The effects on serum lipoprotein(a) of antihyperlipidemic agents

ABSTRACT

BACKGROUND: Many studies to reduce serum lipoprotein(a) are done because serum lipoprotein(a) has been known to be an independent risk factor of coronary artery disease along with age, smoking, diabetes, hypertension, and hyperlipidemia. Till now, oral estrogen/androgen therapy, niacin analogue and plasmapheresis are known therapeutic methods. This study examined the relative effects of three antihyperlipidemic agents, acipimox, lovastatin, fenofibrate. METHODS: Among 70 subjects (male-19, female-51) with their serum cholesterol level of more than 240mg/dL, 56 subjects who were completed 2 months antihyperlipidemic treatment (acipimox-20, lovastatin-18, fenofibrate-18) were examined for baseline total cholesterol, HDL cholesterol, triglyceride, and lipoprotein(a) and were followed up 2 months later. RESULTS: Mean values of each group for acipimox, lovastatin, fenofibrate were as follows total cholesterol (268.1+/-19.03, 287.1+/-36.42, 268.9+/-25.99), HDL cholesterol (43.5+/-10.99, 42.7+/-11.88, 37.9+/-8.20), triglyceride (226.1+/-165.03, 260.4+/-175.98, 234.3+/-124.33), LDL cholesterol (179.3+/-30.40, 192.3+/-41.52, 184.1+/-38.08), lipoprotein(a) (26.2+/-15.32,34.8+/-18.56,29.9+/-12.58). Mean percentile reduction of lipoprotein(a) was acipimox-41.4%(P<0.0001), lovastatin-22.2%(P<0.0001), fenofibrate-16.1%(P<0.05), and p value was less than 0.05 in the comparison of groups. Lipoprotein(a) showed no relations with age, sex, BMI, WHR, smoking, total cholesterol, HDL cholesterol, triglyceride and LDL cholesterol. After 2 months treatment, mean reduction percentages of total cholesterol was acipimox-12.2%(P<0.0001), lovastatin-17.6%(P<0.0001), fenofibrate-8.85%(P<0.05). LDL cholesterol was acipimox-16.12%(P<0.0001), lovastatin-22.89%(P<0.0001), fenofibrate-12.06% (P<0.05). Triglyceride was acipimox-17.24%(P<0.0001), lovastatin-17.39%(P<0.0001), fenofibrate-9,78%(P<0.05). HDL cholesterol was elevated in acipimox-17.24%(P<0.05), lovastatin-16.10%(P<0.05) and fenofibrate-12.06(P<0.05). In total cholesterol(P<0.05) and LDL cholesterol(P<0.05), there were significant differences among 3 groups, but not in HDLcholesterol and triglycerides. CONCLUSION: In two months treatment of acipimox, lovastatin and fenofibrate in hyperlipidemic patients, lipoprotein(a), known for independent risk factor of coronary artery disease, was reduced significantly in the order of acipimox, lovastatin and fenofibrate.