriber’s Letter. January 2015. in patients with combined hyperlipidemia and 2. Product information for WelChol. Daiichi Sankyo. metabolic syndrome. Am J Cardiol 2003;91:956-60. Parsippany, NJ 07054. January 2014. 18. Athyros VG, Papageorgiou AA, Athyrou VV, et al. 3. Pravastatin Multicenter Study Group II. Comparative Atorvastatin and micronized fenofibrate alone and in efficacy and safety of pravastatin and cholestyramine combination in type 2 diabetes with combined alone and combined in patients with hyperlipidemia. Diabetes Care 2002;25:1198-202. hypercholesterolemia. Arch Intern Med 19. Murdock DK, Murdock AK, Murdock RW, et al. 1993;153:1321-9. Long-term safety and efficacy of combination 4. Pan HY, DeVault HR, Swites BJ, et al. gemfibrozil and HMG-CoA reductase inhibitors for Pharmacokinetics and pharmacodynamics of the treatment of mixed lipid disorders. Am Heart J pravastatin alone and with cholestyramine in 1999;138:151-5. hypercholesterolemia. Clin Pharmacol Ther 20. Product information for Lopid. Pfizer, Inc. New York, 1990;48:201-7. NY 10017. November 2014. 5. Sprecher DL, Abrams J, Allen JW, et al. Low-dose 21. Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil combined therapy with fluvastatin and for the secondary prevention of coronary heart cholestyramine in hyperlipidemic patients. Ann disease in men with low levels of high-density Intern Med 1994;120:537-43. lipoprotein cholesterol. Veterans Affairs High- More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com (PL Detail-Document #310703: Page 10 of11)

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Circulation 2000;102:21-7. apolipoprotein B. N Engl J Med 1990;323:1289-98. More. . . Copyright © 2015 by Therapeutic Research Center 3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249 www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~ www.PharmacyTechniciansLetter.com (PL Detail-Document #310703: Page 11 of 11)

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Cite this document as follows: PL Detail-Document, Non-Statin Lipid-Lowering Agents. Pharmacist’s Letter/Prescriber’s Letter. July 2015.

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