Post-prandial effects of gemfibrozil vs simvastatin in hypercholesterolemic subjects with borderline hypertriglyceridemia

Background and Aim: Impaired triglyceride-rich lipoprotein metabolism is mo st probably related to an enhanced cardiovascular risk and may be associate d with pro-congulant state. A double-blind, randomized study was undertaken to evaluate two widely utilized hypolipidemic drugs in the postprandial ph ase and their impact on lipid, coagulation and fibrinolytic parameters. Methods and Results: Thirty middle-aged men selected according to their low density lipoprotein-cholesterol (LDL-C) greater than or equal to 160 and l ess than or equal to 240 mg/dl and borderline hypertriglyceridemia (110-220 mg/dl) after at least one month of a lipid-lowering diet received gemfibro zil (600 mg bid) or simvastatin (20 mg qd) and the corresponding placebo. O n enrollment and Lifter 2 months of drug treatment, they were tested with a standard oral fat load (OFL) (35 g fat/m(2) body surface). On both occasio ns plasma total-cholesterol, LDL-C, HDL-C, triglycerides, lipoprotein[a] (L p[a]), tissue plas -minogen activator (tPA), plasminogen activator inhibito r-1 (PAI-1), antithrombin-lll (AT-III), plasminogen and fibrinogen were det ermined just before the meal (t(0)) and at times 2 hours, 4h, 6h, 8h after it (t(2)-t(8)) A two-factor (time and visit) multivariate analysis for repe ated measurements was performed to evaluate the data. Total cholesterol, an d LDL-C were significantly diminished 2 months after both gemfibrozil and s imvastatin, the latter being more active. Plasma triglycerides showed a mar ked reduction with gemfibrozil at all times, while simvastatin regimen yiel ded only minor modifications. HDL-C was only slightly increased by simvasta tin; Lp[a] plasma levels were almost unaffected. Small fibrinogen (t(0), t( 2), t(6), t(8)), PAI-1 (t(6)) and AT III (t(0)-t(8)) increases were observe d after gemfibrozil, while simvastatin did not significantly modify these p arameters. Conclusions: In the post-prandial phase, gemfibrozil and simvastatin induce different metabolic effects that beneficially influence the lipid pattern, whereas fibrinolytic and coagulative parameters display minor variations o f undetermined significance.