Abstract 16679: Effect of Niacin Extended-Release and Fenofibrate on Lipid and Lipoprotein Level and Composition
Objective: Niacin and fenofibrate are to date the most effective available HDL-raising therapies. We examined the relationship between lipid and lipoprotein profile and CETP and LCAT activity and mass following treatment with niacin extended-release (ER) and fenofibrate.
Methods: In a multicenter, randomized, open-label, cross-over study, 66 dyslipidemic patients; 24 with low HDL-C (<40 mg/dL) and 42 with normal HDL-C (40-59 mg/dL), received 6 weeks’ treatment with niacin ER (0.5 g/d then 1 g/d) and fenofibrate (160 mg/d) with 4 weeks’ wash-out between treatments. Lipoprotein composition and particle size distribution were determined using NMR. Findings were compared using ANCOVA, corrected for treatment, period and baseline HDL-C. CETP and LCAT concentration and activity were measured by standard methods.
Results: Comparable increases in HDL-C and ApoAI were seen with fenofibrate and niacin ER.
The median increase in HDL and decrease in LDL particle numbers was greater with fenofibrate (+14.0 and -24.3% respectively) than with niacin (+6.5 and -12.5% respectively). A shift from baseline was seen in HDL distribution from small (-0.7%) to medium (+101.9%) and large (+20.2%) particles with fenofibrate and from medium (-35.9%) to large (+61.5%) particles with niacin. The number of very small, small and medium-small LDL species decreased with both drugs and was more pronounced with fenofibrate (-40 to -42%) than with niacin (-14 to -22%). Small comparable increases in CETP concentration and decreases in CETP activity were seen with both drugs. The increase in LCAT concentration and decrease in LCAT activity was greater with niacin than with fenofibrate.
Conclusion: Although fenofibrate and niacin ER similarly increased HDL-C and ApoAI with a variable shift in composition toward larger HDL particles (attributed in part to decreased CETP and LCAT activity), clear differences were seen in the overall lipoprotein profiles [ApoAII, LDL-C, ApoCIII, ApoB, Lp(a)].
- © 2010 by American Heart Association, Inc.