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DOI: 10.1055/s-2003-42720
J. A. Barth Verlag in Georg Thieme Verlag Stuttgart · New York
Influence of Etofibrate on LDL-Subtype Distribution in Patients with Diabetic Dyslipoproteinemia
Publication History
Received: July 17, 2002
First decision: October 18, 2002
Accepted: January 10, 2003
Publication Date:
01 October 2003 (online)
Abstract
Low density lipoprotein (LDL-) particles can be subfractionated in large-buoyant (lb), intermediate-dense (id) and small-dense (sd) LDL-subtypes. Fibrates improve the LDL-subtype profile by reducing proatherogenic sd-LDL which are prominent in diabetic dyslipoproteinemia. We evaluated the effect of etofibrate on the LDL-subtype distribution in patients with type 2 diabetes mellitus (n = 13, 55 ± 18 years, BMI 27.9 ± 5.5 kg/m², HbA1c 10.1 ± 3.9 %) and diabetic dyslipoproteinemia (triglycerides 343 ± 253 mg/dl, HDL-cholesterol 36 ± 7 mg/dl, LDL-cholesterol 110 ± 37 mg/dl).
Plasma lipids (enzymatic methods) and LDL-subtypes (7 LDL-subfractions, density gradient ultracentrifugation) were measured before and during etofibrate therapy (500 mg/d, 7 - 16 weeks). Etofibrate significantly (p < 0.05, Wilcoxon-test) reduced triglycerides (- 31 ± 60 %) and increased HDL-cholesterol (+ 24 ± 22 %), whereas total cholesterol and LDL-cholesterol did not change. Cholesterol concentration decreased in sd-LDL by 12 % (p < 0.05), while it increased in id- and lb-LDL (+ 26 %,+ 39 %, respectively). Thus, the LDL-subtype profile showed a relative increase of the fraction of lb- (+ 13 ± 32 %, n.s.) and id-LDL (+ 23 ± 33 %, p < 0.05) and a relative decrease of the fraction of sd-LDL (- 19 ± 18 %, p < 0.05).
We conclude that etofibrate not only decreases triglycerides and increases HDL-cholesterol but also improves the LDL-subtype profile and thus may reduce the cardiovascular risk in patients with an abundance of sd-LDL such as diabetic patients.
Key words
Diabetes mellitus - diabetic dyslipoproteinemia - diabetic dyslipidemia - LDL-subfractions - LDL-subtypes - small dense LDL - etofibrate - fibrate
References
- 1 Chapman M J, Guérin M, Bruckert E. Atherogenic, dense low-density lipoproteins. Pathophysiology and new therapeutic approaches. Eur Heart J. 1998; 19 (Suppl A) A24-A30
- 2 Frost J LR, Otto C, Geiss H C, Schwandt P, Parhofer K G. Effects of atorvastatin versus fenofibrate on lipoprotein profiles, LDL-subfraction distribution and hemorheological parameters in type 2 diabetic patients with mixed hyperlipoproteinemia. Am J Cardiol. 2001; 87 44-48
- 3 Guérin M, Bruckert E, Dolphin P, Turpin G, Chapman M J. Fenofibrate reduces cholesterol ester transfer from HDL to VLDL and normalizes the atherogenic, dense LDL profile in combined hyperlipidemia. Arterioscler Thromb Vasc Biol. 1996; 16 763-772
- 4 Kreisberg R A. Diabetic Dyslipidemia. Am J Cardiol. 1998; 82 67U-73U
- 5 Mc Kenney J M, Mc Cormick L S, Schaefer E J, Black D, Watkins M L. Effect of niacin and atorvastatin on lipoprotein subclasses in patients with atherogenic dyslipidemia. Am J Cardiol. 2001; 88 270-274
- 6 Schamberger B M, Geiss H C, Ritter M M, Schwandt P, Parhofer K G. Influence of LDL-apheresis on LDL-subtypes in patients with coronary heart disease and severe hyperlipoproteinemia. J Lipid Res. 2000; 41 727-733
- 7 Steinmetz A, Fenselau S, Schrezenmeir J. Treatment of dyslipoproteinemia in the metabolic syndrome. Exp Clin Endocrinol Diabetes. 2001; 109 S548-S559
- 8 Tan C E, Chew L S, Tai E S, Chio L F, Lim H S, Loh L M, Shepherd J. Benefits of micronised fenofibrate in type 2 diabetes mellitus subjects with good glycemic control. Atherosclerosis. 2001; 154 469-474
M. D. Klaus G. Parhofer
Department of Internal Medicine II, Klinikum Grosshadern
Marchioninistr. 15
81377 Munich
Germany
Phone: + 498970953011
Fax: + 49 89 70 95 88 79
Email: parhofer@med2.med.uni-muenchen.de