Improvement in endothelial dysfunction in patients with hypoalphalipoproteinemia and coronary artery disease treated with bezafibrate

Isolated low high-density lipoprotein cholesterol (HDLc) is a well-known ri sk factor for cardiovascular disease and is associated with arterial endoth elium dysfunction. Several studies have shown that cholesterol lowering in patients with hypercholesterolemia improves endothelial function, but the e ffect of treating low HDLc levels remains unknown. We studied the effect of increasing HDLc on endothelial function in patients with coronary artery d isease (CAD) and isolated low HDLc (HDLc) <0.91 mM, low-density lipoprotein cholesterol (LDLc) <4.1 mM, and triglycerides <2.8 mM. Flow-mediated endot helium-dependent dilatation (FMD) in response to reactive hyperemia was mea sured by brachial ultrasound, before and after bezafibrate treatment (400 m g daily for 6 months) in 16 patients with CAD and impaired FMD (<10%). Afte r bezafibrate therapy, HDLc increased from 0.79-1.0 mM (p = 0.0008) at the expense of both HDL2 and HDL3 subfractions, apolipoprotein A-I increased fr om 1.04-1.19 g/l (p = 0.0012), and fibrinogen decreased from 4.45-3.39 g/l (p = 0.0007). The impaired FMD increased after bezafibrate treatment from a median of 2.5-12.3% (p = 0.0004). Endothelial function was normalized in e ight patients (50%), improved in four (25%), and did not change in four (25 %). These observations indicate that in patients with isolated low HDLc and CAD, bezafibrate treatment improves endothelial function of brachial arter ies, increases HDLc and apolipoprotein A-I, and lowers fibrinogen concentra tions.