Primary hypertriglyceridemia with borderline high cholesterol and elevated apolipoprotein B concentrations: comparison of gemfibrozil vs lovastatin therapy
Article Abstract:
Fats are carried in the blood in several forms: as triglycerides, high- and low-density lipoprotein (HDL and LDL) cholesterol, total cholesterol, and apolipoproteins (fat-carrying proteins, including apolipoprotein B, or Apo-B). People with premature coronary heart disease (CHD, disease of the arteries that supply the heart with blood) have a characteristic blood lipid profile that includes elevated levels of triglycerides, total cholesterol and Apo-B, and reduced levels of HDL cholesterol. Two drugs with cholesterol-lowering effects that are usually administered together, gemfibrozil and lovastatin, are associated with severe side effects. To evaluate whether these agents would be effective if given separately, a study of 13 male patients with hypertriglyceridemia (increased levels of triglycerides in the blood) was carried out. Their total triglyceride levels were between 250 and 500 milligrams per deciliter (mg/dl), and their total cholesterol levels were between 200 and 240 mg/dl (borderline high cholesterol). The study evaluated patients' lipid, lipoprotein cholesterol, and Apo-B levels during the last two weeks of each of four eight-week trials of gemfibrozil, lovastatin, or placebo (one placebo trial after each drug trial). Fat consumption was controlled with diet during the study. Results showed that lovastatin, but not gemfibrozil, caused a reduction in total cholesterol levels (by 28 percent compared with placebo). Lovastatin also reduced LDL cholesterol levels by 33 percent and Apo-B levels by 32 percent. Both drugs lowered blood triglycerides and VLDL (very-low-density lipoprotein) and IDL (intermediate-density lipoprotein) cholesterol levels significantly. Neither drug was associated with side effects. A discussion of treatment options for hypertriglyceridemic patients is presented. Lovastatin is recommended over gemfibrozil for a subgroup of patients with certain types of blood lipid profiles. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
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Management of primary mixed hyperlipidemia with lovastatin
Article Abstract:
The majority of patients with high blood cholesterol have only an elevation of cholesterol associated with low-density lipoproteins. However, 10 to 20 percent of patients with hypercholesterolemia also have elevated levels of triglycerides, another form of lipids, or fat. This condition is called mixed hyperlipidemia. Increased triglycerides, which are accompanied by reduced levels of high-density lipoprotein cholesterol, are an additional risk factor for coronary heart disease, and therefore the control of triglycerides should accompany the control of cholesterol in these patients. The ideal treatment for mixed hyperlipidemia is not yet clear, but it is apparent that diet therapy alone is often inadequate. The present study, involving 13 men with mixed hyperlipidemia, was designed to examine the effectiveness of lovastatin, a drug which is effective in the treatment of high blood cholesterol. The results indicated that lovastatin reduced total cholesterol by an average of 31 percent, which is in keeping with other studies. Furthermore, the drug reduced triglyceride levels by 32 percent, as compared with an inert placebo. Although lovastatin did not raise levels of high-density lipoprotein cholesterol, the ratio of low- to high-density lipoprotein, which is thought to be an important indicator of risk of coronary disease, was nonetheless lowered. Lovastatin was combined with gemfibrozil for part of the experiment; gemfibrozil is another lipid-lowering treatment. The combination proved more effective than lovastatin used alone. However, the combination also poses higher risk of severe muscle problems, a risk which may not be justified by the increase in effectiveness. The use of lovastatin alone may be the best choice for the treatment of patients with mixed hyperlipidemia. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1990
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Comparison of lovastatin and gemfibrozil in normolipidemic patients with hypoalphalipoproteinemia
Article Abstract:
Previous studies have indicated that hypoalphalipoproteinemia, low levels of high-density lipoprotein (HDL) cholesterol, are associated with the incidence of coronary heart disease. A trial was performed using 22 normolipidemic (having normal lipid levels) men who also had low concentrations of HDLs. The majority of subjects also had a history of heart disease. Two drugs were tested in a effort to assess their usefulness as primary therapeutic agents for lipid imbalances. One trial consisted of dosages of gemfibrozil, a drug that has been shown in other studies to reduce LDL and triglyceride levels and simultaneously raise HDLs. Subsequently a placebo was dispensed and, then, the clinical trial of lovastatin followed. Lovastatin is one of a new class of lipid-reducing drugs whose primary action is to reduce LDL levels. The result of the data indicated that lovastatin reduced the total and LDL cholesterol levels and improved the ratio of HDL cholesterol lipids in these subjects. Gemfibrozil reduced very-low-density lipoprotein and intermediate-density lipoprotein levels and also improved the HDL ratio level. The elevation of HDL cholesterol levels as a result of either drug therapy was not considered significant, but treatment with lovastatin was more effective than treatment with gemfibrozil. Neither drug was recommended for use as primary therapy in treating normolipidemic patients with hypoalphalipoproteinemia to reduce the risk of coronary heart disease. However, lovastatin may be useful in secondary prevention of heart disease and may help to slow the progress of atherosclerosis.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1989
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