Effects of fenofibrate and simvastatin on HDL-related biomarkers in low-HDL patients.
The objective of the present study was to compare the effects of fenofibrate versus simvastatin on various HDL-related biomarkers in dyslipidemic patients with low HDL-C, in whom it is as yet unclear whether a statin or a fibrate is the most appropriate treatment. Fifty-two patients received either fenofibrate (160 mg/day) or simvastatin (40 mg/day) for 8 weeks in a randomized, double-blind, parallel group trial. Simvastatin effectively lowered plasma LDL-C and apoB levels, but did not change plasma HDL levels and HDL-related biomarkers, except for a small, significant increase in the capacity of plasma to promote SR-BI mediated cholesterol efflux. Fenofibrate did not affect plasma LDL-C levels but lowered triglycerides, and exerted a remarkable HDL-C raising activity (+22%), with patients in the lowest range of HDL-C getting the maximal benefit. The HDL-C raise was associated with a shift of HDL from large to small particles, and from LpA-I to LpA-I:A-II, which might explain the observed increase in the plasma capacity to promote ABCA1 mediated efflux with no changes in SR-BI efflux. The distinct and complementary effects of fenofibrate and simvastatin on lipid parameters and HDL-related biomarkers suggest that a combination therapy with the two drugs in dyslipidemic patients with low HDL would be fully justified.
Franceschini
Guido
G
Center E. Grossi Paoletti, Department of Pharmacological Sciences, University of Milano, Italy. Guido.Franceschini@unimi.it
Calabresi
Laura
L
Colombo
Cinzia
C
Favari
Elda
E
Bernini
Franco
F
Sirtori
Cesare R
CR
D064286:ATP Binding Cassette Transporter 1; D018528:ATP-Binding Cassette Transporters / Q000187:drug effects; D000368:Aged; D001053:Apolipoproteins / Q000187:drug effects; D008076:Cholesterol, HDL / Q000187:drug effects*; D008078:Cholesterol, LDL / Q000187:drug effects / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D011345:Fenofibrate / Q000494:pharmacology*; D006801:Humans; D000960:Hypolipidemic Agents / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D051122:Scavenger Receptors, Class B / Q000187:drug effects; D019821:Simvastatin / Q000494:pharmacology*
C577836:ABCA1 protein, human; D064286:ATP Binding Cassette Transporter 1; D018528:ATP-Binding Cassette Transporters; D001053:Apolipoproteins; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; C495124:SCARB1 protein, human; D051122:Scavenger Receptors, Class B; D019821:Simvastatin; D011345:Fenofibrate