Unexpected and abnormally low HDL cholesterol levels on combination hypolipidemic therapy.

In general, Indians have low HDL cholesterol levels. Fenofibrate, a drug widely used in the treatment of hypertriglyceridemia, usually also increases HDL cholesterol. There have been a few reports in the literature of a paradoxical decrease in serum HDL-cholesterol in patients treated with fenofibrate, either alone or in combination with a statin. We report three cases of paradoxical decrease in serum HDL- cholesterol in type 2 diabetic patients treated with a statin-fenofibrate combination. ©

Apolipoprotein modifying effects of statins and fibrate in various age groups of coronary artery disease patients.

These days apolipoproteins especially apo B and apo A I are thought to be better predictors of risk of coronary artery disease as compared to lipids and lipoprotein cholesterol. Lifestyle modification and use of lipid modifying drugs such as statins and fibrates have proven effective in reducing the risk of coronary artery disease. Statins and fibrates are known to possess anti-atherosclerotic properties in addition to lipid modifying effects. Extensive data is available regarding lipid modification especially lowering of low density lipoprotein-cholesterol levels by these drugs. But the data regarding the effect of statins and fibrates, on apolipoprotein levels is scanty. Hence the present study was aimed at assessing the effect of statins (atorvastatin, simvastatin) and fenofibrate on serum apo B and apo A I levels in addition to their lipid modifying effects in various age groups of coronary artery disease patients. One hundred patients suffering from coronary artery disease were randomly assigned to 10 mg atorvastatin, 10 mg simvastatin and 200 mg fenofibrate, separately (without any combination). All the patients were divided into three age groups; group I (35-45 years), group II (46-55 years) and group III (> 55 years). Significant modification was observed in lipid and lipoprotein profile of coronary artery disease patients when treated with these drugs (statins and fibrates). A significant increase in serum apo A I (p < 0.01) and decline in serum apo B levels (p < 0.01) was observed in case of coronary artery disease patients after 16 weeks treatment, though the effect started after 1 month. All the three drugs reduced serum apo B levels in a comparable manner. Fenofibrate increased serum high density lipoprotein-cholesterol and apo A I levels more as compared to statins. It had nearly, proportionate effect in increasing high density lipoprotein-cholesterol and apo A I levels and reducing serum low density lipoprotein-cholesterol and apo B levels while the effect was disproportionate in case of atorvastatin and simvastatin. All the three drugs not only corrected lipid and lipoprotein cholesterol levels but also modified, apolipoprotein levels in a positive direction in coronary artery disease patients. Advancing age had no appreciable effect on the efficacy of these drugs.

Effect of Fenofibrate in Combination with Urate Lowering Agents in Patients with Gout

BACKGROUND: To assess the efficacy of fenofibrate treatment in combination with urate lowering agents in patients with gout. METHODS: Fourteen male patients with chronic tophaceous or recurrent acute attacks of gout were evaluated in an open-label pilot study of the hypolipidemic agent, fenofibrate (Lipidil Supra(R) 160 mg/d). Patients were stable on urate lowering agents (allopurinol or benzbromarone) for > or =three months without acute attack for the most recent one month before participating. All patients were being treated with established doses of urate lowering agents without modification throughout the study. Clinical and biochemical assessments including serum uric acid, creatinine, liver function test and fasting serum lipid were measured at (1) baseline (2) after two months of fenofibrate treatment and (3) two months after fenofibrate was withdrawn. RESULTS: Serum uric acid was lowered by 23% after two months of fenofibrate treatment (6.93+/-2.16 vs. 5.22+/-1.16 mg/dL; p=0.016). Triglyceride levels were also reduced after fenofibrate treatment (p=0.001). However, this effect was reversed after the withdrawal (p=0.002) of the drug. Alkaline phosphatase was reduced after fenofibrate treatment (p=0.006), but increased 21% after the withdrawal of the drug (p=0.002). By contrast, serum levels of high density lipoprotein and creatinine were increased 9% (p=0.018) and 12% (p=0.006), respectively; however, both levels were significantly decreased to the baseline levels upon withdrawal of fenofibrate. CONCLUSIONS: Fenofibrate can effectively reduce uric acid levels in addition to its known hypolipidemic effect. Fenofibrate may be used as a potential urate lowering agent in patients with gout, especially in those with coexisting hyperlipidemia.