Asunto(s)
Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aterosclerosis/terapia , Colesterol/sangre , Dislipidemias/terapia , Aterosclerosis/prevención & control , Biomarcadores/sangre , Enfermedades Cardiovasculares/etiología , Ésteres del Colesterol/sangre , Dislipidemias/sangre , Dislipidemias/prevención & control , Ácidos Grasos/metabolismo , Ácidos Fíbricos/metabolismo , Hipercolesterolemia/sangre , Hipertrigliceridemia/sangre , Esperanza de Vida , Lipoproteínas/metabolismo , Factores de Riesgo , Triglicéridos/sangreRESUMEN
Etofibrate is a hybrid drug which combines niacin with clofibrate. After contact with plasma hydrolases, both constituents are gradually released in a controlled-release manner. In this study, we compared the effects of etofibrate and controlled-release niacin on lipid profile and plasma lipoprotein (a) (Lp(a)) levels of patients with triglyceride levels of 200 to 400 mg/dl, total cholesterol above 240 mg/dl and Lp(a) above 40 mg/dl. These patients were randomly assigned to a double-blind 16-week treatment period with etofibrate (500 mg twice daily, N = 14) or niacin (500 mg twice daily, N = 11). In both treatment groups total cholesterol, VLDL cholesterol and triglycerides were equally reduced and high-density lipoprotein cholesterol was increased. Etofibrate, but not niacin, reduced Lp(a) by 26 percent and low-density lipoprotein (LDL) cholesterol by 23 percent. The hybrid compound etofibrate produced a more effective reduction in plasma LDL cholesterol and Lp(a) levels than controlled-release niacin in type IIb dyslipidemic subjects
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Ácido Clofíbrico/análogos & derivados , Hiperlipidemias/tratamiento farmacológico , Lípidos/sangre , Lipoproteína(a)/efectos de los fármacos , Niacina/uso terapéutico , Análisis de Varianza , HDL-Colesterol/sangre , HDL-Colesterol/efectos de los fármacos , LDL-Colesterol/sangre , LDL-Colesterol/efectos de los fármacos , VLDL-Colesterol/sangre , VLDL-Colesterol/efectos de los fármacos , Método Doble Ciego , Lipoproteína(a)/sangre , Estadísticas no Paramétricas , Triglicéridos/sangreRESUMEN
Total serum lipids, as well as apolipoproteins A-I (apo A-I) and B (apo B), were determined in 74 patients with chronic liver failure without cholestasis and in 82 normal subjects. The VLDL, LDL and HDL lipid fractions were reduced in the liver failure group by 36 percent, 24 percent and 46 percent, respectively (P<0.001). Apolipoproteins A-I and B were also reduced by 26 percent and 25 percent, respectively (P<0.001). However, the reduction of HDL cholesterol (HDLc) was more pronounced than that of apo A-I and HDLc:apo A-I ratio was significantly lower in the liver failure group. After separating these patients into groups with plasma albumin lower than 3.0, between 3.0 and 3.5, and higher than 3.5 g/dl, the HDLc:apo A-I ratio was proportional to plasma albumin, but the correlation was not statistically significant. When these patients were separated by the Child classification of liver function, there was a correlation between the HDLc:apo A-I ratio and liver function. The differences in the HDLc:apo A-I ratio between the Child groups B and C, and A and C were statistically significant (P<0.05). We conclude that there is a more pronounced reduction in HDL cholesterol than in apo A-I in liver failure patients. Therefore, the HDLc:apo A-I ratio is a marker of liver function, probably because there is a decreased lecithin-cholesterol acyltransferase production by the diseased liver.