Serum lipid comparison in patients treated by statins or fibrates: existence of bad HDL-C responders to statins.
BACKGROUND
Major cardiac events are strongly associated with high levels of low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). The HDL-C target level (40 mg/dl) is often not achieved with statins. The aim of this study was to compare the proportions of patients achieving the HDL-C target levels after one year of treatment with statins or fibrates. Furthermore, a subgroup with low HDL-C levels during statin treatment was investigated and suggestions are made for a better management of these patients.


METHODS
A survey of lipid levels, cardiovascular disease and risk factors in 120 outpatients treated with a statin or a fibrate for hyperlipidaemia (total cholesterol (TC) > 250 mg/dl or triglycerides (TG) > 200 mg/dl after diet). After one year of treatment the proportions of patients achieving the target levels for TC, LDL-C, HDL-C,TG,TC/HDL-C and LDL-C/HDL-C are compared for statins and fibrates.


RESULTS
The proportions of patients achieving the target lipid levels with statins or fibrates are comparable except for HDL-C. Compared to the baseline, the proportion of patients achieving the HDL-C target level of 40 mg/dl increases only by 8.3% for statins and by 42.9% for fibrates. In total, 38.5% of the statin group had low HDL-C-levels after one year of treatment. Among these patients, eight were treated with a fibrate before the statin and six were treated with a fibrate afterwards. In those 14 patients, mean HDL-C increased during fibrate treatment by 48.5% and TC/HDL-C and LDL-C/HDL-C decreased by 25.7 and 26.5%, respectively as compared with statins.


CONCLUSIONS
Patients with low levels of HDL-C during statin treatment had far better levels of HDL-C, TC/HDL-C and LDL-C/HDL-C with fibrates. A randomised double-blind crossover trial with simvastatin and fenofibrate has been initiated to corroborate these findings.
Devroey
Dirk
D
Dept. of General Practice, University of Brussels (VUB), Belgium. dirk.devroey@vub.ac.be
Velkeniers
Brigitte
B
Duquet
William
W
Betz
Willem
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects*; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D002995:Clofibric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005229:Fatty Acids, Monounsaturated / Q000627:therapeutic use; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use; D058607:Fibric Acids; D000077340:Fluvastatin; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy*; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D008840:Microfilament Proteins / Q000097:blood / Q000187:drug effects*; D008875:Middle Aged; D009124:Muscle Proteins / Q000097:blood / Q000187:drug effects*; D017035:Pravastatin / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies
D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D005229:Fatty Acids, Monounsaturated; D058607:Fibric Acids; D006538:Heptanoic Acids; D007211:Indoles; D008840:Microfilament Proteins; D009124:Muscle Proteins; D011758:Pyrroles; C058992:Tagln protein, mouse; C051615:transgelin; D000077340:Fluvastatin; D002995:Clofibric Acid; D000069059:Atorvastatin; C019304:ciprofibrate; D017035:Pravastatin; D011345:Fenofibrate