LONG-TERM EFFECT OF GEMFIBROZIL ON CORONARY HEART-DISEASE RISK PROFILE OF PATIENTS WITH PRIMARY COMBINED HYPERLIPIDEMIA

Background: The purpose of the present study was to assess the effect of gemfibrozil on 12 independent coronary heart disease risk factors i n patients with primary combined hyperlipidaemia. Methods: One hundred and five patients (62 men and 43 women), aged 53.2+/-4.8 years, were studied. The 10-year probability of myocardial infarction for the pati ents was calculated using the TYPM1 (Ten-Year Probability for Myocardi al Infarction) computer program, which is constructed to co-evaluate 1 2 independent coronary artery disease risk factors. All patients follo wed a lipid-lowering diet and placebo for 3 months. At month 0, the pa tients received 1200 mg gemfibrozil daily, divided into two equal dose s, for a period of 12 months. At months -3, 0, 1, 3, 6, and 12, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides [only if the low-density lipoprotein (LDL) cholesterol to high-densit y lipoprotein cholesterol ratio was above 5], systolic blood pressure, plasma glucose, left ventricular mass index, and plasma fibrinogen we re measured. Smoking habits, sex, age, physical activity and family hi story of coronary heart disease were also evaluated. The mean 10-year probability of myocardial infarction of all 105 patients at month 0 wa s 27.8%. This was significantly higher than the anticipated probabilit y (10.4%, P<0.001), resulting from an age- and sex-matched group of ge neral population. Results: During the third month of treatment, the fo llowing changes were recorded: total cholesterol -17%, LDL cholesterol -18%, very-low-density lipoprotein (VLDL) cholesterol -45%, HDL chole sterol 20%, triglycerides -43%, apoprotein B -12%, apoprotein A-I 9% a nd plasma fibrinogen -21%. The estimated risk for myocardial infarctio n was reduced to 13.5% (Delta m=-51%). All changes were significant an d sustained until the twelfth treatment month. None of the patients we re withdrawn from the study because of adverse effects of the treatmen t. Conclusion: Gemfibrozil reduces the estimated risk for myocardial i nfarction in patients with primary combined hyperlipidaemia at a level no different from the one of the general population. This beneficial effect of gemfibrozil, which was expressed by the third month and was evident for some time afterwards, was attributed to a significant redu ction of triglyceride and fibrinogen levels, an increase of HDL choles terol concentrations and a moderate decrease of total cholesterol and LDL cholesterol levels.