Comparison of gemfibrozil and fenofibrate in patients with dyslipidemic coronary heart disease.
OBJECTIVE
To compare the lipid-lowering effects of gemfibrozil and fenofibrate in patients with dyslipidemic coronary heart disease.


METHODS
Open label, fixed-dosage, retrospective-prospective, one-way crossover from gemfibrozil to fenofibrate.


METHODS
University-affiliated outpatient clinics.


METHODS
Eighty patients with coronary heart disease with a baseline low-density lipoprotein cholesterol (LDL) level above 130 mg/dl or a triglyceride level of 200 mg/dl or higher who had been receiving gemfibrozil 600 mg twice/day. Thirty-nine (49%) patients had received concomitant therapy with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) for a minimum of 9 months.


METHODS
All patients received gemfibrozil 600 mg twice/day for at least 3 months before being switched to fenofibrate 201 mg/day. Patients receiving concomitant statin therapy before crossover continued the statin at the same dosage after crossover. Before crossover, a fasting lipid profile was determined and patients were queried about the side effects of lipid-lowering therapy. A repeat fasting lipid profile was obtained 12 weeks after the crossover.


RESULTS
Patients were stratified into those receiving versus those not receiving concomitant statin therapy. In both of these groups, fenofibrate was associated with significantly greater reductions in total cholesterol, LDL, and triglycerides than gemfibrozil (all p < 0.001). In addition, fenofibrate was associated with a significantly greater increase in high-density lipoprotein cholesterol (HDL) than gemfibrozil (p < 0.001). No patients reported new-onset adverse effects after the crossover.


CONCLUSIONS
Compared with gemfibrozil, fenofibrate produced significantly greater reductions in total cholesterol, LDL, and triglycerides and significantly greater increases in HDL. These changes were evident in patients receiving and not receiving concomitant statin therapy.
Packard
Kathleen A
KA
Creighton Cardiac Center, Creighton University, Omaha, Nebraska 68131, USA. Katie.Packard@cardiac.creighton.edu
Backes
James M
JM
Lenz
Thomas L
TL
Wurdeman
Richard L
RL
Destache
Christopher
C
Hilleman
Daniel E
DE
D000368:Aged; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy*; D018592:Cross-Over Studies; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use*; D015248:Gemfibrozil / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies
D015248:Gemfibrozil; D011345:Fenofibrate