Contribution of apo CIII reduction to the greater effect of 12-week micronized fenofibrate than atorvastatin therapy on triglyceride levels and LDL size in dyslipidemic patients

• Published in: Annals of medicine (Helsinki) Vol. 35; no. 6; p. 442
• Main Authors: Lemieux, Isabelle, Salomon, Hervé, Després, Jean-Pierre
• Format: Journal Article
• Language: English
• Published: England 2003
• Subjects: Adult; Aged; Anticholesteremic Agents - therapeutic use; Apolipoprotein C-III; Apolipoproteins C - blood; Atorvastatin Calcium; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Coronary Disease - prevention & control; Female; Fenofibrate - therapeutic use; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hyperlipidemias - blood; Hyperlipidemias - drug therapy; Hypolipidemic Agents - therapeutic use; Lipoprotein Lipase - metabolism; Male; Middle Aged; Pyrroles - therapeutic use; Treatment Outcome; Triglycerides - blood
• ISSN: 0785-3890
• DOI: 10.1080/07853890310011969

Apolipoprotein (apo) CIII plays an important role in the catabolism of triglyceride-rich lipoproteins as it is a potent inhibitor of lipoprotein lipase (LPL). A low LPL activity has been simultaneously associated with hypertriglyceridemia, low HDL cholesterol and with small LDL particles.
To compare the effects of a 12-week treatment with micronized fenofibrate (200 mg) versus atorvastatin (10 mg) on apo CIII and lipoprotein-lipid levels including LDL size.
After a 4-week washout period, dyslipidemic patients were randomized to either micronized fenofibrate (n = 64) or atorvastatin (n = 72).
Both fenofibrate and atorvastatin significantly decreased apo CIII levels by -0.03 +/- 0.03 versus -0.01 +/- 0.03 g/l respectively, and increased LDL size by 4.9 +/- 3.3 versus 1.8 +/- 2.9 A. Improvements in these parameters were significantly greater with fenofibrate (P < 0.0001). Significant relationships were found between changes in triglycerides and changes in apo CIII (r = 0.81 and r = 0.59, P < 0.0001) as well as between changes in LDL size and changes in apo CIII (r = -0.41 and r = -0.45, P < 0.001), in both fenofibrate and atorvastatin groups. respectively.
The substantial reduction in apo CIII induced by micronized fenofibrate plays an important role in the greater effect of micronized fenofibrate than atorvastatin on plasma triglycerides and LDL size.