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December 19, 1990, Vol 264, No. 23 >
ARTICLE | December 19, 1990

Reducing High Blood Cholesterol Level With Drugs: Title and subTitle BreakCost-effectiveness of Pharmacologic Management FREE

Kevin A. Schulman, MD; Bruce Kinosian, MD; Terry A. Jacobson, MD; Henry Glick, MA; Mary Kaye Willian, DrPH, RN; Harris Koffer, PharmD; John M. Eisenberg, MD
[+] Author Affiliations

Reprint requests to Program in Geriatric Medicine, Section of General Internal Medicine, Ralston-Penn Center, 3615 Chestnut St, Philadelphia, PA 19104-4283 (Dr Kinosian).


JAMA. 1990;264(23):3025-3033. doi:10.1001/jama.1990.03450230061030
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Article
References

We performed a cost-effectiveness analysis of pharmacologic treatment of high blood cholesterol levels. Agents modeled were cholestyramine, colestipol, gemfibrozil, lovastatin, niacin, and probucol. Pharmacologic effectiveness was estimated from reported studies. Cost estimates reflect societal resource consumption. Annual costs for therapy ranged from $327 (niacin) to $1881 (lovastatin, 80 mg/d). Niacin was the most efficient agent for reducing low-density lipoprotein cholesterol levels, having an average cost over 5 years of $139 per percent reduction in low-density lipoprotein cholesterol level. Lovastatin (20 mg/d) was also efficient ($177 per percent reduction). Cholestyramine was least efficient at $347. For high-density lipoprotein cholesterol, niacin was most efficient, at $116 per percent increase in high-density lipoprotein cholesterol level, followed by gemfibrozil at $271. Analyses combining low-density lipoprotein cholesterol and high-density lipoprotein cholesterol effects suggest that niacin and lovastatin (20mg/d) were most efficient for reducing cardiovascular risk.

(JAMA. 1990;264:3025-3033)

REFERENCES

1 +
 Adult Treatment Panel. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med. 1988;; 148:36-69.
2 +
Frick MH, Elo O, Haapa K, et al.  Helsinki heart study: primary-prevention trial with gemfibrozil in middle aged men with dyslipidemia . N Engl J Med. 1987;;317:1237-1246.
3 +
Coronary Drug Research Project Group.  Clofibrate and niacin in coronary heart disease . JAMA. 1975;;233:360-381.
4 +
Canner PL, Berge KG, Wenger NK, et al.  Fifteen year mortality in coronary artery drug project patients: long term benefit with niacin . J Am Coll Cardiol. 1986;;8:1245-1255.
5 +
 Lipid Research Clinics Program. The Lipid Research Clinics primary prevention trial results: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA. 1984;;251:365-374.
6 +
Sempos C, Fulwood R, Haines C, et al.  The prevalence of high blood cholesterol levels among adults in the United States . JAMA. 1989;;262:45-52.
7 +
Garber AM, Littenberg, B, Sox HC Jr, Gluck ME, Wagner JL, Duffy BM. Costs and Effectiveness of Cholesterol Screening in the Elderly . Washington, DC: Office of Technology Assessment; 1989;. OTA Preventive Health Services paper 3.
8 +
Manninen V, Flo MO, Frick MH, et al.  Lipid alterations and the decline in the incidence of coronary heart disease in the Helsinki Heart Study . JAMA. 1988;;260:641-651.
9 +
Eisenberg JM.  Clinical economics: a guide to the economic analysis of clinical practices . JAMA. 1989;;262:2879-2886.
10 +
L'abbe KA, Detsky AS, O'Rourke K.  Metaanalysis in clinical research . Ann Intern Med. 1987;;107:224-233.
11 +
Vessby B, Lithell H, Boberg J, Hellsing K, Werner I.  Gemfibrozil as a lipid-lowering compound in hyperlipoproteinaemia: a placebo-controlled cross-over trial . Proc R Soc Med. 1976;; 69( (suppl 2) ):32-37.
12 +
Kaukola S, Manninen V, Malkonen M, Ehnholm C.  Gemfibrozil in the treatment of dyslipidaemias in middle-aged male survivors of myocardial infarction . Acta Med Scand. 1981;;209:69-73.
13 +
Manninen V, Malkonen M, Eisalo A, et al.  Gemfibrozil in the treatment of dyslipidaemia: a five-year follow-up study . Acta Med Scand. 1982;; 668( (suppl) ):82-87.
14 +
Lewis JE.  Clinical use of gemfibrozil: a controlled multicenter trial . Pract Cardiol. 1983;;9:99-118.
15 +
Samuel P.  Effects of gemfibrozil on serum lipids . Am J Med. 1983;;74:23-27.
16 +
Glueck C.  Influence of gemfibrozil on high-density lipoproteins . Am J Cardiol. 1983;;52:31B-34B.
17 +
Manninen V.  Clinical results with gemfibrozil and background to the Helsinki heart study . Am J Cardiol. 1983;;52:35B-38B.
18 +
Pickering JE.  Clinical results with gemfibrozil . Am J Cardiol. 1983;;52:39B-40B.
19 +
Virtamo J, Manninen V, Malkonen M.  A placebo-controlled, rising-dose, double-blind trial with gemfibrozil in dieting patients with primary hyperlipoproteinemia . Vase Med. 1984;;2:22-27.
20 +
Canter D.  Long-term studies with gemfibrozil in Finland: an eight-year follow-up . R Soc Med. 1986;;87:41-49.
21 +
Tikkanen MJ, Helve E.  Comparison between lovastatin and gemfibrozil in the treatment of primary hypercholesterolemia: the Finnish multi-center study . Am J Cardiol. 1988;;62:35J-43J.
22 +
Lovastatin Study Group II.  Therapeutic response to lovastatin (mevinolin) in nonfamilial hypercholesterolemia . JAMA. 1986;;256:2829-2834.
23 +
Havel RJ, Hunninghake DB, Illingworth DR, et al.  Lovastatin (mevinolin) in the treatment of heterozygous familial hypercholesterolemia . Ann Intern Med. 1987;;107:609-615.
24 +
Tolbert JA.  The efficacy and long-term adverse effect pattern of lovastatin . Am J Cardiol. 1988;; 62:28J-34J.
25 +
Lovastatin Study Group III.  A multicenter comparison of lovastatin and cholestyramine for severe primary hypercholesterolemia . JAMA. 1988;;260:359-366.
26 +
Berge KG, Achor RW, Christensen NA, Mason HL, Barker NW.  Hypercholesteremia and nicotinic acid: a long-term study . Am J Med. 1961;;31:24-36.
27 +
Schoch HK.  The U.S. Veterans Administration cardiology drug lipid study: an interim report . Adv Exp Biol. 1969;;4:405-420.
28 +
Hoeg JM, Maher MB, Bou E, et al.  Normalization of plasma lipoprotein concentrations in patients with type II hyperlipoproteinemia by combined use of neomycin and niacin . Circulation. 1984;;70:1004-1011.
29 +
Knopp RH, Ginsberg J, Albers JJ, et al.  Contrasting effects of unmodified and time-release forms of niacin on lipoproteins in hyperlipidemic subjects: clues to mechanism of action of niacin . Metabolism. 1985;;34:642-650.
30 +
Polachek AA, Katz HM, Sack J, Selig J, Littman ML.  Probucol in the long-term treatment of hypercholesterolaemia . Curr Med Res Opin. 1973;; 1:323-330.
31 +
Salel AF, Zelis R, Sodhi HS, Price J, Mason DT.  Probucol: a new cholesterol-lowering drug effective in patients with type II hyperlipoproteinemia . Clin Pharmacol Ther. 1976;;20:690-694.
32 +
LeLorier J, DuBreuil-Quidoz S, Lussier-Cacan S, Huang YS, Davignon J.  Diet and probucol in lowering cholesterol concentrations . Arch Intern Med. 1977;;137:1429-1434.
33 +
Heel RC, Brogden RN, Speight TM, Avery GS.  Probucol: a review of its pharmacological properties and therapeutic use in patients with hypercholesterolaemia . Drugs. 1978;;15:409-428.
34 +
Taylor HL, Nolan RB, Tedeschi RE, Maurath CJ.  Combined results of the study of probucol at 1 gm/day in eight centers . Clin Pharmacol Ther. 1978;;23:131-132.
35 +
Riesen WF, Keller M, Mordasini R.  Probucol in hypercholesterolemia: a double blind study . Atherosclerosis. 1980;;36:201-207.
36 +
Mellies MJ, Gartside PS, Glatfelter L, et al.  Effects of probucol on plasma cholesterol, high and low density lipoprotein cholesterol, and apolipoproteins Al and A2 in adults with primary familial hypercholesterolemia . Metabolism. 1980;;29:956-964.
37 +
McCaughan D.  The long-term effects of probucol on serum lipid levels . Arch Intern Med. 1981;;141:1428-1432.
38 +
Glueck CJ.  Colistipol and probucol: treatment of primary and familial hypercholesterolemia and amelioration of atherosclerosis . Ann Intern Med. 1982;;96:475-482.
39 +
Kesaniemi YA, Grundy SM.  Influence of probucol on cholesterol and lipoprotein metabolism in man . J Lipid Res. 1984;;25:780-790.
40 +
Dujovne CA, Krehbiel P, Decoursey S, et al.  Probucol with colestipol in the treatment of hypercholesterolemia . Ann Intern Med. 1984;;100:477-482.
41 +
Dujovne CA, Chernoff SB, Krehbiel P, et al.  Low-dose colestipol plus probucol for hypercholesterolemia . Am J Cardiol. 1984;;53:1514-1518.
42 +
Durrington PN, Miller JP.  Double-blind placebo-controlled, cross-over trial of probucol in hetrozygous familial hypercholesterolaemia . Atherosclerosis. 1985;;55:187-194.
43 +
Fellin R, Gasparotto A, Valerio G, et al.  Effect of probucol treatment on lipoprotein cholesterol and drug levels in blood and lipoproteins in familial hypercholesterolemia . Atherosclerosis. 1986;;59: 47-56.
44 +
Dujovne CA, Atkins F, Wong B, et al.  Electrocardiographic effects of probucol: a controlled prospective clinical trial . Eur J Clin Pharmacol. 1984;;26:735-739.
45 +
Levy RI, Fredrickson DS, Stone NJ, et al.  Cholestyramine in type II hyperlipoproteinemia: a double-blind trial . Ann Intern Med. 1973;;79:51-58.
46 +
 Lipid Research Clinics Program. The Lipid Research Clinics coronary primary prevention trial results: reduction in incidence of coronary heart disease . JAMA. 1984;;251:351-364.
47 +
Brensike JF, Levy RI, Kelsey SF, et al.  Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI type II coronary intervention study . Circulation. 1984;;69:313-324.
48 +
Levy RI, Brensike JF, Epstein SE, et al.  The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: results of the NHLBI type II coronary intervention study . Circulation. 1984;;69:325-337.
49 +
Glueck CJ, Ford S, Scheel D, Steiner P.  Colestipol and cholestyramine resin: comparative effects in familial type II hyperlipoproteinemia . JAMA. 1972;;222:676-681.
50 +
Gundersen K, Cooper EE, Ruoff G, Nikolai T, Assenzo JR.  Cholesterol-lowering effect of colestipol hydrochloride given twice daily in hypercholesterolemic patients . Atherosclerosis. 1976;;25:303-310.
51 +
Dorr AE, Gundersen K, Schneider JC, Spencer TW, Martin WB.  Colestipol hydrochloride in hypercholesterolemic patients: effect on serum cholesterol and mortality . J Chronic Dis. 1978;;31:5-14.
52 +
Kuo PT, Hayase K, Kostis JB, Moreyra AE.  Use of combined diet and colestipol in long-term (7-7 1/2 years) treatment of patients with type II hyperlipoproteinemia . Circulation. 1979;;59:199211.
53 +
Kane JP, Malloy MJ, Tun P, et al.  Normalization of low density-lipoprotein levels in heterozygous familial hypercholesterolemia with a combined drug regimen . N Engl J Med. 1981;;304:251-258.
54 +
Glueck CJ.  Colestipol and probucol: treatment of primary and familial hypercholesterolemia and amelioration of atherosclerosis . Ann Intern Med. 1982;;96:475-482.
55 +
Crouse JR, Grundy SM.  Effects of colestipol, clofibrate, and placebo on plasma lipoproteins of patients with hypercholesterolemia . Metabolism. 1981;;30:123-128.
56 +
Hunninghake DB, Probstfield JL, Crow LO, Isaacson SO.  Effect of colestipol and clofibrate on plasma lipid and lipoproteins in type IIa hyperlipoproteinemia . Metabolism. 1981;;30:605-609.
57 +
Vecchio TJ, Linden CV, O'Connell MJ, Heilman J.  Comparative efficacy of colestipol and clofibrate in type IIa hyperlipoproteinemia . Arch Intern Med. 1982;;142:721-723.
58 +
Blankenhorn DH, Nessim SA, Johnson RL, et al.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA. 1987;;257:3233-3240.
59 +
Alderman JD, Pasternak RC, Sacks FM, et al.  Effect of a modified, well-tolerated niacin regimen on serum total cholesterol, high density lipoprotein cholesterol and the cholesterol to high density lipoprotein ratio . Am J Cardiol. 1989;;64:725-729.
60 +
Gordon DJ.  HDL and CHD: an epidemiological perspective . J Drug Dev. 1990;;3( (suppl) ):11-17.
61 +
Taylor WC, Pass TM, Shepard DS, Komaroff AL. Cost-Effectiveness of a Dietary Program for the Primary Prevention of Coronary Heart Disease . Washington, DC: US Preventive Services Task Force; 1988;.
62 +
Kreling DH.  Assessing potential prescription reimbursement changes: estimated acquisition costs in Wisconsin . Health Care Finance Rev. 1989;;10:67-75.
63 +
Hsiao WC, Braun P, Kelly NL, Becker ER.  Results, potential effects, and implementation issues of the resource-based relative value scale . JAMA. 1988;;260:2429-2438.
64 +
 College of American Pathologists . Manual for Laboratory Workload Recording Method . Skokie, Ill: College of American Pathologists; 1982;.
65 +
Wysowski DK, Kennedy DL, Gross TP.  Prescribed use of cholesterol-lowering drugs in the United States, 1978 through 1988 . JAMA. 1990;;263:2185-2188.
66 +
Probstfield JL, Russel ML, Henske JC.  Successful program for recovery of dropouts to a clinical trial . Am J Med. 1986;;80:777-784.
67 +
Kinosian B, Eisenberg J.  Cutting into cholesterol: cost-effective alternatives for treating hypercholesterolemia . JAMA. 1988;;259:2249-2254.
68 +
Himmelstein D, Woodhandler S.  Free care, cholestyramine and health policy . N Engl J Med. 1984;;311:1511-1514.
69 +
Oster G, Epstein A.  The cost-effectiveness of anti-hyperlipidemic therapy in the prevention of coronary heart disease: the case of cholestyramine . JAMA. 1987;;258:2381-2387.
70 +
Goldman L, Edelson JT, Tosteson AA.  Projected cost-effectiveness of lovastatin for cholesterol reduction . Clin Res. 1988;;36:337A. Abstract.
71 +
Weinstein M, Stason W.  Cost-effectiveness of interventions to prevent or treat coronary heart disease . Ann Rev Public Health. 1985;;6:41-43.
72 +
Trisolini MG, McNeil BJ, Komaroff AL.  The chemistry laboratory: development of average, fixed and variable costs for incorporation into a management control system . Med Care. 1987;;25: 286-299.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 Adult Treatment Panel. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults . Arch Intern Med. 1988;; 148:36-69.
2 +
Frick MH, Elo O, Haapa K, et al.  Helsinki heart study: primary-prevention trial with gemfibrozil in middle aged men with dyslipidemia . N Engl J Med. 1987;;317:1237-1246.
3 +
Coronary Drug Research Project Group.  Clofibrate and niacin in coronary heart disease . JAMA. 1975;;233:360-381.
4 +
Canner PL, Berge KG, Wenger NK, et al.  Fifteen year mortality in coronary artery drug project patients: long term benefit with niacin . J Am Coll Cardiol. 1986;;8:1245-1255.
5 +
 Lipid Research Clinics Program. The Lipid Research Clinics primary prevention trial results: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA. 1984;;251:365-374.
6 +
Sempos C, Fulwood R, Haines C, et al.  The prevalence of high blood cholesterol levels among adults in the United States . JAMA. 1989;;262:45-52.
7 +
Garber AM, Littenberg, B, Sox HC Jr, Gluck ME, Wagner JL, Duffy BM. Costs and Effectiveness of Cholesterol Screening in the Elderly . Washington, DC: Office of Technology Assessment; 1989;. OTA Preventive Health Services paper 3.
8 +
Manninen V, Flo MO, Frick MH, et al.  Lipid alterations and the decline in the incidence of coronary heart disease in the Helsinki Heart Study . JAMA. 1988;;260:641-651.
9 +
Eisenberg JM.  Clinical economics: a guide to the economic analysis of clinical practices . JAMA. 1989;;262:2879-2886.
10 +
L'abbe KA, Detsky AS, O'Rourke K.  Metaanalysis in clinical research . Ann Intern Med. 1987;;107:224-233.
11 +
Vessby B, Lithell H, Boberg J, Hellsing K, Werner I.  Gemfibrozil as a lipid-lowering compound in hyperlipoproteinaemia: a placebo-controlled cross-over trial . Proc R Soc Med. 1976;; 69( (suppl 2) ):32-37.
12 +
Kaukola S, Manninen V, Malkonen M, Ehnholm C.  Gemfibrozil in the treatment of dyslipidaemias in middle-aged male survivors of myocardial infarction . Acta Med Scand. 1981;;209:69-73.
13 +
Manninen V, Malkonen M, Eisalo A, et al.  Gemfibrozil in the treatment of dyslipidaemia: a five-year follow-up study . Acta Med Scand. 1982;; 668( (suppl) ):82-87.
14 +
Lewis JE.  Clinical use of gemfibrozil: a controlled multicenter trial . Pract Cardiol. 1983;;9:99-118.
15 +
Samuel P.  Effects of gemfibrozil on serum lipids . Am J Med. 1983;;74:23-27.
16 +
Glueck C.  Influence of gemfibrozil on high-density lipoproteins . Am J Cardiol. 1983;;52:31B-34B.
17 +
Manninen V.  Clinical results with gemfibrozil and background to the Helsinki heart study . Am J Cardiol. 1983;;52:35B-38B.
18 +
Pickering JE.  Clinical results with gemfibrozil . Am J Cardiol. 1983;;52:39B-40B.
19 +
Virtamo J, Manninen V, Malkonen M.  A placebo-controlled, rising-dose, double-blind trial with gemfibrozil in dieting patients with primary hyperlipoproteinemia . Vase Med. 1984;;2:22-27.
20 +
Canter D.  Long-term studies with gemfibrozil in Finland: an eight-year follow-up . R Soc Med. 1986;;87:41-49.
21 +
Tikkanen MJ, Helve E.  Comparison between lovastatin and gemfibrozil in the treatment of primary hypercholesterolemia: the Finnish multi-center study . Am J Cardiol. 1988;;62:35J-43J.
22 +
Lovastatin Study Group II.  Therapeutic response to lovastatin (mevinolin) in nonfamilial hypercholesterolemia . JAMA. 1986;;256:2829-2834.
23 +
Havel RJ, Hunninghake DB, Illingworth DR, et al.  Lovastatin (mevinolin) in the treatment of heterozygous familial hypercholesterolemia . Ann Intern Med. 1987;;107:609-615.
24 +
Tolbert JA.  The efficacy and long-term adverse effect pattern of lovastatin . Am J Cardiol. 1988;; 62:28J-34J.
25 +
Lovastatin Study Group III.  A multicenter comparison of lovastatin and cholestyramine for severe primary hypercholesterolemia . JAMA. 1988;;260:359-366.
26 +
Berge KG, Achor RW, Christensen NA, Mason HL, Barker NW.  Hypercholesteremia and nicotinic acid: a long-term study . Am J Med. 1961;;31:24-36.
27 +
Schoch HK.  The U.S. Veterans Administration cardiology drug lipid study: an interim report . Adv Exp Biol. 1969;;4:405-420.
28 +
Hoeg JM, Maher MB, Bou E, et al.  Normalization of plasma lipoprotein concentrations in patients with type II hyperlipoproteinemia by combined use of neomycin and niacin . Circulation. 1984;;70:1004-1011.
29 +
Knopp RH, Ginsberg J, Albers JJ, et al.  Contrasting effects of unmodified and time-release forms of niacin on lipoproteins in hyperlipidemic subjects: clues to mechanism of action of niacin . Metabolism. 1985;;34:642-650.
30 +
Polachek AA, Katz HM, Sack J, Selig J, Littman ML.  Probucol in the long-term treatment of hypercholesterolaemia . Curr Med Res Opin. 1973;; 1:323-330.
31 +
Salel AF, Zelis R, Sodhi HS, Price J, Mason DT.  Probucol: a new cholesterol-lowering drug effective in patients with type II hyperlipoproteinemia . Clin Pharmacol Ther. 1976;;20:690-694.
32 +
LeLorier J, DuBreuil-Quidoz S, Lussier-Cacan S, Huang YS, Davignon J.  Diet and probucol in lowering cholesterol concentrations . Arch Intern Med. 1977;;137:1429-1434.
33 +
Heel RC, Brogden RN, Speight TM, Avery GS.  Probucol: a review of its pharmacological properties and therapeutic use in patients with hypercholesterolaemia . Drugs. 1978;;15:409-428.
34 +
Taylor HL, Nolan RB, Tedeschi RE, Maurath CJ.  Combined results of the study of probucol at 1 gm/day in eight centers . Clin Pharmacol Ther. 1978;;23:131-132.
35 +
Riesen WF, Keller M, Mordasini R.  Probucol in hypercholesterolemia: a double blind study . Atherosclerosis. 1980;;36:201-207.
36 +
Mellies MJ, Gartside PS, Glatfelter L, et al.  Effects of probucol on plasma cholesterol, high and low density lipoprotein cholesterol, and apolipoproteins Al and A2 in adults with primary familial hypercholesterolemia . Metabolism. 1980;;29:956-964.
37 +
McCaughan D.  The long-term effects of probucol on serum lipid levels . Arch Intern Med. 1981;;141:1428-1432.
38 +
Glueck CJ.  Colistipol and probucol: treatment of primary and familial hypercholesterolemia and amelioration of atherosclerosis . Ann Intern Med. 1982;;96:475-482.
39 +
Kesaniemi YA, Grundy SM.  Influence of probucol on cholesterol and lipoprotein metabolism in man . J Lipid Res. 1984;;25:780-790.
40 +
Dujovne CA, Krehbiel P, Decoursey S, et al.  Probucol with colestipol in the treatment of hypercholesterolemia . Ann Intern Med. 1984;;100:477-482.
41 +
Dujovne CA, Chernoff SB, Krehbiel P, et al.  Low-dose colestipol plus probucol for hypercholesterolemia . Am J Cardiol. 1984;;53:1514-1518.
42 +
Durrington PN, Miller JP.  Double-blind placebo-controlled, cross-over trial of probucol in hetrozygous familial hypercholesterolaemia . Atherosclerosis. 1985;;55:187-194.
43 +
Fellin R, Gasparotto A, Valerio G, et al.  Effect of probucol treatment on lipoprotein cholesterol and drug levels in blood and lipoproteins in familial hypercholesterolemia . Atherosclerosis. 1986;;59: 47-56.
44 +
Dujovne CA, Atkins F, Wong B, et al.  Electrocardiographic effects of probucol: a controlled prospective clinical trial . Eur J Clin Pharmacol. 1984;;26:735-739.
45 +
Levy RI, Fredrickson DS, Stone NJ, et al.  Cholestyramine in type II hyperlipoproteinemia: a double-blind trial . Ann Intern Med. 1973;;79:51-58.
46 +
 Lipid Research Clinics Program. The Lipid Research Clinics coronary primary prevention trial results: reduction in incidence of coronary heart disease . JAMA. 1984;;251:351-364.
47 +
Brensike JF, Levy RI, Kelsey SF, et al.  Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI type II coronary intervention study . Circulation. 1984;;69:313-324.
48 +
Levy RI, Brensike JF, Epstein SE, et al.  The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: results of the NHLBI type II coronary intervention study . Circulation. 1984;;69:325-337.
49 +
Glueck CJ, Ford S, Scheel D, Steiner P.  Colestipol and cholestyramine resin: comparative effects in familial type II hyperlipoproteinemia . JAMA. 1972;;222:676-681.
50 +
Gundersen K, Cooper EE, Ruoff G, Nikolai T, Assenzo JR.  Cholesterol-lowering effect of colestipol hydrochloride given twice daily in hypercholesterolemic patients . Atherosclerosis. 1976;;25:303-310.
51 +
Dorr AE, Gundersen K, Schneider JC, Spencer TW, Martin WB.  Colestipol hydrochloride in hypercholesterolemic patients: effect on serum cholesterol and mortality . J Chronic Dis. 1978;;31:5-14.
52 +
Kuo PT, Hayase K, Kostis JB, Moreyra AE.  Use of combined diet and colestipol in long-term (7-7 1/2 years) treatment of patients with type II hyperlipoproteinemia . Circulation. 1979;;59:199211.
53 +
Kane JP, Malloy MJ, Tun P, et al.  Normalization of low density-lipoprotein levels in heterozygous familial hypercholesterolemia with a combined drug regimen . N Engl J Med. 1981;;304:251-258.
54 +
Glueck CJ.  Colestipol and probucol: treatment of primary and familial hypercholesterolemia and amelioration of atherosclerosis . Ann Intern Med. 1982;;96:475-482.
55 +
Crouse JR, Grundy SM.  Effects of colestipol, clofibrate, and placebo on plasma lipoproteins of patients with hypercholesterolemia . Metabolism. 1981;;30:123-128.
56 +
Hunninghake DB, Probstfield JL, Crow LO, Isaacson SO.  Effect of colestipol and clofibrate on plasma lipid and lipoproteins in type IIa hyperlipoproteinemia . Metabolism. 1981;;30:605-609.
57 +
Vecchio TJ, Linden CV, O'Connell MJ, Heilman J.  Comparative efficacy of colestipol and clofibrate in type IIa hyperlipoproteinemia . Arch Intern Med. 1982;;142:721-723.
58 +
Blankenhorn DH, Nessim SA, Johnson RL, et al.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts . JAMA. 1987;;257:3233-3240.
59 +
Alderman JD, Pasternak RC, Sacks FM, et al.  Effect of a modified, well-tolerated niacin regimen on serum total cholesterol, high density lipoprotein cholesterol and the cholesterol to high density lipoprotein ratio . Am J Cardiol. 1989;;64:725-729.
60 +
Gordon DJ.  HDL and CHD: an epidemiological perspective . J Drug Dev. 1990;;3( (suppl) ):11-17.
61 +
Taylor WC, Pass TM, Shepard DS, Komaroff AL. Cost-Effectiveness of a Dietary Program for the Primary Prevention of Coronary Heart Disease . Washington, DC: US Preventive Services Task Force; 1988;.
62 +
Kreling DH.  Assessing potential prescription reimbursement changes: estimated acquisition costs in Wisconsin . Health Care Finance Rev. 1989;;10:67-75.
63 +
Hsiao WC, Braun P, Kelly NL, Becker ER.  Results, potential effects, and implementation issues of the resource-based relative value scale . JAMA. 1988;;260:2429-2438.
64 +
 College of American Pathologists . Manual for Laboratory Workload Recording Method . Skokie, Ill: College of American Pathologists; 1982;.
65 +
Wysowski DK, Kennedy DL, Gross TP.  Prescribed use of cholesterol-lowering drugs in the United States, 1978 through 1988 . JAMA. 1990;;263:2185-2188.
66 +
Probstfield JL, Russel ML, Henske JC.  Successful program for recovery of dropouts to a clinical trial . Am J Med. 1986;;80:777-784.
67 +
Kinosian B, Eisenberg J.  Cutting into cholesterol: cost-effective alternatives for treating hypercholesterolemia . JAMA. 1988;;259:2249-2254.
68 +
Himmelstein D, Woodhandler S.  Free care, cholestyramine and health policy . N Engl J Med. 1984;;311:1511-1514.
69 +
Oster G, Epstein A.  The cost-effectiveness of anti-hyperlipidemic therapy in the prevention of coronary heart disease: the case of cholestyramine . JAMA. 1987;;258:2381-2387.
70 +
Goldman L, Edelson JT, Tosteson AA.  Projected cost-effectiveness of lovastatin for cholesterol reduction . Clin Res. 1988;;36:337A. Abstract.
71 +
Weinstein M, Stason W.  Cost-effectiveness of interventions to prevent or treat coronary heart disease . Ann Rev Public Health. 1985;;6:41-43.
72 +
Trisolini MG, McNeil BJ, Komaroff AL.  The chemistry laboratory: development of average, fixed and variable costs for incorporation into a management control system . Med Care. 1987;;25: 286-299.

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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
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