Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey.
Department of Cardiology, Merkezi Klinika, Baku, Azerbaijan.
Turk Kardiyol Dern Ars. 2020 Jun;48(4):359-367. doi: 10.5543/tkda.2019.25169.
Though epidemiological data suggest that an elevated triglyceride (TG) level may be a risk factor for coronary artery disease (CAD), there is still insufficient clinical evidence. This study was designed to evaluate the real-life efficacy and side effects of fibrate treatment for hypertriglyceridemia seen in a lipid clinic, as well as cardiovascular and diabetic outcomes.
This retrospective study evaluated patients who were followed-up for a diagnosis of hypertriglyceridemia at the lipid outpatient clinic of the Ege University Cardiology Department between 1997 and 2018. Data of demographic and clinical characteristics were obtained from hospital records. All patients (n=240) with at least 1 year of follow-up were included in the analysis. During follow-up, patients were treated with fenofibrate, and less frequently, gemfibrozile (14 patients), at different doses according to the TG level and disease severity.
Of the study population, 23% had CAD, 21% were diabetic, and 52% were obese. On admission, 20% were using fibrates and 17% were on statins. The mean admission lipid levels were TG: 281±194 mg/dL, low-density lipoprotein cholesterol: 115±37 mg/dL, high-density lipoprotein (HDL) cholesterol: 43±13 mg/dL, and non-HDL cholesterol: 166±42 mg/dL. The mean length of follow-up was 5.3±4.7 years (range: 1-16 years). A total of 8 (4.3%) patients had adverse effects during follow-up (1 on statin combination and 7 on fibrates alone). The side effects observed were an elevation of liver enzymes in 3, myalgia in 2, insomnia in 1, malaise in 1, and a skin rash in 1 patient. No rhabdomyolysis or myopathy was seen. During follow-up, diabetes developed in 14 and cardiovascular disease (CVD) in 14 patients. The cumulative non-HDL cholesterol level was significantly high in patients who developed diabetes or CVD. Receiver operating curve analysis indicated that a cumulative non-HDL cholesterol value of 1016 mg/dL was predictive of the development of diabetes mellitus or CVD with 85% sensitivity and 70% specificity.
In real life, long-term fibrate use is effective and safe. The cumulative non-HDL cholesterol burden can be used to assess the efficacy of treatment as a simple and easily calculated method. Large studies are needed to further clarify the value of this parameter in predicting the development of both diabetes and CVD.
尽管流行病学数据表明，甘油三酯（TG）水平升高可能是冠心病（CAD）的危险因素，但仍缺乏临床证据。本研究旨在评估脂质门诊中贝特类药物治疗高甘油三酯血症的真实疗效和副作用，以及心血管和糖尿病结局。
本回顾性研究评估了 1997 年至 2018 年间在伊兹密尔大学心脏病学系脂质门诊接受高甘油三酯血症诊断随访的患者。从医院记录中获取人口统计学和临床特征数据。所有至少随访 1 年的 240 例患者均纳入分析。在随访期间，根据 TG 水平和疾病严重程度，所有患者（n=240）均接受了非诺贝特治疗，偶尔也使用吉非贝齐（14 例）治疗，剂量各不相同。
研究人群中，23%有 CAD，21%有糖尿病，52%肥胖。入院时，20%正在服用贝特类药物，17%正在服用他汀类药物。入院时平均血脂水平为 TG：281±194mg/dL，低密度脂蛋白胆固醇：115±37mg/dL，高密度脂蛋白（HDL）胆固醇：43±13mg/dL，非高密度脂蛋白胆固醇：166±42mg/dL。平均随访时间为 5.3±4.7 年（范围：1-16 年）。共有 8（4.3%）例患者在随访期间出现不良反应（1 例他汀类药物联合治疗，7 例贝特类药物单独治疗）。观察到的副作用包括 3 例肝酶升高、2 例肌痛、1 例失眠、1 例不适和 1 例皮疹。未观察到横纹肌溶解症或肌病。随访期间，14 例患者发生糖尿病，14 例发生心血管疾病（CVD）。发生糖尿病或 CVD 的患者非高密度脂蛋白胆固醇水平明显升高。受试者工作特征曲线分析表明，累积非高密度脂蛋白胆固醇值为 1016mg/dL 时，对糖尿病或 CVD 的发生具有 85%的敏感性和 70%的特异性。
在现实生活中，长期使用贝特类药物是有效且安全的。累积非高密度脂蛋白胆固醇负担可作为一种简单且易于计算的方法来评估治疗效果。需要进行大型研究以进一步阐明该参数在预测糖尿病和 CVD 发展中的价值。
