Bij cholesterolpatiënten die slecht reageren op statines kan een behandeling met een fibraat de goede cholesterol met bijna de helft doen stijgen. Dat blijkt uit onderzoek van Dirk Devroey van de Vakgroep Huisartsgeneeskunde van de Vrije Universiteit Brussel.
Om de totale en de slechte cholesterol (LDL) te doen dalen en de goede (hdl) in beperkte mate te doen stijgen, worden meestal statines toegediend. Maar ongeveer 6 procent van de patiënten reageert ongunstig en ziet zijn goede cholesterol ook dalen. Vaak gaat het om mannen met overgewicht en een verhoogd risico op diabetes en hart- en vaatziekten.
Wie ongunstig reageert op statine krijgt met fibraat een betere verhouding tussen de totale cholesterol en de goede cholesterol. Dat zou kunnen bijdragen tot het voorkomen van hart- en vaatziekten. als een grootschalige klinische studie de resultaten bevestigt, hebben we alvast een goedkoper alternatief voor de dure statine, stelt Devroey. Het onderzoek verscheen in het International Journal of Cardiology.
Background: Lowering high levels of low-density lipoprotein cholesterol (LDL-C) is the primary aim in the prevention of cardiac events. However, low levels of high-density lipoprotein cholesterol (hdl-C) are also associated with an increased risk of ischemic heart disease. Some patients have lower HDL-C during statin treatment than before the treatment. These patients were first described in 2002 as ‘bad HDL-C responders to statins’. The aim of this study was to describe the benefit of fibrates in monotherapy for these patients. Methods: A cross-sectional survey of lipid levels, cardiovascular disease and risk factors in outpatients treated for dyslipidemia. For this study we analyzed the lipid levels, drug treatment and medical history for 14 patients with low HDL-C (<40 mg/dl) during statin treatment and ever treated with fibrates. Results: Total cholesterol (TC) and LDL-C were respectively 8% and 6% higher with fibrates compared to statins. Mean HDL-C was 49% higher during fibrate treatment and TC to HDL-C and LDL-C to HDL-C were respectively 26% and 27% lower with fibrates. Conclusions: Patients with low levels of HDL-C during statin treatment had far better levels for HDL-C, TC to HDL-C and LDL-C to HDL-C with fibrates in monotherapy. For bad HDL-C responders to statins with low or normal LDL-C treatment with fibrates instead of statins should be considered. For those with high LDL-C fibrates should be added to statins. A randomized double-blind crossover trial with simvastatin and fenofibrate has been initiated to corroborate these findings.
Int J Cardiol 2005;101:231-235
Wie ongunstig reageert op statine krijgt met fibraat een betere verhouding tussen de totale cholesterol en de goede cholesterol. Dat zou kunnen bijdragen tot het voorkomen van hart- en vaatziekten. als een grootschalige klinische studie de resultaten bevestigt, hebben we alvast een goedkoper alternatief voor de dure statine, stelt Devroey. Het onderzoek verscheen in het International Journal of Cardiology.
Abstract
Background: Lowering high levels of low-density lipoprotein cholesterol (LDL-C) is the primary aim in the prevention of cardiac events. However, low levels of high-density lipoprotein cholesterol (hdl-C) are also associated with an increased risk of ischemic heart disease. Some patients have lower HDL-C during statin treatment than before the treatment. These patients were first described in 2002 as ‘bad HDL-C responders to statins’. The aim of this study was to describe the benefit of fibrates in monotherapy for these patients. Methods: A cross-sectional survey of lipid levels, cardiovascular disease and risk factors in outpatients treated for dyslipidemia. For this study we analyzed the lipid levels, drug treatment and medical history for 14 patients with low HDL-C (<40 mg/dl) during statin treatment and ever treated with fibrates. Results: Total cholesterol (TC) and LDL-C were respectively 8% and 6% higher with fibrates compared to statins. Mean HDL-C was 49% higher during fibrate treatment and TC to HDL-C and LDL-C to HDL-C were respectively 26% and 27% lower with fibrates. Conclusions: Patients with low levels of HDL-C during statin treatment had far better levels for HDL-C, TC to HDL-C and LDL-C to HDL-C with fibrates in monotherapy. For bad HDL-C responders to statins with low or normal LDL-C treatment with fibrates instead of statins should be considered. For those with high LDL-C fibrates should be added to statins. A randomized double-blind crossover trial with simvastatin and fenofibrate has been initiated to corroborate these findings.
Int J Cardiol 2005;101:231-235
