[Treatment of hyperlipidemia in obese patients: monotherapy versus bi-therapy]

Severe hyperlipoproteinaemia (increased LDL, light density lipoproteins, and VLDL, very light density lipoproteins) in patients with high body mass index (BMI) is positively associated with the occurrence of coronary heart disease. This condition requires combined drug regimen because high lipid levels frequently remain after monotherapy and diet. The aim of our study was to investigate the efficacy of combined therapy utilizing the following association: HMG CoA reductase inhibitors plus fibrates.

We examined 50 patients, males, affected by obesity (BMI > 30) and hyperlipoproteinaemia (phenotype IIB, Fredrickson). The first group, 20 obese subjects with severe dislipidaemia, and the second group, 10 mildly hyperlipidaemic obese patients received bezafibrate 600 mg/d and pravastatin 40 mg/d. The other subjects, all obese and highly dyslipidaemic patients, received monotherapy: 10 patients, bezafibrate 600 mg/d and the rest pravastatin 40 mg/d. Weekly, for ten weeks, we evaluated the following serum parameters: total cholesterol and HDL-cholesterol, triglycerides and apolipoprotein A1 and B.

We observed no significant changes in HDL-cholesterol and apolipoprotein levels, while an important reduction in total cholesterol and triglycerides, induced by combined therapy, was particularly evident in those patients with the higher lipidic alterations, compared with the additive effects of single drugs.

The data show that this combined treatment could be proposed for these subjects to reduce hyperlipidaemia and the risk of premature atherosclerosis.