Efficacy of combination of atorvastatin and micronised fenofibrate in the treatment of severe mixed hyperlipidemia

Objectives: In patients with mixed lipid disorders, monotherapy may not eff ectively control all lipid abnormalities. We undertook this study to assess the efficacy of fenofibrate in combination with atorvastatin in patients w ith severe mixed dyslipidemia. Methods: This was an 18-week, open-label study conducted in our lipid clini c. After a 6-week dietary baseline phase, patients received 200 mg/day micr onised fenofibrate for 6 weeks. At the end of this period the subjects disc ontinued this treatment and received 40 mg/day atorvastatin for 6 weeks. Fi nally 200 mg/day of micronised fenofibrate was added to the statin therapy. Results: Administration of micronised fenofibrate reduced serum triglyceri des (P < 0.01) and total cholesterol and low-density lipoprotein (LDL) chol esterol (P < 0.05 for both parameters), while it evoked a significant incre ase in serum high-density lipoprotein (HDL) cholesterol levels (P < 0.05). Atorvastatin monotherapy induced a more pronounced decrease of total and LD L cholesterol. However, plasma triglycerides, although significantly lower than baseline values (P < 0.05), were higher than the values observed durin g treatment with fenofibrate. Moreover, serum HDL cholesterol concentration s were higher during fibrate therapy than during the statin one. During the combination therapy, the decrease in triglycerides was greater than that o bserved with fenofibrate alone, while the decrease in LDL cholesterol was m ore pronounced than that observed with atorvastatin alone. Conclusion: The combination of atorvastatin with micronised fenofibrate in patients with severe mixed dyslipidemia may have a favourable effect on som e major coronary artery disease risk factors.