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Effect of gemfibrozil in men with primary isolated low high-density lipoprotein cholesterol: a randomized,
M Miller1, P S Bachorik, B W McCrindle
1Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
Gemfibrozil effectively raises high-density lipoprotein cholesterol (HDL-C) and lowers triglyceride (TG) levels in men with isolated low HDL-C. These beneficial lipid changes were most significant in individuals with higher baseline TG levels.
Area of Science:
- Cardiology
- Pharmacology
- Metabolic Disorders
Background:
- Isolated low high-density lipoprotein cholesterol (HDL-C) is a risk factor for cardiovascular disease.
- Management strategies for low HDL-C, particularly in men with otherwise normal lipid profiles, require further investigation.
- Gemfibrozil is a fibrate medication known for its lipid-modifying effects.
Purpose of the Study:
- To assess the efficacy of gemfibrozil in improving lipid profiles of men with primary isolated low HDL-C.
- To determine if gemfibrozil can raise HDL-C levels in men with desirable total cholesterol.
- To evaluate the impact of gemfibrozil on triglyceride (TG) levels in this specific patient group.
Main Methods:
- A randomized, double-blind, placebo-controlled, crossover trial involving 14 men with low HDL-C and normal total cholesterol.
- Participants adhered to a National Cholesterol Education Program Step-Two Diet.
- Gemfibrozil and placebo were administered for 3-month periods, separated by a 1-month washout interval.
Main Results:
- Gemfibrozil significantly increased total HDL-C by 9.2% (p=0.001) and reduced TG by 38% (p<0.01).
- The cholesterol:HDL-C ratio was significantly lowered (p=0.01).
- Greater improvements in HDL-C and TG were observed in men with higher baseline fasting TG levels.
Conclusions:
- Gemfibrozil effectively raises HDL-C and lowers TG levels in men with isolated low HDL-C and desirable total cholesterol.
- The lipid-altering effects of gemfibrozil in this cohort are comparable to those reported in hyperlipidemic populations.
- The study highlights the potential benefit of gemfibrozil for men with low HDL-C, particularly those with elevated TG levels.
Purpose:
To evaluate the efficacy of gemfibrozil in men with primary isolated low high-density lipoprotein cholesterol (HDL-C) levels.
Patients And Methods:
Fourteen men with low levels of HDL-C but desirable total cholesterol levels received gemfibrozil in a randomized, double-blind, placebo-controlled, crossover trial. The men were placed on a National Cholesterol Education Program Step-Two Diet. They were randomly assigned to receive placebo and gemfibrozil each for 3 months, with a 1-month washout period between phases.
Results:
Overall, gemfibrozil increased the total HDL-C concentration by 9.2% (p = 0.001), reduced triglyceride (TG) levels by 38% (p < 0.01), and significantly lowered the total cholesterol:HDL-C ratio (p = 0.01). Those with fasting TG levels of 1.07 mmol/L (95 mg/dL) or greater had a significant elevation in the HDL-C level (14.6%, p = 0.005) and a reduction in TG levels (50%, p = 0.002) with gemfibrozil; those with fasting TG levels less than 1.07 mmol/L had a smaller increase in the HDL-C level (4.1%, p > 0.05) and a smaller reduction in TG levels (15%, p = 0.02). There were no significant differences in the plasma levels of low density lipoprotein-cholesterol, HDL2-C, apolipoproteins (apo) A-I and B, or Lp(a). HDL3-C and apo A-II levels rose slightly. The adverse effects attributable to gemfibrozil were minimal.
Conclusion:
In men with desirable total cholesterol levels, gemfibrozil raises HDL-C and lowers TG levels to a similar extent as reported for hyperlipidemic men in the Helsinki Heart Study. These lipid-altering effects were most pronounced in those with the highest fasting TG levels.