Turk Kardiyol Dern Ars. Ahead of Print: TKDA-25169 | DOI: 10.5543/tkda.2019.25169
Cumulative Non-HDL-Cholesterol burden in patients with hypertriglyceridemia receiving long-term fibrate therapy: Real life data from a lipid clinic cohort
, Shafa Shahbazova2
, Firdovsi İbrahimov2
, Levent Hürkan Can11
Ege University Medical School, Cardiology Department, Izmir, Turkey2
Merkezi Klinika, Cardiology Department, Baku, Azerbaijan
Though epidemiological data suggests elevated triglyceride (TG) levels as a risk factor for coronary artery disease (CAD), the clinical trials are low in number to denote an evidence. This study was aimed to evaluate the efficacy, side effects and rates of both cardiovascular and diabetic outcomes of patients on fibrate treatment for hypertriglyceridemia in a lipid clinic, on a real life basis. Keywords:
METHODS This retrospective study evaluated all patients who were followed with the diagnosis of hypertriglyceridemia in the Lipid out-patient clinic of Ege University Cardiology Department of between the years of 1997 and 2018. Data were obtained from hospital records on demographic and clinical characteristics. All patients (n: 240) with at least 1 year follow-up were included to the analysis. During follow-up, patients were treated with fenofibrate and less frequently gemfibrozile (14 patients) at different doses according to both TG levels and disease severity.
RESULTS 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. Admission lipid levels were as follow: TGs: 281±194 mg/dL; LDL-cholesterol: 115±37 mg/dL, HDL-cholesterol: 43±13 mg/dL; and non-HDL cholesterol was 166±42 mg/dL. The mean follow-up was 5.3±4.7 (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). Side effects were elevation liver enzymes in 3, myalgia in 2, insomnia in 1, malaise in 1, and skin rash in 1 patient. No rhabdomyolysis or myopathy was observed. During follow-up, diabetes was developed in 14 and cardiovascular disease (CVD) in 14 patients. Cumulative non-HDL-cholesterol at the time of the event was significantly high in patients who developed diabetes or CVD. In ROC analysis, the cumulative non-HDL-cholesterol value of 1016 mg/dL was predictive of the development of diabetes mellitus and CVD with 85% sensitivity and 70% specificity.
CONCLUSION 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. Further large studies are needed to clarify the value of this parameter in predicting the development of both diabetes and CVD.
fibrates, long-term lipid changes, cumulative non-HDL cholesterol burden, triglycerides
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Corresponding Author: Meral Kayikcioglu, Türkiye