Clofibrate therapy and gallstone induction.

Abstract

Two hundred consecutive patients, referred to a clinic established for the management of serum lipid disorders, were studied to assess the prevalence of gallbladder disease: 163 patients agreed to cholecystography of whom 23 had gallstones; 5 other patients had had cholecystectomy. There was a strong associction between clofibrate therapy and gallstones, which were found in 9 of 18 patients. Fifty-six patients with normal gallbladders had duodenal bile analyzed for lipid composition, and results were compared with those from 15 other patients with gallstones but normal serum lipids. Bile in hyperlipidemia and normolipidemic controls contained less cholesterol (9.21±3.48 mol/100 mol) than in clofibrate-treated patients (13.33±3.48 mol/100 mol, P<0.01), and in gallstone patients with normal serum lipids (11.87±4.52 mol/100 mol). There was no relationship demonstrable between patterns of hyperlipidemia or ischemic heart disease and the presence of gallbladder disease. There was also no association between biliary lipid composition and serum lipids or low-animal-fat diet. It is concluded that clofibrate therapy markedly increases biliary cholesterol content and is a potent lithogenic agent in patients not otherwise especially prone to gallstones. Since its role in prevention of ischemic heart disease is now uncertain, its continued wide use warrants close scrutiny.