Collins M W, König C S, Abbas A, Jewkes C, Jones A F, Ramachandran S
School of Engineering and Design, Brunel University, London UB8 3PH, United Kingdom.
Brunel Institute of Bioengineering, Brunel University, London UB8 3PH, United Kingdom.
Diabetes Metab Syndr. 2014 Oct-Dec;8(4):212-5. doi: 10.1016/j.dsx.2014.09.004. Epub 2014 Oct 6.
Debate surrounding the role of fibrates has followed mixed outcomes from several randomised controlled trials. Subgroup analysis of even the negative trials reveals significant reduction in cardiovascular risk amongst patients with low HDL-C and high TG. We previously described factors associated with HDL-C change following fibrates. As fibrates influence both HDL-C and TG levels via their action on PPAR-α, we now wished to study TG change following fibrate therapy and any associations with baseline and change in HDL-C and TC levels.
Data was collected from case notes of patients started on fibrates (n=248) between 2002 and 2008 in the lipid clinics at Heart of England NHS Foundation Trust. Regression analyses were carried out to determine factors associated with changes in TG.
Multiple regression analysis revealed that TG change was associated with pre-treatment TG (p<0.001) and TC levels (p=0.029). The association between TG change and pre-treatment TG remained significant when all factors including gender, concurrent statin treatment, diabetes and baseline HDL-C were entered into the regression model. Our previous study demonstrated significant post-fibrate HDL-C change in the group with baseline HDL-C values <1.0mmol/l. In our present study significant TG reduction was observed regardless of the baseline patient characteristics including HDL-C levels.
The actions of fibrates are considered to be mediated via PPAR-α, but our data suggest that the effects on TG and HDL-C are different. Thus, the mechanisms mediating the changes of these lipids following fibrate treatment may vary.
围绕贝特类药物作用的争论源于多项随机对照试验的混合结果。即使是阴性试验的亚组分析也显示，高密度脂蛋白胆固醇（HDL-C）水平低且甘油三酯（TG）水平高的患者心血管风险显著降低。我们之前描述了贝特类药物治疗后HDL-C变化的相关因素。由于贝特类药物通过作用于过氧化物酶体增殖物激活受体α（PPAR-α）来影响HDL-C和TG水平，我们现在希望研究贝特类药物治疗后的TG变化以及与基线和HDL-C及总胆固醇（TC）水平变化的任何关联。
从2002年至2008年在英格兰心脏国民保健服务基金会信托基金脂质诊所开始使用贝特类药物治疗的患者（n = 248）病历中收集数据。进行回归分析以确定与TG变化相关的因素。
多元回归分析显示，TG变化与治疗前TG（p < 0.001）和TC水平（p = 0.029）相关。当将包括性别、同时使用他汀类药物治疗、糖尿病和基线HDL-C在内的所有因素纳入回归模型时，TG变化与治疗前TG之间的关联仍然显著。我们之前的研究表明，基线HDL-C值<1.0mmol/l的组在使用贝特类药物治疗后HDL-C有显著变化。在我们目前的研究中，无论患者的基线特征（包括HDL-C水平）如何，均观察到TG显著降低。
贝特类药物的作用被认为是通过PPAR-α介导的，但我们的数据表明其对TG和HDL-C的影响不同。因此，贝特类药物治疗后这些脂质变化的介导机制可能有所不同。
