Moderate Dyslipidemia Research Articles

The Evaluation of Chinese Therapeutic Food for the Treatment of Moderate Dyslipidemia

The clinical efficacy of the Chinese therapeutic food (specifically hawthorn fruit and Chinese kiwifruit-extract compound) on dyslipidemia was evaluated in this placebo-controlled, double blind, paired clinical trial conducted in Melbourne, Australia. Forty-three participants diagnosed with moderate dyslipidemia and met the study criteria were randomly assigned to Group A or B, with baseline characteristics matched. Twenty-seven participants completed all the tests, the blood lipid profile including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) was analysed. The traditional Chinese medicine diagnosis was made based on participants' symptoms and signs. The results indicate that a four-week intake of the compound increased the serum HDL-c levels by 5% (P = 0.026) and decreased the ratios of TC/HDL-c and LDL-c/HDL-c (P = 0.012 and P = 0.044, resp.). The placebo intake did not significantly change the blood lipid profile. In the initial 43 participants with dyslipidemia, 76.7% of them were diagnosed with “Spleen deficiency” and 58.1% with “Liver qi stagnation.” The intake of hawthorn fruit and Chinese kiwifruit extract compound may increase the serum levels of HDL-c and decrease the ratios of TC/HDL-c and LDL-c/HDL-c, therefore, may reduce the risk of cardiovascular disease.

Effects of aerobic vs. resistance training on visceral and liver fat stores, liver enzymes, and insulin resistance by HOMA in overweight adults from STRRIDE AT/RT

While the benefits of exercise are clear, many unresolved issues surround the optimal exercise prescription. Many organizations recommend aerobic training (AT) and resistance training (RT), yet few studies have compared their effects alone or in combination. The purpose of this study, part of Studies Targeting Risk Reduction Interventions Through Defined Exercise-Aerobic Training and/or Resistance Training (STRRIDE/AT/RT), was to compare the effects of AT, RT, and the full combination (AT/RT) on central ectopic fat, liver enzymes, and fasting insulin resistance [homeostatic model assessment (HOMA)]. In a randomized trial, 249 subjects [18-70 yr old, overweight, sedentary, with moderate dyslipidemia (LDL cholesterol 130-190 mg/dl or HDL cholesterol ≤ 40 mg/dl for men or ≤ 45 mg/dl for women)] performed an initial 4-mo run-in period. Of these, 196 finished the run-in and were randomized into one of the following 8-mo exercise-training groups: 1) RT, which comprised 3 days/wk, 8 exercises, 3 sets/exercise, 8-12 repetitions/set, 2) AT, which was equivalent to ∼19.2 km/wk (12 miles/wk) at 75% peak O(2) uptake, and 3) full AT + full RT (AT/RT), with 155 subjects completing the intervention. The primary outcome variables were as follows: visceral and liver fat via CT, plasma liver enzymes, and HOMA. AT led to significant reductions in liver fat, visceral fat, alanine aminotransferase, HOMA, and total and subcutaneous abdominal fat (all P < 0.05). RT resulted in a decrease in subcutaneous abdominal fat (P < 0.05) but did not significantly improve the other variables. AT was more effective than RT at improving visceral fat, liver-to-spleen ratio, and total abdominal fat (all P < 0.05) and trended toward a greater reduction in liver fat score (P < 0.10). The effects of AT/RT were statistically indistinguishable from the effects of AT. These data show that, for overweight and obese individuals who want to reduce measures of visceral fat and fatty liver infiltration and improve HOMA and alanine aminotransferase, a moderate amount of aerobic exercise is the most time-efficient and effective exercise mode.

Universal Versus Targeted Blood Cholesterol Screening Among Youth: The CARDIAC Project

The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. A total of 20,266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein > or =130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein > or =160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.

Effects of Supervised Aerobic Exercise Training on Serum Adiponectin and Parameters of Lipid and Glucose Metabolism in Subjects with Moderate Dyslipidemia

To examine the effects of supervised aerobic exercise training on serum adiponectin and lipids, including triglyceride (TG)-rich lipoproteins, in moderate dyslipidemic subjects. Twenty-five dyslipidemic patients [mean body mass index (BMI)=24.6 kg/m²; mean age= 39 years; mean total cholesterol=226 mg/dL; mean TG=149 mg/dL] without metabolic syndrome, diabetes, and hypertension underwent supervised aerobic exercise training (60 min/day, 2 to 3 times/week) at an intensity of 60-80% of age-predicted maximal heart rate for 16 weeks. Lipoprotein cholesterol levels were measured by our established anion-exchange HPLC method. Aerobic exercise training significantly decreased BMI, cholesterol levels of LDL- and IDL-, and markedly reduced VLDL-cholesterol at week 8 (-45%) and week 16 (-50%), but changes in TG and HDL-cholesterol were not significant. Adiponectin significantly increased by 51% and HOMA-R was significantly decreased at week 16, although changes in these parameters were not significant at week 8. There was no significant relationship between changes in adiponectin and in VLDL- or IDL- cholesterol, but changes in adiponectin were inversely but insignificantly associated with changes in BMI (r=-0.343, p=0.095). These results suggest that supervised aerobic exercise training two to three times/week in the presence of body weight loss increases serum adiponectin with an improved lipid profile and insulin sensitivity at week 16 in non-obese moderate dyslipidemic patients, and that VLDL-cholesterol is markedly decreased by supervised aerobic exercise training.

Doctors’ perceptions of the prognostic benefit of statins in patients who have had myocardial infarction

We wished to assess how General Practitioners (GPs) and cardiologists perceive and communicate the benefits of therapy with statins (hydroxymethylglutaryl-coenzyme A reductase inhibitors) in a patient following myocardial infarction. We interviewed 20 GPs and 22 cardiologists to determine treatment policy and ways of expressing its benefits to a patient after myocardial infarction with moderate dyslipidaemia. We asked what drug and dosage they would recommend and how they would express potential benefits of therapy, given a range of options including reduced relative and absolute risk of events. Most GPs would start a low dose (10-20 mg/day) of simvastatin (the only freely prescribable funded statin in New Zealand) whereas cardiologists would commence 40 mg/day immediately (P = 0.001). All but one cardiologist would justify therapy to the patient by citing a reduced chance of a major adverse cardiovascular event. Nine GPs and one cardiologist estimated a gain of more than 5 years of life from statin therapy. Cardiologists were more optimistic than GPs about relative risk reduction (P = 0.04). Only 50% of GPs and 68% of cardiologists were able to estimate an absolute risk reduction over 5 years, such estimates varying widely with no significant difference in responses between the groups (P = 0.2). No doctors felt comfortable using number needed to treat or odds ratio. There were substantial differences between the two groups of clinicians in perception and policy of statin therapy, frequent overestimation of treatment benefits and a reluctance to impart numerical estimates of benefit to patients.

Progression of Kidney Disease in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin Versus Usual Care: A Report From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Dyslipidemia is common in patients with chronic kidney disease. The role of statin therapy in the progression of kidney disease is unclear. Prospective randomized clinical trial, post hoc analyses. 10,060 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (lipid-lowering component) stratified by baseline estimated glomerular filtration rate (eGFR): less than 60, 60 to 89, and 90 or greater mL/min/1.73 m(2). Mean follow-up was 4.8 years. Randomized; pravastatin, 40 mg/d, or usual care. Total, high-density lipoprotein, and low-density lipoprotein cholesterol; end-stage renal disease (ESRD), eGFR. Through year 6, total cholesterol levels decreased in the pravastatin (-20.7%) and usual-care groups (-11.2%). No significant differences were seen between groups for rates of ESRD (1.36 v 1.45/100 patient-years; P = 0.9), composite end points of ESRD and 50% or 25% decrease in eGFR, or rate of change in eGFR. Findings were consistent across eGFR strata. In patients with eGFR of 90 mL/min/1.73 m(2) or greater, the pravastatin arm tended to have a higher eGFR. Proteinuria data unavailable, post hoc analyses, unconfirmed validity of the Modification of Diet in Renal Disease Study equation in normal eGFR range, statin drop-in rate in usual-care group with small cholesterol differential between groups. In hypertensive patients with moderate dyslipidemia and decreased eGFR, pravastatin was not superior to usual care in preventing clinical renal outcomes. This was consistent across the strata of baseline eGFR. However, benefit from statin therapy may depend on the degree of the cholesterol level decrease achieved.

Particularities of peripheral arterial disease managed in vascular surgery in the French West Indies

Epidemiology of peripheral arterial disease is currently unknown in French West Indies (Antilles). The aim of this study is to present peripheral arterial disease (PAD) occurring in the French West Indian subjects through the analysis of our database of vascular surgery. The study population included 754 patients (mean age 73 +/- 10 years), mostly from African descents. The main clinical presentation was critical limb ischemia (66%, including tissue loss in 48% of cases), followed by claudication (20%). The lesions affected the infragenicular arteries in 86% of cases, including 24% isolated to this level as well as 51% combined to femoro-popliteal lesions and only 7% of cases affecting the aorto-iliac level. Ankle-brachial index was at 0.57 +/- 0.13 and 0.34 +/- 0.22 (p<0.001) in patients with claudication and critical limb ischemia (CLI), respectively. The severity scores were significantly higher in claudicants with aorto-iliac disease and CLI patients with infragenicular lesions. Except for hypertension (85%) and obesity (19%), the other risk factors were differently distributed between the 2 groups. While in the CLI group, patients were older, with higher rates of female sex, diabetes (62% vs. 48%, p<0.001) and severe renal failure, claudicants were significantly younger, with higher rates of smokers among men (75% vs. 51%, p<0.001) and moderate dyslipidemia (52% vs. 36%, p<0.001). The association with carotid stenosis (12%) and ischemic heart disease (18%) were quite uncommon. Renal disease (glomerular filtration rate<60 ml/mn/1.73 m2) was present in 61% of cases. This study highlights clear differences regarding the presentation, localization and associations of PAD in the West Indies subjects managed in vascular surgery, especially with a severe infragenicular disease, even in claudicants. This study suggests the effect of a different distribution of risk factors as well as other ethnic and socio-economic factors.

Study of Homocysteine Concentration in Coronary Heart Disease Patients and Comparison of Two Determination Methods

Introduction: Elevated total homocysteine (tHCY) is a known risk factor for atherosclerotic vascular disease, but the mechanism is not well understood. The study was designed to estimate tHCY concentration and other risk factors in coronary heart disease (CHD) males, evaluating two different methods for tHCY measurement: gas chromatography-mass spectrometry (GC-MS) method and competitive immunoassay method. Materials and Methods: Fifty men, mean age 53.9 years with CHD and a body mass index (BMI) >25.0, were examined for tHCY concentrations, lipids, blood glucose, uric acid, complete blood picture and erythrocyte sedimentation rate and high-sensitive C-reactive protein (hsCRP). Biochemical and hematological indices were determined by routine methods, hsCRP – by immunometric chemiluminescence method, and tHCY – by two different methods: a gas chromatographic method, using GC-MS and a competitive immunoassay method on an Immulite device. Results: The mean values of the lipids showed moderate dyslipidemia while the other parameters were within reference range. Mean BMI was 28.5 ± 0.42. Values of tHCY determined by the immunoassay method were 13.2 ± 0.95 µmol/l, and determined by GC-MS – 14.6 ± 1.09 µmol/l. We found a linear agreement between the DPC and GC-MS sets of measurements (r = 0.87, p ≤ 0.001). The median tHCY concentrations measured by immunoassay werelower than those measured with GC-MS, but differences were insignificant. An agreement between the competitive immunoassay and the GC-MS method evaluated by the Bland and Altman method was found. tHCY was >15 µmol/l in 12 patients as determined by the competitive immunoassay, and in 15 patients by the GC-MS method. tHCY levels were between 10 and 15 µmol/l in 24 patients by the immunoassay and in 29 patients by the GC-MS method. Twenty-four percent of the patients with CHD have an ‘increased risk’ with tHCY >15 µmol/l, and 48% are in the ‘gray zone’ with tHCY levels between 10 and 15 µmol/l. Conclusions: 40.8% of the studied patients had increased tHCY levels, not associated with the other lipid and nonlipid risk factors. The closest conformity between GC-MS and immunoassay methods was observed for serum tHCY concentrations. The between-method comparison revealsthat the above-mentioned methods can be used interchangeably.

Inactivity, exercise, and visceral fat. STRRIDE: a randomized, controlled study of exercise intensity and amount

Despite the importance of randomized, dose-response studies for proper evaluation of effective clinical interventions, there have been no dose-response studies on the effects of exercise amount on abdominal obesity, a major risk factor for metabolic syndrome, diabetes, and cardiovascular disease. One hundred seventy-five sedentary, overweight men and women with mild to moderate dyslipidemia were randomly assigned to participate for 6 mo in a control group or for approximately 8 mo in one of three exercise groups: 1) low amount, moderate intensity, equivalent to walking 12 miles/wk (19.2 km) at 40-55% of peak oxygen consumption; 2) low amount, vigorous intensity, equivalent to jogging 12 miles/wk at 65-80% of peak oxygen consumption; or 3) high amount, vigorous intensity, equivalent to jogging 20 miles/wk (32.0 km). Computed tomography scans were analyzed for abdominal fat. Controls gained visceral fat (8.6 +/- 17.2%; P = 0.001). The equivalent of 11 miles of exercise per week, at either intensity, prevented significant accumulation of visceral fat. The highest amount of exercise resulted in decreased visceral (-6.9 +/- 20.8%; P = 0.038) and subcutaneous (-7.0 +/- 10.8%; P < 0.001) abdominal fat. Significant gains in visceral fat over only 6 mo emphasize the high cost of continued inactivity. A modest exercise program, consistent with recommendations from the Centers for Disease Control/American College of Sports Medicine (CDC/ACSM), prevented significant increases in visceral fat. Importantly, a modest increase over the CDC/ACSM exercise recommendations resulted in significant decreases in visceral, subcutaneous, and total abdominal fat without changes in caloric intake.

Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity

Obesity is a major health problem due, in part, to physical inactivity. The amount of activity needed to prevent weight gain is unknown. To determine the effects of different amounts and intensities of exercise training. Randomized controlled trial (February 1999-July 2002). Sedentary, overweight men and women (aged 40-65 years) with mild to moderate dyslipidemia were recruited from Durham, NC, and surrounding communities. Eight-month exercise program with 3 groups: (1) high amount/vigorous intensity (calorically equivalent to approximately 20 miles [32.0 km] of jogging per week at 65%-80% peak oxygen consumption); (2) low amount/vigorous intensity (equivalent to approximately 12 miles [19.2 km] of jogging per week at 65%-80%), and (3) low amount/moderate intensity (equivalent to approximately 12 miles [19.2 km] of walking per week at 40%-55%). Subjects were counseled not to change their diet and were encouraged to maintain body weight. Body weight, body composition (via skinfolds), and waist circumference. Of 302 subjects screened, 182 met criteria and were randomized and 120 completed the study. There was a significant (P<.05) dose-response relationship between amount of exercise and amount of weight loss and fat mass loss. The high-amount/vigorous-intensity group lost significantly more body mass (in mean [SD] kilograms) and fat mass (in mean [SD] kilograms) (-2.9 [2.8] and -4.8 [3.0], respectively) than the low-amount/moderate-intensity group (-0.9 [1.8] and -2.0 [2.6], respectively), the low-amount/vigorous-intensity group (-0.6 [2.0] and -2.5 [3.4], respectively), and the controls (+1.0 [2.1] and +0.4 [3.0], respectively). Both low-amount groups had significantly greater improvements than controls but were not different from each other. Compared with controls, all exercise groups significantly decreased abdominal, minimal waist, and hip circumference measurements. There were no significant changes in dietary intake for any group. In nondieting, overweight subjects, the controls gained weight, both low-amount exercise groups lost weight and fat, and the high-amount group lost more of each in a dose-response manner. These findings strongly suggest that, absent changes in diet, a higher amount of activity is necessary for weight maintenance and that the positive caloric imbalance observed in the overweight controls is small and can be reversed by a modest amount of exercise. Most individuals can accomplish this by walking 30 minutes every day.

EFFECTS OF EXERCISE DOSE AND DETRAINING ON LIPID LEVELS AND LIPOPROTEIN SUBFRACTIONS IN OVERWEIGHT ADULTS

It has recently been shown that aerobic exercise leads to widespread beneficial effects on lipoprotein levels and subfractions. However, it is unclear how long these benefits will be maintained during a detraining period and whether the amount and intensity of exercise performed prior to detraining plays a role in any sustained improvements. PURPOSE To determine the effects of different amounts and intensities of exercise on lipid levels and subfractions during a 14-day detraining period. METHODS 139 sedentary, overweight men and women (40–65 yrs.) with mild to moderate dyslipidemia [LDL > 130 and < 190 mg/dL or HDL < 40 mg/dL for men and < 45 mg/dL for women] were randomized into one of three exercise groups: 1) low [14 kcal/kg body weight/week at 40–55% VO2max], 2) moderate [14 kcal/kg/wk at 65–80% VO2max] or 3) high [23 kcal/kg/wk at 65–80% VO2max]. Subjects trained for ⁁8 months and were encouraged to maintain body weight. Fasting plasma samples were collected at three detraining time points: within 24 hours, five days and 14 days of the final exercise bout. RESULTS The high group had significant improvements in HDL cholesterol, large HDL and HDL size (p < 0.05) for all three time points compared to pre-training baseline. The low group maintained significant improvements in triglycerides. No significant, sustained improvements were seen in the moderate group. CONCLUSION The prolonged beneficial effects demonstrated by these data suggest a chronic adaptation due to exercise. Further research should examine the potential mechanism(s) of these sustained improvements. Supported by NIH Grant RO1 HL-57354.

Efficacy and tolerability of a “suprabioavailable” formulation of fenofibrate in patients with dyslipidemia: a pooled analysis of two open-label trials

Background: Newer fibrates such as micronized fenofibrate lower triglyceride (TG) levels, raise high-density lipoprotein cholesterol (HDL-C) levels, and lower fibrinogen levels, in addition to markedly lowering levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). A new microcoated “suprabioavailable” formulation of fenofibrate has demonstrated a superior pharmacokinetic profile compared with micronized fenofibrate 200 mg/d and may effectively reduce cardiovascular risk factors at the lower dose of 160 mg/d.Objective: The goal of this study was to assess the efficacy and tolerability of the “suprabioavailable” formulation of fenofibrate in patients with type IIa, type IIb, or type IV dyslipidemia.Methods: This was a pooled analysis of data from 2 unpublished multicenter, open-label trials with a common protocol. After a 4-week washout period, patients with dyslipidemias not corrected by diet alone were assigned to receive microcoated fenofibrate 160 mg/d for 12 weeks. Changes in lipid profiles and safety variables (vital signs, body weight, and laboratory measures) were monitored throughout the study, and adverse events occurring between visits 1 and 5 were recorded by the study investigators.Results: The 2 trials included 375 men and women (mean age, 55.2 years) with type IIa (n = 158), type IIb (n = 195), type IV (n = 21), or other (n = 1) dyslipidemias. At end point, HDL-C levels in patients with type IIa, IIb, or IV dyslipidemia were increased by a respective 10.9% (P < 0.001), 16.1% (P < 0.001), and 12.1% (P < 0.05), whereas TG levels were decreased by a respective 27.7% (P < 0.001), 46.4% (P < 0.001), and 40.2% (P < 0.05). In patients with type IIa or IIb dyslipidemia, TC decreased (−14.3% in each group), LDL-C decreased (−20.6% and −13.2%, respectively), and the LDL-C/HDL-C ratio decreased (−26.7% and −22.0%) (all, P < 0.001). Overall, 121 of 375 (32.3%) patients experienced ≥1 adverse event (AE) (202 nonserious, 8 serious). Of these, 10.1% were judged to be possibly drug related. The most common nonserious AEs were those affecting the body as a whole (2.7% of patients) and the digestive system (5.3% of patients). No serious AE was considered drug related.Conclusions: The new “suprabioavailable” microcoated, micronized formulation of fenofibrate appears to maintain the good efficacy and safety profile of micronized fenofibrate. In the study population with moderate dyslipidemia (types IIa and IIb), it promoted beneficial changes in major lipid risk factors for cardiovascular disease.

EFFECT OF EXERCISE TRAINING DOSE AND INTENSITY ON LIPOPROTEINS AND LIPOPROTEIN SUBFRACTIONS

Increased levels of physical activity are clearly related to reduced risk of CVD. One possible mechanism is through improvements in lipoproteins. However, the optimal exercise stimulus is unknown as there are no dose-response studies. PURPOSE: We investigated the effects of training dose and intensity on lipoproteins and their subfractions. METHODS: Eightyfour males and females, aged 40–65, who were overweight/obese (BMI 25–35 kg/m2) with dyslipidemia (LDL-C: 130–190 OR HDL-C < 40) were randomized to a control or one of three exercise groups: low dose/moderate intensity (12 miles/wk at 50% peak VO2), low dose/vigorous intensity (12 miles/wk at 75%), high dose/vigorous intensity (20 miles/wk at 75%). Training included a 2–3 month ramp period plus 6 months of exercise at the assigned intensity/dose. RESULTS: Exercise did not effect total or LDL-C. High dose exercise significantly (P < 0.05) decreased small LDL's, LDL particle concentration, average LDL size, triglycerides, and total VLDL-TG and increased large HDL's, average HDL size, and total HDL's, with a tendency (P < 0.06) for reduced large VLDL's compared to controls. Low dose exercise was less beneficial. The high dose-vigorous group had a larger improvement than low dose-vigorous on 10 of 11 variables and the low dose had a better effect than the control on all 11 variables - clear evidence of a dose-response effect. CONCLUSION: The data show that, for individuals with mild to moderate dyslipidemia, high dose exercise has widespread beneficial effects on lipoproteins. However, few of these benefits would be detected by a typical lipid panel. The data also demonstrate a clear dose-response effect. The effects of exercise intensity appear to be much less important than exercise dose.

Noninvasive tracking of coronary atherosclerosis by electron beam computed tomography: Rationale and design of the Felodipine Atherosclerosis Prevention Study (FAPS)

The Felodipine Atherosclerosis Prevention Study is designed to evaluate the efficacy of the calcium antagonist felodipine ER and combined felodipine/simvastatin therapy on retarding the progression or atherosclerosis, estimated by serial changes in coronary calcium evaluated by noninvasive electron beam computed tomography. Subjects include 180 men and women aged 40 to 69 and 50 to 69 years, respectively, with moderate type lla dyslipidemia, with either cardiovascular disease or risk factors. All subjects receive simvastatin lipid-lowering therapy, and are randomized either to felodipine or placebo for a treatment period of 2 years. Monitoring of blood chemistry, measures of lipids and apolipoproteins, blood pressure, evaluation of symptoms, and interim clinical event monitoring are done at routine follow-up visits. Baseline and 2-year follow-up electron beam computed tomography, measuring changes in total calcium score, area, and mass, evaluate the effects of intervention on the progression of calcified atherosclerosis. The results from the Felodipine Atherosclerosis Prevention Study will provide valuable information about the effect of felodipine alone and in combination with simvastatin on progression of calcified atherosclerosis evaluated noninvasively.

Atherogenic risk reduction in patients with dyslipidaemia Comparison between bezafibrate and lovastatin

To examine the atherogenic risk-reducing effect of bezafibrate and lovastatin. Double-blind, randomized clinical trial of male and female patients with moderate hypercholesterolaemia with or without hypertriglyceridaemia. Two months dietary treatment followed by 400 mg sustained release bezafibrate every day or 20 mg lovastatin every day for 6 months. Patients recruited (n = 561) and treated (n = 524) by primary care physicians throughout Austria. Multifactorial assessment of atherogenic risk profile. Bezafibrate increased high density lipoprotein cholesterol by 16%, lovastatin by 10% (P < 0.05). Bezafibrate decreased low density lipoprotein cholesterol by 20%, lovastatin by 27% (P < 0.001). Bezafibrate decreased total cholesterol by 15%, lovastatin by 18% (P < 0.001). Bezafibrate reduced triglycerides by 29%, lovastatin by 13% (P < 0.001); and fibrinogen by 9.4% and 3.0%, respectively. Fibrinogen reduction as a result of bezafibrate administration was dependent on starting levels. The risk ratio cholesterol:high density lipoprotein cholesterol (baseline both 6.1) reduction was 27% in both groups. The low:high density lipoprotein ratio (baseline: 4.1/4.2) reduction reached 31% and 34% respectively. Coronary events' probability (calculated from multifactorial risk functions) were greatly reduced by both agents (41%/33%). Hypertriglyceridaemic patients had a higher initial global coronary risk and profited more from treatment. Bezafibrate was significantly better tolerated (P < 0.001) than lovastatin; most events were gastrointestinal (6 vs 14, ns) or as a result of creatine phosphokinase elevations (3 vs 12, P < 0.05). Both treatments significantly reduced the risk parameters for developing coronary heart disease, and calculated multifactorial coronary risk was similarly decreased. When selecting a drug for moderate dyslipidaemia and if haemostatic regulation is disturbed, the additional effect of bezafibrate on elevated fibrinogen levels should be considered.