***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Niacin extended-release/lovastatin is a new combination product approved for treatment of primary hypercholesterolemia and mixed dyslipidemia . This open-labeled , multicenter study evaluated the safety of bedtime niacin extended-release/lovastatin when dosed as initial therapy and patient compliance to treatment in various clinical practice setting s. A total of 4,499 patients with dyslipidemia requiring drug intervention was enrolled at 1,081 sites . Patients were treated with 1 tablet ( 500 mg of niacin extended-release/20 mg of lovastatin ) once nightly for 4 weeks and then 2 tablets for 8 weeks . Patients also received dietary counseling , educational material s , and reminders to call a toll-free number that provided further education about dyslipidemia and niacin extended-release/lovastatin . Primary end points were study compliance , increases in liver transaminases to > 3 times the upper limit of normal , and clinical myopathy . Final study status was available for 4,217 patients ( 94 % ) .  Compliance to niacin extended-release/lovastatin  was 77 % , with 3,245 patients completing the study . Patients in the southeast and those enrolled by endocrinologists had the lowest compliance and highest adverse event rates . Flushing was the most common adverse event , reported by 18 % of patients and leading to discontinuation by 6 % . Incidence of increased aspartate aminotransferase and /or alanine aminotransferase > 3 times the upper limit of normal was < 0.3 % . An increase of creatine phosphokinase to > 5 times the upper limit of normal occurred in 0.24 % of patients , and no cases of drug-induced myopathy were observed . Niacin extended-release/lovastatin 1,000/40 mg , dosed as initial therapy , was associated with good compliance and safety and had very low incidences of increased liver and muscle enzymes A computerized tracking system was developed for the monitoring of recruitment and participant follow-up in the Worcester Area Trial for Counseling in Hyperlipidemia ( WATCH ) . In this study , over 8,000 subjects were screened , from which 1,278 were recruited over a two-year period . Subjects were r and omized into three conditions ( one is control , the other two with interventions ) and followed for one year . Patient lipid profiles , dietary intakes , and psychosocial data were collected at baseline and after one year . The tracking system developed proved essential to the efficient management of WATCH and can be adapted for other research and non research purpose The Study of Cardiovascular Risk Intervention by Pharmacists , a r and omized , controlled trial in over 50 community pharmacies in Alberta and Saskatchewan , Canada , demonstrated that a pharmacist intervention program improved cholesterol risk management in patients at high risk for cardiovascular disease . In a sub study , costs and consequences were analyzed to describe the economic impact of the program . Two perspectives were taken : a government-funded health care system and a pharmacy manager . Costs were reported in 1999 Canadian dollars . Incremental costs to a government payor and community pharmacy manager were $ 6.40/patient and $ 21.76/patient , respectively , during the 4-month follow-up period . The community pharmacy manager had an initial investment of $ 683.50 . The change in Framingham risk function for the intervention group from baseline also was reported . The 10-year risk of cardiovascular disease decreased from 17.3 % to 16.4 % ( p<0.0001 ) during the 4 months . The intervention program in this study led to a significant reduction in cardiovascular risk in the intervention group during the 4-month follow-up period . The incremental cost to provide the program appeared minimal from both government and pharmacy manager perspectives . It is hoped that these results could support negotiations for reimbursement of clinical pharmacy services with payors The Women ’s Lifestyle Heart Trial was a small ( N=28 ) r and omized controlled trial to evaluate the effects of a comprehensive lifestyle self-management program ( very low-fat vegetarian diet , stress-management training , exercise , group support , and smoking cessation ) on reduction of cardiovascular risk factors in postmenopausal women with coronary heart disease ( CHD ) . Women assigned to the treatment condition ( Prime Time ) participated in a week-long retreat followed by twice-weekly 4-hour meetings . Endpoints were program adherence ; changes in lipid profiles , body mass , blood pressure , hypolipidemic and antihypertensive medications ; and quality of life . Risk factor and psychosocial evaluations were conducted at baseline and at 4 , 12 , and 24 months . Repeated measures analyses of covariance revealed that the dietary , stress management , and physical activity changes made by intervention women were dramatic and lasting . There were significantly greater improvements in the Prime Time condition compared to the usual care control group on body mass , angina symptoms , and quality of life , and a tendency for a greater reduction in blood pressure-lowering medications . Similar patterns were seen in lipids , blood pressure , and lipid-lowering medications , but did not reach significance . These results demonstrate that postmenopausal CHD women can make lasting lifestyle changes , and that these changes may reduce the need for cardiac medications and improve CHD risk factors and quality of life Abstract Objective To investigate the effects of compliance and periodic telephone counselling by a pharmacist on mortality in patients receiving polypharmacy . Design Two year r and omised controlled trial . Setting Hospital medical clinic . Participants 502 of 1011 patients receiving five or more drugs for chronic disease found to be non-compliant at the screening visit were invited for r and omisation to either the telephone counselling group ( n = 219 ) or control group ( n = 223 ) at enrolment 12 - 16 weeks later . Main outcome measures Primary outcome was all cause mortality  in r and omised patients . Associations between compliance and mortality in the entire cohort of 1011 patients were also examined . Patients were defined as compliant with a drug if they took 80 - 120 % of the prescribed daily dose . To calculate a compliance score for the whole treatment regimen , the number of drugs that the patient was fully compliant with was divided by the total number of prescribed drugs and expressed as a percentage . Only patients who complied with all recommended drugs were considered compliant ( 100 % score ) . Results 60 of the 502 eligible patients defaulted and only 442 patients were r and omised . After two years , 31 ( 52 % ) of the defaulters had died , 38 ( 17 % ) of the control group had died , and 25 ( 11 % ) of the intervention group had died . After adjustment for confounders , telephone counselling was associated with a 41 % reduction in the risk of death ( relative risk 0.59 , 95 % confidence interval 0.35 to 0.97 ; P = 0.039 ) . The number needed to treat to prevent one death at two years was 16 . Other predictors included old age , living alone , rate of admission to hospital , compliance score , number of drugs for chronic disease , and non-treatment with lipid lowering drugs at screening visit . In the cohort of 1011 patients , the adjusted relative risk for death was 1.61 ( 1.05 to 2.48 ; P = 0.029 ) and 2.87 ( 1.80 to 2.57 ; P < 0.001 ) in patients with compliance scores of 34 - 66 % and 0 - 33 % , respectively , compared with those who had a compliance score of 67 % or more . Conclusion In patients receiving polypharmacy , poor compliance was associated with increased mortality .  Periodic telephone counselling by a pharmacist improved compliance and reduced mortality . Trial registration International St and ard R and omised Controlled Trial Number Register : S RCT N48076318 CONTEXT Poor medication adherence diminishes the health benefits of pharmacotherapies . Elderly patients with coronary risk factors frequently require treatment with multiple medications , placing them at increased risk for nonadherence . OBJECTIVE To test the efficacy of a comprehensive pharmacy care program to improve medication adherence and its associated effects on blood pressure ( BP ) and low-density lipoprotein cholesterol ( LDL-C ) . DESIGN , SETTING , AND PATIENTS A multiphase , prospect i ve study with an observational phase and a r and omized controlled trial conducted at the Walter Reed Army Medical Center of 200 community-based patients aged 65 years or older taking at least 4 chronic medications . The study was conducted from June 2004 to August 2006 . INTERVENTION After a 2-month run-in phase ( measurement of baseline adherence , BP , and LDL-C ) , patients entered a 6-month intervention phase ( st and ardized medication education , regular follow-up by pharmacists , and medications dispensed in time-specific packs ) . Following the intervention phase , patients were r and omized to continued pharmacy care vs usual care for an additional 6 months . MAIN OUTCOME MEASURES Primary end point of the observation phase was change in the proportion of pills taken vs baseline ; secondary end points were the associated changes in BP and LDL-C. Primary end point of the r and omization phase was the between-group comparison of medication persistence . RESULTS A total of 200 elderly patients ( 77.1 % men ; mean [ SD ] age , 78 [ 8.3 ] years ) , taking a mean ( SD ) of 9 ( 3 ) chronic medications were enrolled . Coronary risk factors included drug-treated hypertension in 184 patients ( 91.5 % ) and drug-treated hyperlipidemia in 162 ( 80.6 % ) . Mean ( SD ) baseline medication adherence was 61.2 % ( 13.5 % ) . After 6 months of intervention , medication adherence increased to 96.9 % ( 5.2 % ; P<.001 ) and was associated with significant improvements in systolic BP ( 133.2 [ 14.9 ] to 129.9 [ 16.0 ] mm Hg ; P = .02 ) and LDL-C ( 91.7 [ 26.1 ] to 86.8 [ 23.4 ] mg/dL ; P = .001 ) . Six months after r and omization , the persistence of medication adherence decreased to 69.1 % ( 16.4 % ) among those patients assigned to usual care , whereas it was sustained at 95.5 % ( 7.7 % ) in pharmacy care ( P<.001 ) . This was associated with significant reductions in systolic BP in the pharmacy care group ( -6.9 mm Hg ; 95 % CI , -10.7 to -3.1 mm Hg ) vs the usual care group ( -1.0 mm Hg ; 95 % CI , -5.9 to 3.9 mm Hg ; P = .04 ) , but no significant between-group differences in LDL-C levels or reductions . CONCLUSIONS A pharmacy care program led to increases in medication adherence , medication persistence , and clinical ly meaningful reductions in BP , whereas discontinuation of the program was associated with decreased medication adherence and persistence . TRIAL REGISTRATION clinical trials.gov Identifier : Few studies have evaluated the efficacy of cholesterol-lowering interventions in a community setting and have included a control or comparison group . As part of a preventive health demonstration project in rural Pennsylvania , Medicare beneficiaries underwent cholesterol screening to identify high-risk individuals with serum cholesterol levels > or = 240 mg/dL. These high-risk individuals were r and omized to a  cholesterol-lowering intervention  through either local hospitals or physicians ' offices or to a control group . Baseline and follow-up serum cholesterol levels collected two to three years later were compared according to service location ( hospital versus physician 's office ) , intervention attendance , degree of participation , baseline heart disease history , and cholesterol-lowering medication use at follow-up . Serum cholesterol levels decreased between 5.7 % and 6.6 % in the hospital-based and physician-based groups , as well as in a control group not offered the intervention .  Participation rates did not differ between treatment groups , nor did participation affect serum cholesterol levels . Attendance level and heart disease history were not associated with a greater decrease in serum cholesterol levels . Individuals reporting cholesterol-lowering drug use at follow-up had significantly higher baseline serum cholesterol levels and a significantly greater decrease in total serum cholesterol ( P < .0001 ) than those not on medication . Both nonpharmacological ( diet ) and pharmacological ( drug ) interventions will reduce serum cholesterol levels and heart attack risk . The study results suggest that , at least for older individuals , the impact of nonpharmacological interventions on the community is minimal . We conclude that only very aggressive treatment will significantly loser serum cholesterol levels in older individuals at risk for heart attack BACKGROUND Siblings of individuals with premature coronary heart disease have a high prevalence of low-density lipoprotein cholesterol ( LDL-C ) levels requiring treatment . OBJECTIVE To evaluate management strategies for high LDL-C levels in apparently healthy 30- to 59-year-old siblings of individuals with documented coronary heart disease prior to age 60 years . METHODS In a 2-year trial of care provided by either a nurse trained in lipid management ( NURS ) 
    Output:
    
Interventions could be stratified into four categories : 1 .
simplification of drug regimen , 2 .
patient information/education , 3 .
intensified patient care such as reminding and 4 .
The fact that the successful interventions were evenly spread across the categories , does not suggest any advantage of one particular type of intervention .
REVIEW ERS ' CONCLUSIONS At this stage , no specific intervention aim ed at improving adherence to lipid lowering drugs can be recommended .