IS COMBINED STATIN AND FIBRATE THERAPY IN DICATED IN MIXED HYPERLIPIDEMIA

Insufficient progress: The treatment of hyperlipidemia leads to a redu ced risk of coronary disease. This has been displayed notably since cl inical trials have used statins. However, despite these treatments, a risk of coronary ischemia remains, which is not insignificant. There a re several causes of this persistent risk which need to be analyzed. T he qualitative aspect of low density lipoproteins: LDL are heterogeneo us. This is displayed by a distribution of sizes varying from one subj ect to another. The predominance of small LDL is frequently found in c oronary subjects detected during prospective or retrospective studies. The atherogenicity of small LDL can be explained by their physico-che mical characteristics. A remarkable fact is the predominance of small LDL in subjects with a mixed hyperlipidemia presenting a high risk of atherosclerosis. The effects of hypolipidemiants: Statins greatly decr ease LDL-cholesterol without changing LDL distribution according to si ze. Conversely, fibrates noticeably modify LDL distribution, reducing the percentage of small LDL. A proposal for the treatment of subjects suffering from mixed hyperlipidemia: If the concentration of LDL (refl ected by LDL-cholesterol) and LDL distribution are two risk factors of atherosclerosis, hypolipidemic treatment should aim to act upon these two parameters, but no commercialized hypolipidemiant is effective en ough as far as they are both concerned. Therefore the combination of t wo hypolipidemiants, a statin and a fibrate, each having a predominant effect on one of the two factors, could be particularly effective in reducing coronary risk This therapeutic association is effective on cl assic lipid parameters, does not entail more side effects than a monot herapy, and is not precluded by the RMO when there is a high vascular risk, which is often the case in mixed hyperlipidemia. (C) 1998, Masso n, Paris.