Cor Vasa 2002, 43(1):19-25

Metabolic effects of fenofibrate and atorvastatin (Fenofibrate versus Atorvastatin Trial, FAT

Jan Malík^1,*, Vojtěch Melenovský¹, Dan Wichterle¹, Jan Šimek¹, Jaromír Hradec¹, Jan Škrha¹, Alexandra Pisaříková², Petr Stávek³, Rudolf Poledne³, Richard Češka¹

¹ III. interní klinika

² IV. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy

³ Laboratoř pro výzkum aterosklerózy, Institut klinické a experimentální medicíny, Praha, Česká republika

Introduction:
Combined hyperlipoproteinemia is treated using fibrates, and atorvastatin in particular. We compared the hypolipidemic and other metabolic effects of micronized fenofibrate and atorvastatin administered in regular daily doses.


Group of patients:
29 males, non-smokers with untreated combined hyperlipidemia, without associated diseases, aged 47.4 ± 7.8 years, with the levels of total cholesterol of 7.53 ± 1.22 mmol/L, HDL-cholesterol 1.25 ± 0.32 mmol/L, LDL-chole- sterol 4.39 ± 0.89 mmol/L, and triglycerides 5.40 ± 4.66 mmol/L, were randomized into two groups. One group was
first treated with micronized fenofibrate 200 mg daily, the other group with atorvastatin 10 mg daily for 10 weeks. Next, medication was changed for 10 weeks using the cross-over design.

Methods:
Total and HDL-cholesterol, triglycerides and uric acid were determined using enzymatic methods. LDL-cholesterol and non-HDL-cholesterol were calculated. Apolipoprotein AI (Apo AI), apolipoprotein B (Apo B) and lipoprotein(a) were determined by immunophoresis. Plasma fibrinogen was determined using the method developed by Clauss, C-reactive protein (CRP) by immunoturbidimetry. The mean LDL particle size was determined by polyacrylamide gel electrophoresis. Homocysteine levels were determined by chromatography, and insulinemia by a radioimmunoassay. Malonyl dialdehyde (MDA) was used as oxidative stress marker, as determined by fluorimetry. A significant effect of the period was seen with changes in insulinemia, mean LDL particle size, and MDA.

Results:
Atorvastatin reduced total cholesterol, LDL-cholesterol, non-HDL-cholesterol, and Apo B statistically more significantly than fenofibrate. Fenofibrate decreased more significantly triglycerides, CRP, and uricemia, and increased HDL-
-cholesterol. Both drugs were equally effective in increasing Apo AI and average LDL particle size and decreased MDA levels. The significant increases in fibrinogen and homocysteine after atorvastatin and fenofibrate, respectively, can be regarded as side effects.

Keywords: Combined hyperlipidemia; Fenofibrate; Atorvastatin

Published: January 1, 2002  Show citation