Gemfibrozil, nicotinic acid and combination therapy in patients with isolated hypoalphalipoproteinemia: a randomized, open-label, crossover study.

Abstract

OBJECTIVES:

To assess the effects of nicotinic acid (NA), gemfibrozil and combination therapy on the lipid profile of patients with clinical atherosclerotic disease and isolated hypoalphalipoproteinemia.

BACKGROUND:

Isolated hypoalphalipoproteinemia (low high density lipoprotein cholesterol [HDL-C] alone) accounts for a significant percentage of patients with premature atherosclerosis. However, it remains unclear whether currently available pharmacotherapy has the ability to favorably affect the lipid profile and therefore potentially reduce clinical events.

METHODS:

Twenty-three patients with clinically well-defined atherosclerosis and isolated hypoalphalipoproteinemia were prospectively randomized to receive gemfibrozil, NA or combination therapy in an open-label, crossover design trial to assess the effects on serum lipids. Lipid profiles and other relevant laboratory variables were monitored while the patients were on and off pharmacologic lipid-modulating therapy.

RESULTS:

In those 14 patients able to tolerate all forms of pharmacotherapy, HDL-C of 0.89 +/- 0.17 mmol/liter (34.5 +/- 6.5 mg/dl) increased by 15%, to 1.02 +/- 0.18 mmol/liter (39.7 +/- 7.1 mg/dl), while taking gemfibrozil (1,200 mg/day); by 35%, to 1.20 +/- 0.21 mmol/liter (46.5 +/- 8.1 mg/dl), while taking NA (mean dose 2,250 mg/day); and by 45%, to 1.29 +/- 0.19 mmol/liter (50.0 +/- 7.5 mg/dl), while taking combination therapy of gemfibrozil plus NA (p < 0.001 for all interventions as compared with baseline/washout; p < 0.005 NA vs. gemfibrozil; p < 0.001 combination therapy vs. gemfibrozil alone; p = 0.088 combination therapy vs. NA alone). Statistically significant favorable alterations were also observed with low density lipoprotein cholesterol (LDL-C), LDL-C/HDL-C, non-HDL-C/HDL-C, apolipoprotein (Apo) B and Apo B/Apo A1.

CONCLUSIONS:

In the majority of patients with clinical atherosclerotic disease and isolated hypoalphalipoproteinemia, pharmacologic therapy to raise HDL-C is not only feasible but is also effective with currently available agents, particularly when used in combination.

• Authors: M J Zema
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 35 Issue 3 Pg. 640-6 (Mar 01 2000) ISSN: 0735-1097 [Print] United States
• PMID: 10716466 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Cholesterol, HDL
• Cholesterol, LDL
• Hypolipidemic Agents
• Niacin
• Gemfibrozil

Topics

• Adult
• Aged
• Aged, 80 and over
• Arteriosclerosis (blood, drug therapy)
• Cholesterol, HDL (blood)
• Cholesterol, LDL (blood)
• Cross-Over Studies
• Drug Therapy, Combination
• Female
• Gemfibrozil (therapeutic use)
• Humans
• Hypolipidemic Agents (therapeutic use)
• Hypolipoproteinemias (blood, drug therapy)
• Male
• Middle Aged
• Niacin (therapeutic use)
• Prospective Studies
• Treatment Outcome