Women with mixed dyslipidemia benefit from fenofibric acid plus a statin

Combined therapy with fenofibric acid and a statin can safely and effectively treat women with multiple lipid abnormalities, researchers from Washington University School of Medicine, St. Louis, report.

Their study evaluated 1,393 women who had participated in any 1 of 3 large, multicenter, randomized clinical trials that assessed therapy combining fenofibric acid with rosuvastatin, simvastatin, or atorvastatin. The women were randomized to receive combination therapy with fenofibric acid plus a low- or moderate-dose statin; fenobibric acid alone; or low-, moderate-, or high-dose statin therapy alone. All of the women had low-density liproprotein (LDL) cholesterol levels of at least 130 mg/dL, triglyceride levels at least 150 mg/dL, and high-density lipoprotein (HDL) cholesterol levels lower than 50 mg/dL.

“With the moderate-dose combination, the baseline HDL cholesterol increased 21% and TG [triglycerides] decreased 44% compared to an 8% HDL cholesterol increase and 26% TG decrease with moderate-dose statins alone,” the authors write. Low-dose combination therapy raised HDL cholesterol by 20% and lowered triglycerides by 46%; low-dose statins alone raised HDL by 8% and lowered triglycerides by 20%.

Combination therapy with low- and moderate-dose statins decreased LDL cholesterol by about the same percentage as low- and moderate-dose statins alone (37% to 39% for combination therapy vs 36% to 43% for statins alone). High-dose statin treatment reduced LDL cholesterol by 47% but didn’t change HDL cholesterol or triglyceride levels more than the lower statin doses.

Lipid levels with combination therapy “were comparable to, or better than, those attained using high-dose statins,” the researchers write. “A clinical decision to treat with high-dose statins in women must reasonably weigh their tolerability and efficacy against those of combination therapies using low- to moderate-dose statins plus fenobric acid.”

Incidence of serious treatment-related side effects ranged from 2% to 4% across treatment groups. Although women receiving combination therapy had significantly greater mean changes in serum creatinine than those on monotherapy, none discontinued treatment because of increased creatinine.

The study was published online January 19 in the American Journal of Cardiology.