Lipoprotein Responses to Treatment With Lovastatin, Gemfibrozil, and Nicotinic Acid in Normolipidemic Patients With Hypoalphalipoproteinemia

doi:10.1001/archinte.1994.00420010101012

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Vol. 154 No. 1, 10 January 1994

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Lipoprotein Responses to Treatment With Lovastatin, Gemfibrozil, and Nicotinic Acid in Normolipidemic Patients With Hypoalphalipoproteinemia

Gloria Lena Vega, PhD; Scott M. Grundy, MD, PhD

Arch Intern Med. 1994;154(1):73-82.

Abstract

Background
The lipoprotein responses to conventional lipid-modifying drugshave not been adequately evaluated in normolipidemic patientswith hypoalphalipoproteinemia (low levels of high-density lipoproteins).The purpose of this study was to compare responses to lovastatin,gemfibrozil, and nicotinic acid in such patients.

Methods
The first phase of the study compared lipoprotein responsesto lovastatin and gemfibrozil in 61 middle-aged men with lowlevels of high-density lipoproteins. In the second phase, 37patients agreed to take nicotinic acid; 27 patients finishedthis phase at a dose of 4.5 g/d. Nicotinic acid results werecompared with those with lovastatin and gemfibrozil in the samepatients.

Results
In the first phase, both drugs effectively lowered triglyceridelevels. Gemfibrozil therapy increased high-density lipoproteincholesterol levels by 10% and lovastatin by 6%, but lovastatinwas much more effective for reducing low-density lipoproteinlevels. Nicotinic acid did not significantly lower low-densitylipoprotein levels in the second phase, but it raised high-densitylipoprotein levels by 30%.

Conclusions
Gemfibrozil therapy produced the least favorable response ofthe three drugs. Lovastatin markedly lowered low-density lipoproteinlevels but only modestly raised levels of high-density lipoprotein,whereas nicotinic acid had the opposite effect. Consequently,the latter two drugs similarly reduced low-density lipoprotein—high-density lipoprotein ratios, although these effects wereobtained in different ways. Between these two drugs, lovastatintherapy was more likely to reduce low-density lipoprotein cholesterollevels to below 2.6 mmol/L (100 mg/dL), and in view of recentrecommendations, it may be preferable to nicotinic acid formany normolipidemic patients with established coronary heartdisease.

(Arch Intern Med. 1994;154:73-82)

Author Affiliations

From the Center for Human Nutrition (Drs Vega and Grundy) and the Departments of Internal Medicine (Dr Grundy), Biochemistry (Dr Grundy), and Clinical Nutrition (Drs Vega and Grundy), The University of Texas Southwestern Medical Center at Dallas, and the Veterans Affairs Medical Center at Dallas (Drs Vega and Grundy).

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