Comparison of the hypolipidemic effect of gemfibrozil versus simvastatin in patients with type III hyperlipoproteinemia

Background Type III hyperlipoproteinemia is characterized by the accumulati on of chylomicron and very low density lipoprotein (VLDL) remnants. Individ uals with this disorder have a high risk of premature atherosclerosis, and hypolipidemic drugs ore useful in their management. Methods We compared, in a double-blind, placebo-controlled, randomized cros sed study, the effects of gemfibrozil (1200 mg/day) and simvastatin (20 mg/ day) on lipids, apolipoprotein Al, apolipoprotein B, and apolipoprotein E a nd on lipids and apolipoprotein B content in VLDL, intermediate-density lip oprotein (IDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) in 10 patients with type III hyperlipoproteinemia. Results levels of total cholesterol, VLDL cholesterol, IDL cholesterol, and apolipoprotein B decreased with both drugs. larger reductions in triglycer ides (109 +/- 28.2 mg/dL P = .005), VLDL cholesterol (24.7 +/- 10.9 mg/dL, P = .05), and VLDL triglycerides (86.3 +/- 20.2 mg/dL, P = .003) were obtai ned with gemfibrozil compared with simvastatin. LDL cholesterol reduction w as more effective with simvastatin than with gemfibrozil (44.3 +/- 17.1 mg/ dL, P 1.03). HDL cholesterol after gemfibrozil was 5.71 +/- 2.37 mg/dL high er than after simvastatin. Conclusions In patients with type III hyperlipoproteinemia gemfibrozil is m ore effective in reducing total triglyceride and VLDL lipid levels than sim vastatin, and simvastatin is better in reducing IDL cholesterol than gemfib rozil is. IDL and apolipoprotein E levels were reduced similarly with both drugs.