Després J-P, Lemieux I, Salomon H, Delaval D
Lipid Reseach Center, CHUL Research Center, Canada.
J Intern Med. 2002 Jun;251(6):490-9. doi: 10.1046/j.1365-2796.2002.00988.x.
Studies have suggested that raising low levels of high-density lipoprotein cholesterol (HDL-C) may be an important target for the prevention of coronary heart disease.
To compare the ability of micronized fenofibrate and atorvastatin to increase plasma HDL-C levels.
Multicentre, randomized open-label study. Settings. The study was conducted in 19 centres across the UK and Canada.
One hundred and eighty-one patients were randomized and the full analysis set included 165 nondiabetic patients with low HDL-C (women <46 mg dL-1, i.e. 1.2 mmol L-1 and men <43 mg dL-1, i.e. 1.1 mmol L-1): 86 patients in the atorvastatin group and 79 patients in the micronized fenofibrate group. Interventions. Micronized fenofibrate (200 mg day-1, 87 patients) or atorvastatin (10 mg day-1, 94 patients) for a period of 12 weeks. Main outcome measures. Percent change in HDL-C levels.
After 12 weeks of treatment, the mean percent change from baseline in HDL-C was significantly higher in the micronized fenofibrate group (13.3%) compared with the atorvastatin group (5.3%, P=0.0003). The magnitude of such relative change was inversely related to the baseline HDL-C levels only in the micronized fenofibrate group. Furthermore, in the fenofibrate treatment group, 50.9% of the patients (29 of 57 patients) with a baseline HDL-C <40 mg dL-1 achieved a plasma HDL-C level above 40 mg dL-1 after 12 weeks of treatment versus 27.9% of the patients (19 of 68 patients) in the atorvastatin group (P=0.01).
On the basis of (1) the greater impact of fenofibrate than atorvastatin on HDL-C levels and (2) the greater proportion of dyslipidemic patients achieving HDL-C levels above 40 mg dL-1 with fenofibrate than atorvastatin, it is suggested that micronized fenofibrate should be considered as a good therapeutic option to treat dyslipidemic patients with low HDL-C and moderately elevated LDL-C concentrations.
研究表明，提高低密度的高密度脂蛋白胆固醇（HDL-C）水平可能是预防冠心病的一个重要目标。
比较微粒化非诺贝特和阿托伐他汀提高血浆HDL-C水平的能力。
多中心、随机开放标签研究。地点。该研究在英国和加拿大的19个中心进行。
181例患者被随机分组，完整分析集包括165例HDL-C水平低的非糖尿病患者（女性<46mg/dL，即1.2mmol/L，男性<43mg/dL，即1.1mmol/L）：阿托伐他汀组86例患者，微粒化非诺贝特组79例患者。干预措施。微粒化非诺贝特（200mg/天，87例患者）或阿托伐他汀（10mg/天，94例患者），为期12周。主要观察指标。HDL-C水平的百分比变化。
治疗12周后，微粒化非诺贝特组HDL-C较基线的平均百分比变化（13.3%）显著高于阿托伐他汀组（5.3%，P=0.0003）。仅在微粒化非诺贝特组中，这种相对变化的幅度与基线HDL-C水平呈负相关。此外，在非诺贝特治疗组中，基线HDL-C<40mg/dL的患者中有50.9%（57例中的29例）在治疗12周后血浆HDL-C水平达到40mg/dL以上，而阿托伐他汀组为27.9%（68例中的19例）（P=0.01）。
基于（1）非诺贝特对HDL-C水平的影响大于阿托伐他汀，以及（2）使用非诺贝特使血脂异常患者HDL-C水平达到40mg/dL以上的比例高于阿托伐他汀，建议微粒化非诺贝特应被视为治疗HDL-C水平低且低密度脂蛋白胆固醇（LDL-C）浓度中度升高的血脂异常患者的良好治疗选择。
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