Comparative Study of Bezafibrate and Pravastatin in Patients With Coronary Artery Disease and High Levels of Remnant Lipoprotein

Keita Sano, Takamitsu Nakamura, Mitsumasa Hirano, Yoshinobu Kitta, Tsuyoshi Kobayashi, Daisuke Fujioka, Yukio Saito, Toshiaki Yano, Kazuhiro Watanabe, Yosuke Watanabe, Hideto Mishina, Jyun-ei Obata (+2 others)
2010 Circulation Journal  
Remnant lipoproteinemia is a strong risk factor for cardiovascular (CV) diseases. This study examined which of 2 common lipid-lowering drugs (fibrates and statins) is more effective in patients with remnant lipoproteinemia and if lowering remnant lipoprotein levels can reduce CV risk. Methods and Results: Remnant lipoprotein levels were measured by an immunoseparation method (remnantlike lipoprotein particles cholesterol: RLP-C) in 274 patients with coronary artery disease and high RLP-C levels
more » ... (≥5.0 mg/dl). They were randomly assigned to receive bezafibrate (200-400 mg/day) or pravastatin (10-20 mg/day), and were prospectively followed-up for 1 year or until the occurrence of CV events. Complete follow-up data were obtained in 180 patients. RLP-C levels at 1 year of treatment were reduced more by bezafibrate than pravastatin (−37% and −25% from baseline, respectively). During follow-up, bezafibrate-treated patients had 3 CV events, compared with 12 events in pravastatin-treated patients (P<0.01). In multivariate logistic regression analysis, a decrease in RLP-C level was significantly associated with a reduction in CV events after adjustment for treatment group and changes in levels of other lipids. Conclusions: Bezafibrate therapy decreased RLP-C levels to a greater extent than pravastatin and a decrease in RLP-C level may be associated with a reduction in CV events in patients with high RLP-C levels. (Circ J 2010; 74: 1644 - 1650 , 274 patients with CAD and high levels of RLP-C (≥5.0 mg/dl) at 17 hospitals (Appendix 1) were enrolled in this study. All patients met the following inclusion criteria: (1) total cholesterol (TC) level in fasting serum ≥180 mg/dl but <260 mg/dl; (2) TG level in fasting serum ≥150 mg/dl but <400 mg/dl; (3) presence of CAD based on angiographic evidence of organic diameter stenosis >50% of at least 1 major coronary artery, but patients were included if they had had a significant stenosis previously, which had been reduced to ≤50% after coronary revascularization; and (4) age 35-75 years. If lipid-lowering drugs were being administered at the time of enrollment, RLP-C, TC, high-density lipoprotein-cholesterol (HDL-C) and TG levels were measured after a wash-out period of more than 4 weeks. The exclusion criteria were: (1) acute coronary syndrome within 10 days prior to enrollment; (2) congestive heart failure (New York Heart Association class III or greater);
doi:10.1253/circj.cj-10-0079 pmid:20574136 fatcat:5g3wt5ymgna3nimosucpyel2de