EFFECTS OF N-3 FATTY-ACIDS AND FENOFIBRATE ON LIPID AND HEMORRHEOLOGICAL PARAMETERS IN FAMILIAL DYSBETALIPOPROTEINEMIA AND FAMILIAL HYPERTRIGLYCERIDEMIA

There is increasing evidence that hemorrheological abnormalities are a ssociated with an enhanced risk of atherosclerosis. The n-3 fatty acid s (n-3-FA) have been shown to have beneficial effects on atheroscleros is in patients with dyslipoproteinemias. We studied 23 patients with e levated plasma triglycerides to evaluate the influence of fish oil and fenofibrate therapy on hemorrheological parameters (15 patients with familiar hypertriglyceridemia [FHTG] and eight with familial dysbetali poproteinemia [FDL]). The patients (one woman and 22 men aged 45.7 +/- 2.0 years) were treated with increasing doses of n-3-FA (1.8 to 3.6 g /d: 0.9 to 1.8 g eicosapentaenoic acid and 0.6 to 1.2 g docosahexaenoi c acid) for 8 weeks. Lipid parameters, whole-blood viscosity at differ ent shear rates, plasma viscosity, fibrinogen concentration, and red b lood cell aggregation (RCA) were measured at baseline and at weeks 2, 4, 8 (end of n-3-FA therapy), and 12. Compliance was ensured by measur ing plasma concentrations of eicosapentaenoic acid and docosahexaenoic acid. After 12 weeks, patients began treatment with fenofibrate (250 mg daily); investigations were performed again at week 20. Total trigl ycerides (from 6.90 +/- 1.70 to 3.61 +/- 0.78 mmol/L in FDL and 7.44 /- 1.50 to 4.15 +/- 0.55 in FHTG), very-low-density lipoprotein (VLDL) triglycerides, and VLDL cholesterol were significantly decreased with n-3-FA therapy in both groups (P < .05). In FHTG, low-density lipopro tein (LDL) cholesterol increased significantly (from 2.75 +/- 0.28 to 3.97 +/- 0.35 mmol/L, P < .01); in FDL, total cholesterol decreased (f rom 9.76 +/- 1.32 to 7.34 +/- 1.07 mmol/L, P < .05). No significant ch anges were observed in hemorrheological parameters, except for reduced RCA with 3.6 g n-3-FA in FHTG. However, with fenofibrate therapy, in addition to comparable lipoprotein changes seen with fish oil, fibrino gen levels and plasma and blood viscosity decreased in patients with F DL. We conclude that n-3-FA and fenofibrate have comparable effects on lipid parameters in patients with FDL and FHTG. Because of additional beneficial effects on hemorrheological parameters, fenofibrate may be preferred for the treatment of FDL. Copyright (C) 1996 by W.B. Saunde rs Company