Long-Lasting Combination Treatment of Mixed Hyperlipoproteinaemiaswith Statins and Fibrates

Overview

Background.
It is difficult to achieve satisfactory decreases of both plasma LDL-cholesterol (LDL-C) andtriglycerides (TG) and increase of HDL-C with only single statin or fibrate treatment of patients with mixedhyperlipoproteinaemias (HLP). Combination treatment with both statin and fibrate has been shown to enhanceachieving of recommended targets in these patients with high-risk of coronary heart disease. On the other handunpleasant side effects including myopathy and rhabdomyolysis were described in some cases after statin-fibratecombination therapy. Aim of the study was to evaluate efficacy and safety of long-term treatment of pravastatin+fenofibrateor simvastatin+ciprofibrate therapy in the high-risk group of patients with severe mixed hyperlipoproteinemia.Methods and Results. A set of 86 patients (55 M/31 F) was followed for a period at least one year (median 3 years).These patients were randomly assigned to combination of pravastatin 20 mg + fenofibrate 200mg (n=46) (group A),or simvastatin 20 mg + ciprofibrate 100 mg (n=40) (group B). We have observed significant reduction in plasma TC(22 % in group A, 20 % in group B), in LDL-C (36 %, resp. 33 %), reduction of TG (44 %, resp. 46 %), apo-B (35 %,resp. 33 %) whilst HDL-C significantly increased (18 %, resp. 16 %). Concomitantly we have seen significantdecreases in uricaemia (14 %, resp. 18 %). No patient needed to stop treatment due to abnormalities in liver functiontests. Levels of creatinkinase became non-significantly elevated (by 16%, resp. 13%).No patient exhibitedmyopathyor rhabdomyolysis.Conclusions. The long-term combined therapy with statin-fibrate (pravastatin 20 mg + fenofibrate 200 mg, orsimvastatin 20 mg + ciprofibrate 100 mg) in severe mixed HLP was safe and effectively improved plasma lipid andapolipoprotein levels. Both combinations seemed to be similarly efficient and safe.

Key words:
combination hypolipidemic therapy, statins, fibrates, mixed hyperlipoproteinemia.