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Maxepa versus bezafibrate in hyperlipidemic cardiac transplant recipients
1Department of Research Haematology, Harefield Hospital, Uxbridge, Middlesex, United Kingdom.
Insights
Bezafibrate improved lipid profiles and reduced fibrinogen in heart transplant patients, while fish oil primarily lowered triglycerides. Bezafibrate showed better lipid-modifying effects but may impact kidney function.
Area of Science:
- Cardiology
- Pharmacology
- Transplantation Medicine
Background:
- Accelerated coronary artery disease (CAD) significantly impacts long-term survival in cardiac transplant recipients.
- Lipid abnormalities are common post-transplant and contribute to accelerated CAD development.
- Optimal lipid-lowering therapy in this population remains undefined.
Purpose of the Study:
- To compare the efficacy and safety of bezafibrate versus fish oil (Maxepa) in managing lipid abnormalities in cardiac transplant recipients.
- To evaluate the effects of these treatments on lipid profiles, apolipoproteins, fibrinogen, and renal function.
Main Methods:
- An open, randomized study involving 87 cardiac transplant recipients with hyperlipidemia.
- Participants received either bezafibrate (400 mg/day) or Maxepa (10 g/day) for 3 months.
- Measurements included lipid levels, apolipoproteins, fibrinogen, lipoprotein (a), and serum creatinine.
Main Results:
- Bezafibrate significantly reduced total cholesterol, LDL cholesterol, and apolipoprotein B within 1 month.
- Bezafibrate increased HDL cholesterol and apolipoprotein A1, and decreased fibrinogen by 3 months.
- Both bezafibrate and Maxepa effectively reduced triglycerides; Maxepa had no significant effect on other lipid parameters. Bezafibrate increased serum creatinine.
Conclusions:
- Bezafibrate demonstrates superior lipid-, apolipoprotein-, and hemostatic-modifying properties compared to Maxepa in heart transplant patients.
- The potential adverse effect of bezafibrate on renal function requires further investigation.
- Neither treatment significantly altered lipoprotein (a) levels.
Abstract:
Accelerated coronary artery disease is the most serious obstacle to long-term survival in cardiac transplant recipients. Lipid abnormalities are found frequently in these patients, and there is growing evidence that even minimally increased levels of cholesterol and triglycerides contribute to the development of accelerated coronary artery disease. However, the optimal lipid-lowering therapy after cardiac transplantation has not been defined. In an open, randomized study, the efficacy and safety of bezafibrate (400 mg/day) and fish oil (Maxepa) (10 g/day) for 3 months were compared in 87 cardiac transplant recipients with serum total cholesterol > 6.5 or triglycerides > 2.8 mmol/liter, or both. After 1 month, bezafibrate reduced total cholesterol by 13%, low-density lipoprotein cholesterol by 20% and apolipoprotein B by 13%. It also increased apolipoprotein A1 and high-density lipoprotein cholesterol by 12 and 20%, respectively, and significantly reduced fibrinogen at 3 months. Maxepa had no significant effect on these variables, but was as effective as bezafibrate in reducing triglycerides (36 and 31%, respectively). Both drugs increased lipoprotein (a) to a similar extent, and bezafibrate significantly increased serum creatinine. These results suggest that bezafibrate has better lipid-, apolipoprotein- and hemostatic modifying properties than does Maxepa, but its potentially adverse effect on renal function needs further investigation.