Effects of fenofibrate on atherogenic dyslipidemia in hypertriglyceridemic subjects.
BACKGROUND
The metabolic syndrome (MS) is often accompanied by atherogenic dyslipidemia, which is characterized by elevated triglycerides (TG), reduced high-density lipoprotein cholesterol (HDL-C), and elevated numbers of small, dense low-density lipoprotein (LDL) particles.


OBJECTIVE
It was hypothesized that a threshold exists for the circulating TG level needed to produce changes in LDL subclass distribution.


METHODS
Hypertriglyceridemic (TG > or =300 and <1000 mg/dl) subjects with the MS were randomly assigned to placebo (n=50) or 130 mg/day of micronized fenofibrate-coated microgranules (n=96) for 8 weeks.


RESULTS
In the overall analysis, fenofibrate treatment resulted in significant (p < 0.05) changes versus placebo in TG (-36.6%), non-HDL-C (-7.5%), very low-density lipoprotein-C (-32.7%), LDL-C (15.0%), HDL-C (14.0%), remnant lipoprotein-C (-35.1%), apolipoprotein B (-6.0%), apolipoprotein A-I (5.3%), and apolipoprotein C-III--29.7%). Changes in LDL particle diameter in the fenofibrate group were significantly inversely associated with the TG level achieved on treatment (p = 0.019). When individually matched for percent change in TG, subjects with on-treatment TG < 200 mg/dl, in contrast to those with on-treatment values > or =200 mg/dl, had significantly different median responses (p < 0.05) in LDL size (0.79 vs. -0.06 nm) and cholesterol carried by small (-35 vs. 21 mg/dl) and large (31 vs. 11 mg/dl) particles.


CONCLUSIONS
These data support the view that a threshold exists below which the TG level must be lowered to produce shifts in LDL particle size.
Davidson
Michael H
MH
Department of Cardiology, Rush University Medical College, 60610, USA. michaeldavidson@radiantresearch.com
Bays
Harold E
HE
Stein
Evan
E
Maki
Kevin C
KC
Shalwitz
Robert A
RA
Doyle
Ralph
R
D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000188:drug therapy; D008078:Cholesterol, LDL / Q000097:blood; D004311:Double-Blind Method; D050171:Dyslipidemias / Q000097:blood; D005260:Female; D011345:Fenofibrate / Q000494:pharmacology*; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000494:pharmacology*; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome; D008875:Middle Aged; D010316:Particle Size
D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D008055:Lipids; D011345:Fenofibrate