GEMFIBROZIL TREATMENT OF THE HIGH TRIGLYCERIDE-LOW HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL TRAIT IN MEN WITH ESTABLISHED ATHEROSCLEROSIS

Objective. To study the short-term efficacy, tolerability and safety of the treatment with gemfibrozil 600 mg twice daily or placebo in male patients with established atherosclerosis, with a lipid profile matching the 'high triglyceride-low high-density lipoprotein (HDL) cholesterol trait'. Design. Double-blind randomized placebo controlled prospective trial. Setting. Amsterdam Lipid Research Clinic at the Academic Medical Centre of the University of Amsterdam and the Slotervaart Training Hospital affiliated to the University of Amsterdam, Amsterdam, the Netherlands. Subjects. Thirty-five male patients, age 30-70, with established atherosclerosis and the high triglyceride-low HDL cholesterol trait. Main outcome measures. Plasma total cholesterol, triglycerides, lipoproteins, apolipoproteins A(1) and B-100, clinical and laboratory safety parameters. Results. Seventeen patients in the gemfibrozil group and 16 patients in the placebo group completed the study period. Compliance was considered adequate. Mean (+/-standard deviation) plasma HDL cholesterol levels increased 20.3% (+/-12.22) from 0.82 to 0.99 mmol L(-1) in the gemfibrozil group against 9.9% (+/-18.31) from 0.79 to 0.87 mmol L(-1) in the placebo group (P = 0.001). Mean plasma triglyceride level fell 49.5% (+/-14.2 7) from 3.65 to 1.82 mmol L(-1) in the gemfibrozil group against an increase of 13.6% (+/-40.31) from 3.62 to 4.01 mmol L(-1) in the placebo group (P < 0.001). Although plasma HDL cholesterol and triglyceride levels improved in all patients, normalization of these lipoproteins was only observed in approximately half of them. Plasma total and low-density lipoprotein (LDL) cholesterol levels, as well as plasma levels of apolipoprotein (ape) A(1), B-100 and lipoprotein [Lp(a)], did not show significant alterations compared to the placebo. All safety parameters were comparable between the two groups and remained within the reference limits. Gemfibrozil was well tolerated during treatment. Minor inconveniences were equally distributed between the two treatment groups. Conclusions. Gemfibrozil is an effective and safe drug in patients with coronary heart disease (CHD) and the high triglyceride-low HDL cholesterol trait.