Comparison of atorvastatin versus fenofibrate in reaching lipid targets and influencing biomarkers of endothelial damage in patients with familial combined hyperlipidemia
Abstract
Statins and fibrates have different effects on lipid abnormalities of familial combined hyperlipidemia (FCHL); thus, the selection of the first-line drug is troublesome. We evaluated to what extent monotherapy with a potent statin is more effective than fibrate in reaching the recommended lipid targets in FCHL. Fifty-six patients were randomized to receive optimal dosage of atorvastatin (n = 27) or 200 mg/d micronized fenofibrate (n = 29) for 24 weeks. To reach the optimal dosage, atorvastatin was up-titrated at each follow-up visit if low-density lipoprotein (LDL) cholesterol >130 mg/dL (>100 mg/dL in patients with coronary or cerebrovascular disease). The effects of fenofibrate and atorvastatin on lipoprotein fractions as well as on plasma levels of endothelin-1 (ET-1) and adrenomedullin (AM) were also evaluated. At end of trial, a greater proportion of patients on atorvastatin (average dosage, 20.8 mg/d) reached lipid targets in comparison with those on fenofibrate (64% vs 32.1%, P = .02). Atorvastatin was significantly more effective in reducing total cholesterol, LDL cholesterol, apolipoprotein B, and non-high-density lipoprotein (HDL) cholesterol. Conversely, triglycerides decreased and HDL increased more during fenofibrate. Nevertheless, atorvastatin produced a marked reduction in very low-density lipoprotein and very low-density lipoprotein remnants. Atorvastatin lowered all LDL subtypes, although fenofibrate appeared to be more effective on denser LDL. Compared with 43 normolipemic controls, FCHL patients presented increased baseline plasma levels of ET-1 (P = .007) but not of AM. Fenofibrate, but not atorvastatin, significantly lowered ET-1 levels by 16.7% (P < .05). Neither drug significantly affected plasma concentrations of AM. In summary, although fenofibrate showed superiority in raising HDL and reducing ET-1, atorvastatin was more effective in reaching lipid targets in FCHL so that it can be proposed as the first-line option in the management of this atherogenic hyperlipidemia.
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Fenofibrate treatment typically reduces serum triglycerides by a mean change of −93.7 mg/dL (−39.3%), increases high density lipoprotein cholesterol by +5.5 mg/dL (+12.4%), and reduces low density lipoprotein cholesterol by −17.9 mg/dL (−12.3%).
“Typical changes in serum lipids as a result of FF treatment include clinically important mean reductions of serum triglycerides (TG) by a mean change of −93.7 mg/dL (−39.3%), increases of high density lipoprotein cholesterol (HDLC) by +5.5 mg/dL (+12.4%), and reductions in low density lipoprotein cholesterol (LDLC) by −17.9 mg/dL (−12.3%).”
From Fenofibrate and metabolic syndrome (2010) · cites this paper as [37]
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- Authors
- Arca, M., Montali, A., Pigna, G., Antonini, R., Antonini, T. M., Luigi, P., Fraioli, A., Mastrantoni, M., Maddaloni, M., & Letizia, C.
- Affiliations
- Sapienza University of Rome (IT)
- Pfizer (Italy) (IT)
- Corresponding author
- Arca, Marcello
- Venue
- Metabolism
- Publisher
- Elsevier BV
- Published
- 2007-11
- Volume
- 56
- Issue
- 11
- Pages
- 1534-1541
- ISSN
- 0026-0495 (ISSN-L)
- OpenAlex
- W1996629241
- Cited by
- 21
- References
- 48
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2020: 4 · 2019: 1 · 2018: 2 · 2015: 1 · 2013: 1 · 2012: 2
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Metabolism (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- atorvastatin, fenofibrate, familial combined hyperlipidemia, statins, fibrates, lipid targets, LDL cholesterol, apolipoprotein B, HDL cholesterol, triglycerides, endothelin-1, adrenomedullin, endothelial injury, hyperlipidemia treatment
- MeSH terms
- Atorvastatin, Adult, Aged, Hypolipidemic Agents, Endothelium, Vascular, Female, Heptanoic Acids, Humans, Hyperlipidemias, Male, Middle Aged, Fenofibrate, Pyrroles, Biomarkers, Endothelin-1
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