ESSENTIAL PHOSPHOLIPIDS VERSUS NICOTINIC-ACID IN THE TREATMENT OF PATIENTS WITH TYPE IIB HYPERLIPOPROTEINEMIA AND ISCHEMIC-HEART-DISEASE

In patients with moderate, dietary noncorrigible hyperlipoproteinemia type IIb and ischemic heart disease, treatment with nicotinic acid is limited by the side effects of the drug. In 100 patients, 6-month trea tment with nicotinic acid (n = 50) or ''essential'' phospholipids (EPL ); Lipostabil(R) manufacturer: Rhone-Poulenc Borer) (n = 50) indicated comparable efficacy for both substances: Significant (p < .001) reduc tions of serum total cholesterol, low-density lipoprotein (LDL) choles terol, and triglyceride values were similar in both groups, while nico tinic acid increased high-density lipoprotein (HDL) cholesterol signif icantly (p < .01) better than Lipostabil. A detailed analysis of ultra centrifugal lipoprotein profiles, hydroperoxide concentrations in LDL, and cholesterol-accepting properties of HDL in a small number of Lipo stabil- and nicotinic acid-treated patients revealed favorable shifts in the lipoprotein profile, significant (p < .05) reductions of LDL hy droperoxides, and favorable increases of the most antiatherogenic HDL( 2b) subfraction only in the Lipostabil-treated group. Clinically, both medications reduced the intensity and number of angina pectoris attac ks per week (p < .05), but only Lipostabil-treated patients significan tly (p < .05) increased their working capacity in the veloergometric t est. Since in the nicotinic acid-treated group dropouts (nine patients , eight related to the drug) and side effects [14] exceeded those in t he Lipostabil-treated group (two dropouts not related to the drug, no side effects), it is suggested that Lipostabil is a preferable alterna tive in the treatment of patients with moderate, dietary noncorrigible hyperlipoproteinemia IIb and ischemic heart disease.