Probucol and cholestyramine combination in the treatment of severe hypercholesterolemia

This study was carried out to evaluate the effect of the combined probucol and cholestyramine treatment on the lipoprotein pattern of hypercholesterolemic patients. Probucol was given in the dose of 1 g and cholestyramine in the dose of 16 g per day in 3 different sequences: Probucol, Cholestyramine, Probucol + Cholestyramine; Probucol + Cholestyramine, Probucol, Cholestyramine; Cholestyramine, Probucol + Cholestyramine, Probucol. After a period of dietary stabilization, 12 patients were randomly allocated to one of the treatment sequences to be followed for 9 months. Each treatment period lasted 3 months. During the cholestyramine period serum cholesterol decreased on the average by 18% and LDL cholesterol by 26%; during probucol, the mean decrease was 13% and 14%, and during the combined therapy 26% and 32%, respectively. Serum triglycerides and VLDL cholesterol showed a trend toward an increase during the cholestyramine period. HDL2 cholesterol significantly decreased during probucol treatment. Variation in both VLDL and HDL2 cholesterol observed when the drugs were given singly were no longer seen during the combination therapy.

Interrelationships between body mass and lipid and lipoprotein triglycerides and cholesterol in obese women

In 72 obese women body mass index positively correlated with age and both showed multiple correlations with serum lipids and lipoprotein lipids. After adjustment for age (partial correlation procedure), body mass index resulted to be positively correlated with serum triglycerides, VLDL lipids, HDL-triglycerides and negatively correlated with HDL-cholesterol. The decrease in HDL-cholesterol concentration along with the increase in body weight was due to the reduction of cholesterol in HDL2 subfraction, while HDL3-cholesterol did not show any significant correlation with body mass index. The negative correlation between HDL2-cholesterol and body mass index was independent of other lipoprotein variables and in particular of VLDL lipid levels that were, as expected, inversely related to HDL2-cholesterol. HDL2-cholesterol is believed to be a strong protective factor against atherosclerosis, while doubts exist on the meaning of VLDL lipids as risk factors. Thus, the decrease in HDL2-cholesterol concentration, rather than the increase in VLDL lipids, might give a rational basis to the high incidence rate of vascular disease in obese subjects.

Relationship between metabolic control and HDL2-cholesterol in type I diabetic patients

The relationship of the degree of metabolic control to the serum lipoprotein pattern has been studied in 62 young insulin treated diabetic patients. Stable HbA1 and 24-h mean blood glucose, but not daily insulin dosage, were positively correlated to VLDL-TG (p less than 0.001) and negatively correlated to HDL2-C (p less than 0.05). HDL2-C was higher in patients with HbA1 less than 10% than in patients with HbA1 greater than 10%. In 13 patients, in whom an improvement of metabolic control was achieved, a significant increase of HDL2-C was recorded after three months. Our data are consistent with the view that in insulin-treated patients, good metabolic control is associated with low VLDL-TG and high HDL2-C levels.

Changes in serum lipoprotein pattern following bezafibrate. Differential effects in type IIa and in type IIb hyperlipoproteinemic patients

Sixteen type IIb and 26 type IIa hyperlipoproteinemic patients were treated with bezafibrate 200 mg t.i.d. After 1 month VLDL-TG decreased by 54% in type IIb and by 43% in type IIa; LDL-C decreased by 13% in type IIb and by 23% in type IIa patients. HDL3-C rose in both group of patients, while HDL2-C significantly increased (52%) only in patients with phenotype IIb. The change in LDL-C and in HDL2-C concentrations resulted to be related to the pretreatment VLDL lipid concentration and to its change during the treatment. Twenty patients were treated with bezafibrate for 4 months. On the average, the changes in lipoprotein lipid concentration attained at the end of the first month of therapy remained substantially constant in the following 3 months.

Changes in the serum lipoprotein pattern induced by two low-fat diets with a different vegetable content in hypercholesterolemic patients

Thirty-two hypercholesterolemic outpatients were treated by a conventional low-fat diet (carbohydrate 56%; fat 25%; vegetable proteins 7%; animal proteins 12% of energy; P/S ratio 1.0). After 1 month T-C decreased by 11%, VLDL-C by 32%, LDL-C by 8%, HDLt-C by 10% and HDL2-C by 11%. Thirty-two comparable patients were treated by a different low-fat diet which provided 69% of energy as carbohydrate, 19% as fat, 7% as vegetable proteins and 5% as animal proteins; P/S ratio was 1.3. After 1 month T-C decreased by 9% and LDL-C by 12%. VLDL-C, HDL2-C and HDL3-C did not change significantly. A cross-over study on 24 patients confirmed that both diets have lowering effects on T-C and LDL-C levels, but only the conventional low-fat diet decreases VLDL-C and HDL2-C.

Long-term effects of fenofibrate on serum lipids and on lipoprotein cholesterol in type II hyperlipoproteinemic patients

Twenty two patients with primary type II hyperlipoproteinemia (13 phenotype IIa and 9 phenotype IIb) were treated with fenofibrate 300 mg a day for 4-12 months. Serum total cholesterol decreased, on the average, by 22 per cent and LDL cholesterol by 24 per cent. In the patients with familial hypercholesterolemia, total cholesterol decreased by 28 per cent and LDL cholesterol by 31 per cent. One patient with homozygous familial hypercholesterolemia showed the greatest fall of total and LDL cholesterol (44 and 48 per cent respectively) and this was accompanied by a nearly complete disappearance of xanthelasmas and xanthomas.

Fenofibrate therapy of hypertriglyceridaemia. Differential effects on LDL cholesterol level in type IV and in type IIb primary hyperlipoproteinaemia

Twenty five hypertriglyceridaemic patients (16 Type IV and 9 Type IIb) were treated with fenofibrate 300 mg/d. In Type IV patients serum triglycerides and VLDL cholesterol decreased, while LDL and HDL cholesterol rose significantly. In Type IIb patients, triglycerides and total, VLDL, IDL and LDL cholesterol were significantly reduced by the treatment. The correction of hypertriglyceridaemia by fenofibrate seems, therefore, to induce different changes in lipoproteins in Type IIb and in Type IV hyperlipoproteinaemic patients. The practical implications of these results are discussed.