What are the advantages and disadvantages of adding a fibrate or niacin?
The addition of a fibrate should raise the HDL-C into the desirable range. However, the risk of rhabdomyolysis is increased in this situation. A joint statement issued by the American College of Cardiology, the American Heart Association, and the National Heart, Lung and Blood Institute (ACC/AHA/NHLBI)11 states that statin treatment alone or fibrate treatment alone is associated with a small risk of severe myopathy (approximately 0.8% to 0.9%), and that the risk is increased when a statin and a fibrate are used in combination. Although no head-to-head studies have compared the incidence of myopathy/rhabdomyolysis in patients treated with pravastatin and other statins in combination with fibrates, pravastatin offers some differences among other marketed statins because it does not enter the myocyte. In addition, it has a clear route of exertion by the liver and thus may have a better safety profile with regard to rhabdomyolysis compared to other statins.12 In addition, fenofibrate may h
