THE ATHEROGENIC ROLE OF TRIGLYCERIDES AND SMALL, DENSE LOW-DENSITY LIPOPROTEINS - IMPACT OF CIPROFIBRATE THERAPY

Triglyceride levels greater than 150 mg/dl are associated with the ath erogenic lipoprotein phenotype, represented by a predominance of small , dense low density lipoproteins (LDL) and diminished concentrations o f high density lipoproteins. This phenotype is characteristic of patie nts with combined hyperlipidemia (CHL). We evaluated the impact of cip rofibrate therapy (100 mg daily) for 1 month on the quantitative and q ualitative characteristics of the LDL particle profile in CHL patients (n = 9). Marked reductions in plasma levels of triglycerides (-33%), cholesterol (-15.5%), LDL-cholesterol (-15.2%) and apolipoprotein-B (- 22.7%) were accompanied by a significant degree of normalisation in th e LDL subspecies profile; such normalisation resulted from a preferent ial reduction in the elevated levels of dense LDL subspecies (LDL-4 an d LDL-5, -43% and -54%, respectively; P < 0.03 and P < 0.006, respecti vely). Concentrations of light LDL (LDL-1) were also reduced significa ntly (-30%, P < 0.006), while those of LDL-3 of intermediate density ( d = 1.029-1.039 g/ml) were moderately increased (+23%). The ciprofibat e-induced normalisation of both the quantitative and qualitative featu res of the atherogenic LDL particle profile characteristic of combined hyperlipidemia is consistent with a reduction in the elevated cardiov ascular risk in this patient group.