tion with a variety of medications, including cyclosporine, fibrates, macrolide antibiotics, certain antifungal drugs, and niacin (19–21). Some of the drug to drug interactions involve specific interactions with the cytochrome P-450 drug-metabolizing system, especially those involving the 3A4 isozyme (22,23). The combination of statins with a fibrate is attractive for persons who have both high serum cholesterol and high triglycerides or for those who continue to have elevated triglycerides after reaching their LDLcholesterol target on statin therapy. However, there may be a concern about an increased danger of developing myop- 568 Pasternak et al. JACC Vol. 40, No. 3, 2002 ACC/AHA/NHLBI Clinical Advisory on Statins August 7, 2002:567–72