Normalization of daytime triglyceridemia by simvastatin in fasting normotriglyceridemic patients with premature coronary sclerosis.
Postprandial hyperlipidemia is associated with premature coronary sclerosis in fasting normolipidemic subjects. Self-determined daytime capillary triglyceride (cTG) profiles were compared between 26 fasting normotriglyceridemic patients with premature coronary artery disease (CAD) and 26 controls matched for gender, age and BMI. Daytime triglyceridemia was calculated as total area under the cTG-curve (cTG-AUC). Total and LDL cholesterol were not different between CAD patients (5.4+/-0.8 mmol/l and 3.6+/-0.7 mmol/l, respectively) and controls (5.0+/-0.9 mmol/l and 3.3+/-0.8 mmol/l, respectively). Patients with CAD were characterized by a 44% higher cTG-AUC than matched controls (P<0.01). Using logistic regression analysis, cTG-AUC was the strongest predictor of the presence of CAD (P<0.001). Adding apo AI to the model improved the predictive power from 71 to 77%. Sixteen patients were studied after increasing doses of simvastatin up to 80 mg/day. Although the target for LDL cholesterol was reached by simvastatin 20mg/day, significant effects on cTG-AUC were found only by higher doses of simvastatin. Simvastatin 40 mg/day decreased cTG-AUC by 28% (P<0.05 versus baseline), reaching comparable values as in controls, without further improvement with simvastatin 80 mg/day (26% reduction versus baseline; P<0.05). Daytime triglyceridemia is linked to premature coronary sclerosis in fasting normotriglyceridemic patients. A higher dose of simvastatin was needed to normalize daytime triglyceridemia than was required to "normalize" LDL cholesterol.
van Wijk
J P H
JP
Department of Vascular Medicine, University Medical Center Utrecht, F02.126, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Halkes
C J M
CJ
De Jaegere
P P Th
PP
Plokker
H W M
HW
Erkelens
D W
DW
Cabezas
M Castro
MC
D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood / Q000187:drug effects; D001055:Apolipoproteins B / Q000097:blood / Q000187:drug effects; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002940:Circadian Rhythm / Q000502:physiology*; D003324:Coronary Artery Disease / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D004041:Dietary Fats / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D002149:Energy Intake / Q000187:drug effects; D005215:Fasting / Q000097:blood*; D005260:Female; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D019821:Simvastatin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D015415:Biomarkers; D004041:Dietary Fats; D000960:Hypolipidemic Agents; D014280:Triglycerides; D019821:Simvastatin