[Is combined statin and fibrate therapy indicated in the management of mixed hyperlipidemia?].
INSUFFICIENT PROGRESS: The treatment of hyperlipidemia leads to a reduced risk of coronary disease. This has been displayed notably since clinical trials have used statins. However, despite these treatments, a risk of coronary ischemia remains, which is not insignificant. There are several causes of this persistent risk which need to be analyzed. THE QUALITATIVE ASPECT OF LOW DENSITY LIPOPROTEINS: LDL are heterogeneous. This is displayed by a distribution of sizes varying from one subject to another. The predominance of small LDL is frequently found in coronary subjects detected during prospective or retrospective studies. The atherogenicity of small LDL can be explained by their physico-chemical characteristics. A remarkable fact is the predominance of small LDL in subjects with a mixed hyperlipidemia presenting a high risk of atherosclerosis. THE EFFECTS OF HYPOLIPIDEMIANTS: Statins greatly decrease LDL-cholesterol without changing LDL distribution according to size. Conversely, fibrates noticeably modify LDL distribution, reducing the percentage of small LDL. A PROPOSAL FOR THE TREATMENT OF SUBJECTS SUFFERING FROM MIXED HYPERLIPIDEMIA: If the concentration of LDL (reflected by LDL-cholesterol) and LDL distribution are two risk factors of atherosclerosis, hypolipidemic treatment should aim to act upon these two parameters, but no commercialized hypolipidemiant is effective enough as fas as they are both concerned. Therefore the combination of two hypolipidemiants, a statin and a fibrate, each having a predominant effect on one of the two factors, could be particularly effective in reducing coronary risk. This therapeutic association is effective on classic lipid parameters, does not entail more side effects than a monotherapy, and is not precluded by the RMO when there is a high vascular risk, which is often the case in mixed hyperlipidemia.
Département d'Athérosclérose, INSERM U325, Institut Pasteur de Lille.
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D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008148:Lovastatin / Q000627:therapeutic use*; D019821:Simvastatin / Q000627:therapeutic use*
D000924:Anticholesteremic Agents; D000960:Hypolipidemic Agents; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D008148:Lovastatin; D019821:Simvastatin
Faut-il associer statines et fibrates dans le traitement des hyperlipidémies mixtes?