Combination drug therapy for familial combined hyperlipidemia.

Abstract

STUDY OBJECTIVE:

To compare the efficacy of gemfibrozil and colestipol with gemfibrozil and lovastatin in patients with familial combined hyperlipidemia.

DESIGN:

A prospective, randomized trial.

SETTING:

An outpatient clinical research center in a tertiary care center.

PATIENTS:

Seventeen patients with familial combined hyperlipidemia documented by studies of first-degree relatives; nine patients with type 2b hyperlipoproteinemia, and eight patients with type 4 hyperlipoproteinemia.

INTERVENTIONS:

Baseline lipid, lipoprotein, and apolipoprotein levels were obtained during control periods on diet alone and on gemfibrozil therapy. Patients then received gemfibrozil and colestipol or gemfibrozil and lovastatin in a randomized order.

MEASUREMENTS AND MAIN RESULTS:

In patients with type 2b hyperlipoproteinemia, gemfibrozil alone significantly reduced total cholesterol by 11%, and low density lipoprotein (LDL)-apolipoprotein B by 18%, did not change LDL-cholesterol, and raised high density lipoprotein (HDL)-cholesterol levels by 26%. Addition of either colestipol or lovastatin reduced LDL-cholesterol levels by 17% and 25%, respectively, compared to gemfibrozil alone. However, colestipol mitigated the HDL-cholesterol raising effect of gemfibrozil and did not further reduce LDL-apolipoprotein B levels. In contrast, addition of lovastatin caused an additional reduction of LDL-apolipoprotein B 19% compared with gemfibrozil alone. In patients with type 4 hyperlipoproteinemia, gemfibrozil alone reduced triglycerides by 40%, raised HDL-cholesterol by 26%, and increased LDL-cholesterol levels by 29%. The addition of either colestipol or lovastatin reduced LDL-cholesterol levels by 34% and 33%, respectively (compared with gemfibrozil alone), but greater reductions of LDL-apolipoprotein B (30% with lovastatin compared with 15% with colestipol, compared with gemfibrozil alone), and increases in HDL-cholesterol levels (8% increase with lovastatin compared with 10% decrease with colestipol, compared to gemfibrozil alone) were seen with the lovastatin combination.

CONCLUSIONS:

Although gemfibrozil with either colestipol or lovastatin favorably altered lipoprotein levels in patients with hypertriglyceridemia and familial combined hyperlipidemia, the combination of gemfibrozil and lovastatin appeared superior overall.

• Authors: C East, D W Bilheimer, S M Grundy
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 109 Issue 1 Pg. 25-32 (Jul 01 1988) ISSN: 0003-4819 [Print] United States
• PMID: 3288029 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Hypolipidemic Agents
• Pentanoic Acids
• Polyamines
• Valerates
• Lovastatin
• Colestipol
• Gemfibrozil

Topics

• Adult
• Cholelithiasis (diagnosis)
• Colestipol (therapeutic use)
• Drug Therapy, Combination
• Female
• Gemfibrozil
• Humans
• Hyperlipidemia, Familial Combined (blood, drug therapy)
• Hyperlipoproteinemia Type II (drug therapy)
• Hyperlipoproteinemia Type IV (drug therapy)
• Hypolipidemic Agents (therapeutic use)
• Lovastatin (therapeutic use)
• Male
• Middle Aged
• Pentanoic Acids (therapeutic use)
• Polyamines (therapeutic use)
• Random Allocation
• Ultrasonography
• Valerates (therapeutic use)