HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zema, M. J. Search for Related Content PubMed PubMed Citation Articles by Zema, M. J.

CLINICAL STUDIES

Gemfibrozil, nicotinic acid and combination therapy in patients with isolated hypoalphalipoproteinemia: a randomized, open-label, crossover study

^a Department of Medicine, Division of Cardiology, Brookhaven Memorial Hospital Medical Center, Patchogue, New York, USA
^b Clinical Professor Medicine, State University of New York, Stony Brook, New York, USA

Manuscript received February 9, 1999; revised manuscript received September 21, 1999, accepted November 3, 1999.

Reprint requests and correspondence: Dr. Michael J. Zema, Brookhaven Memorial Hospital Medical Center, 101 Hospital Road, Patchogue, New York 11772

OBJECTIVES

To assess the effects of nicotinic acid (NA), gemfibrozil and combination therapy on the lipid profile of patients with clinical atherosclerotic disease and isolated hypoalphalipoproteinemia.

BACKGROUND

Isolated hypoalphalipoproteinemia (low high density lipoprotein cholesterol [HDL-C] alone) accounts for a significant percentage of patients with premature atherosclerosis. However, it remains unclear whether currently available pharmacotherapy has the ability to favorably affect the lipid profile and therefore potentially reduce clinical events.

METHODS

Twenty-three patients with clinically well-defined atherosclerosis and isolated hypoalphalipoproteinemia were prospectively randomized to receive gemfibrozil, NA or combination therapy in an open-label, crossover design trial to assess the effects on serum lipids. Lipid profiles and other relevant laboratory variables were monitored while the patients were on and off pharmacologic lipid-modulating therapy.

RESULTS

In those 14 patients able to tolerate all forms of pharmacotherapy, HDL-C of 0.89 ± 0.17 mmol/liter (34.5 ± 6.5 mg/dl) increased by 15%, to 1.02 ± 0.18 mmol/liter (39.7 ± 7.1 mg/dl), while taking gemfibrozil (1200 mg/day); by 35%, to 1.20 ± 0.21 mmol/liter (46.5 ± 8.1 mg/dl), while taking NA (mean dose 2,250 mg/day); and by 45%, to 1.29 ± 0.19 mmol/liter (50.0 ± 7.5 mg/dl), while taking combination therapy of gemfibrozil plus NA (p < 0.001 for all interventions as compared with baseline/washout; p < 0.005 NA vs. gemfibrozil; p < 0.001 combination therapy vs. gemfibrozil alone; p = 0.088 combination therapy vs. NA alone). Statistically significant favorable alterations were also observed with low density lipoprotein cholesterol (LDL-C), LDL-C/HDL-C, non-HDL-C/HDL-C, apolipoprotein (Apo) B and Apo B/Apo A1.

CONCLUSIONS

In the majority of patients with clinical atherosclerotic disease and isolated hypoalphalipoproteinemia, pharmacologic therapy to raise HDL-C is not only feasible but is also effective with currently available agents, particularly when used in combination.

Abbreviations and Acronyms   Apo A1 = apolipoprotein A1   Apo B = apolipoprotein B   CAD = coronary artery disease   HDL-C = high density lipoprotein cholesterol   LDL-C = low density lipoprotein cholesterol   NA = nicotinic acid   NCEP = National Cholesterol Education Program   TC = total cholesterol   VA-HIT = High-density-lipoprotein Intervention Trial of the Department of Veterans Affairs   VLDL-C = very low density lipoprotein cholesterol

This article has been cited by other articles:

				J. McKenney New Perspectives on the Use of Niacin in the Treatment of Lipid Disorders Arch Intern Med, April 12, 2004; 164(7): 697 - 705. [Abstract] [Full Text] [PDF]

				References Circulation, December 17, 2002; 106(25): 3373 - 3421. [Full Text]