Effects of lipid-lowering drugs on intermediate-density lipoprotein in uremic patients.
BACKGROUND
Patients with chronic renal failure often have alterations in lipoprotein profile including elevated very-low density lipoprotein (VLDL) and intermediate density lipoprotein (IDL), and reduced high density lipoprotein (HDL) levels. Among these changes, raised IDL has been shown as an independent risk factor for atherosclerosis in hemodialysis patients. There are a limited number of studies reporting pharmacological approaches to IDL reduction in a uremic population.


METHODS
We therefore summarize the effects of lipid-lowering drugs on IDL levels in patients with chronic renal failure treated by hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).


RESULTS
First, a nicotinic acid analog niceritrol was given to hemodialysis patients. The drug increased HDL-cholesterol by 11%, but the reductions in VLDL-, IDL- and LDL-cholesterol were not significant. Second, CAPD patients were treated with a fibric acid derivative clinofibrate, which was excreted mainly into bile unlike other drugs in this class. The fibrate resulted in a remarkable reduction in VLDL-triglycerides, although it did not reduce IDL-cholesterol. Finally, an HMG-CoA reductase inhibitor (statin) pravastatin was used in HD and CAPD patients. Pravastatin reduced IDL- and LDL-cholesterol to the same extent (by 31%). None of these treatments caused serious adverse effects.


CONCLUSIONS
We propose that IDL is an important target in the management of uremic dyslipidemia. To date, statins have been shown to be suitable for this purpose, although it remains to be clarified whether such an intervention reduces the risk for atherosclerotic vascular events in the uremic population.
Nishizawa
Y
Y
Osaka City University Medical School, Japan. m6413203@med.osaka-cu.ac.jp
Shoji
T
T
Tabata
T
T
Inoue
T
T
Morii
H
H
D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D015243:Cholesterol, VLDL / Q000097:blood / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D017270:Lipoprotein(a) / Q000097:blood / Q000187:drug effects; D008074:Lipoproteins / Q000097:blood / Q000187:drug effects*; D008079:Lipoproteins, VLDL / Q000097:blood / Q000187:drug effects; D009531:Niceritrol / Q000627:therapeutic use; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010642:Phenoxyacetates / Q000627:therapeutic use; D017035:Pravastatin / Q000627:therapeutic use; D006435:Renal Dialysis; D014511:Uremia / Q000097:blood* / Q000628:therapy
D008078:Cholesterol, LDL; D015243:Cholesterol, VLDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D017270:Lipoprotein(a); D008074:Lipoproteins; D008079:Lipoproteins, VLDL; D010642:Phenoxyacetates; C006231:clinofibrate; D009531:Niceritrol; D017035:Pravastatin