LIPOPROTEIN RESPONSES TO TREATMENT WITH LOVASTATIN, GEMFIBROZIL, AND NICOTINIC-ACID IN NORMOLIPIDEMIC PATIENTS WITH HYPOALPHALIPOPROTEINEMIA

Background: The lipoprotein responses to conventional lipid-modifying drugs have not been adequately evaluated in normolipidemic patients wi th hypoalphalipoproteinemia (low levels of high-density lipoproteins). The purpose of this study was to compare responses to lovastatin, gem fibrozil, and nicotinic acid in such patients. Methods: The first phas e of the study compared lipoprotein responses to lovastatin and gemfib rozil in 61 middle-aged men with low levels of high-density lipoprotei ns. In the second phase, 37 patients agreed to take nicotinic acid; 27 patients finished this phase at a dose of 4.5 g/d. Nicotinic acid res ults were compared with those with lovastatin and gemfibrozil in the s ame patients. Results: In the first phase, both drugs effectively lowe red triglyceride levels. Gemfibrozil therapy increased high-density li poprotein cholesterol levels by 10% and lovastatin by 6%, but lovastat in was much more effective for reducing low-density lipoprotein levels . Nicotinic acid did not significantly lower low-density lipoprotein l evels in the second phase, but it raised high-density lipoprotein leve ls by 30%. Conclusions: Gemfibrozil therapy produced the least favorab le response of the three drugs. Lovastatin markedly lowered low-densit y lipoprotein levels but only modestly raised levels of high-density l ipoprotein, whereas nicotinic acid had the opposite effect. Consequent ly, the latter two drugs similarly reduced low-density lipoprotein-hig h-density lipoprotein ratios, although these effects were obtained in different ways. Between these two drugs, lovastatin therapy was more l ikely to reduce low-density lipoprotein cholesterol levels to below 2. 6 mmol/L (100 mg/dL), and in view of recent recommendations, it may be preferable to nicotinic acid for many normolipidemic patients with es tablished coronary heart disease.