Combined therapy of mixed dyslipidemia in patients with high cardiovascular risk and changes in the lipid target values and atherogenic index of plasma
Abstract
Purpose: To evaluate the safety and efficacy of combined lipid-modifying agents (statin + fenofibrate) on plasma lipid profile including the atherogenic index of plasma (AIP = log[TG/HDL-C]) in patients at high and very high cardiovascular (CV) risk and mixed dyslipidemia. Method: A total of 81 patients (53 males, 28 females; 60 +- 9.8 years) were included.
Mixed dyslipidemia was defined as having 2 of the following 3 lipid abnormalities: LDL-cholesterol (C) >2.5 mmol/l, HDL-C 1.7 mmol/l. Global CV risk was estimated according to the current European guidelines.
Management with fenofibrate (160-267 mg) + atorvastatin (10-20 mg) or simvastatin (20-40 mg) was indicated for 6 months. Males and females were stratified according to the AIP risk categories: AIP 0.21 (high risk).
Results: About 3/4 of high or very high CV risk patients with mixed dyslipidemia (n = 81) suffer from impaired glucose metabolism (44% had type 2 diabetes, 30% had impaired fasting glucose). Six-month combined therapy reduced LDL-C (by 29%) and TG (by 40%) significantly, but the increase of HDL-C (by 3%) was not significant.
There were 47% of males and 57% of females who achieved the target LDL-C levels (<25 or <1.8 mmol/l) and 14% of males and 37% of females who received non-HDL-C <2.6 mmol/l at the end of the study. Also AIP was decreased significantly in majority of the patients (high risk AIP decreased from 87% to 47% of males and from 71% to 25% of females).
Conclusion: The combined lipid-modifying therapy led to a significant improvement of the plasma lipid profile, particularly of LDL-C, TG, non-HDL-C and AIP. Atherogenic index of plasma seems to be a very useful marker of CV risk in high and very high CV risk patients with mixed dyslipidemia and glucose abnormalities.
More intensive management is needed in those patients.