COMPARISON OF BEZAFIBRATE VERSUS LOVASTATIN FOR LOWERING PLASMA-INSULIN, FIBRINOGEN, AND PLASMINOGEN-ACTIVATOR INHIBITOR-1 CONCENTRATIONS IN HYPERLIPEMIC HEART-TRANSPLANT PATIENTS

Accelerated coronary artery disease is the most serious obstacle to lo ng-term survival in heart transplant recipients. Hyperlipemia, hyperin sulinism, and changes in endothelial cell hemostatic function have bee n implicated in cardiac allograft vascular disease, Both lovastatin an d bezafibrate are safe, effective, and well tolerated therapies for hy perlipidemia, Our study compares the effect of these lipid-lowering dr ugs in 21 patients with post-heart transplantation hyperlipidemia on d ifferent risk factors related to insulin resistance syndrome. patients were given the same diet for 3 months, then randomized to lovastatin or bezafibrate for a period of 8 weeks, and crossed over to an additio nal 8 weeks of either bezafibrate or lovastatin. Baseline parameters w ere also compared with those of a control group of healthy subjects an d after both periods of pharmacologic treatment. Transplant patients h ad higher insulin (35 +/- 3 vs 24 +/- 3 mu IU/L), fibrinogen (298 +/- 15 vs 261 +/- 14 mg/dl), and plasminogen activator inhibitor-1 (PAI-1) (17 +/- 2 vs 11.7 +/- 2 arbitrary units/ml) plasma levels than contro ls. Significant decreases in insulin (-37 +/- 3%), fibrinogen (-12 +/- 4 %), and PAI-1 plasma levels (-18 +/- 12%) were only observed after bezafibrate treatment. In conclusion, bezafibrate decreases plasma ins ulin, fibrinogen, and PAI-1 in hyperlipidemic heart transplant recipie nts. (C) 1997 by Excerpta Medico, Inc.