Conclusions Fibrates have a significantly greater effect in reducing plasma Lp(a ) concentrations than statins .
Addition of fibrates to statins can enhance the Lp(a)-lowering effect of statins
Background Raised plasma lipoprotein(a ) ( Lp(a ) ) concentration is an independent and causal risk factor for atherosclerotic cardiovascular disease .
Several types of pharmacological approaches are under evaluation for their potential to reduce plasma Lp(a ) levels .
There is suggestive evidence that statins and fibrates , two frequently employed lipid-lowering drugs , can lower plasma Lp(a ) .
The present study aims to compare the efficacy of fibrates and statins in reducing plasma concentrations of Lp(a ) using a meta- analysis of r and omized head-to-head trials .
Effects of lipid-lowering drugs on left ventricular function and exercise tolerance in dyslipidemic coronary patients.
Previous studies suggested that certain lipid-lowering drugs such as statins suppress ubiquinone , affect mitochondrial function , and may have deleterious effect on skeletal or cardiac muscles with potentially serious clinical consequences , especially in patients with established coronary heart disease and left ventricular dysfunction . In this double-blind study , we assessed the effects of 20 mg simvastatin ( S , n = 32 ) or 200 mg micronized fenofibrate ( F  , n = 32 ,  control group ) on rest and exercise left ventricular function in hypercholesterolemic survivors of a previous Q-wave acute myocardial infa rct ion . Left ventricular radionuclide imaging was performed at rest and during submaximal exercise and global and segmental ( nine segment regional wall-motion score ) ejection fractions were measured before treatment and 12 weeks later . Serum ubiquinone was reduced after treatment ( p = 0.03 ) in the S but not the F group , whereas total and low-density lipoprotein ( LDL ) cholesterol were significantly reduced in both groups . Before treatment , mean global ejection fraction was 52.1+/-12.2 % and 49.3+/-11.8 % at rest in F and S patients , respectively , and increased ( 56.0+/-13.7 % in F and 52.1+/-12.9 % in S ) at peak exercise ( no difference between groups ) . After treatment , the increase in ejection fraction tended to be lower in S ( 0 ) than in F ( + 3.8 % ) but not significantly . However , ejection fraction at rest increased after treatment in S ( p = 0.009 ) but not in F. Subgroup analyses indicated that the improvement in rest ejection fraction in S was essentially observed in patients with ejection fraction < 40 % ( n = 8 , + 6 % ) , whereas it was stable in patients with ejection fraction > 40 % ( + 1.8 % ) . Finally , the numbers of akinetic or hypokinetic segments at rest and during exercise were not different in the two groups before and after treatment . Mean maximal exercise load ( 113+/-23 watts in F vs. 104+/-27 W in S before treatment ) was not modified by the treatment ( 111+/-21 and 104+/-27 W ) . Thus a 12-week lipid-lowering treatment with either S or F did not negatively alter left ventricular function during exercise in dyslipidemic patients with established coronary heart disease and did not affect their ability to exercise . The improvement in left ventricular function at rest after simvastatin in patients with left ventricular dysfunction warrants confirmation in further studies with large sample size
Conclusions Fibrates have a significantly greater effect in reducing plasma Lp(a ) concentrations than statins .
Addition of fibrates to statins can enhance the Lp(a)-lowering effect of statins
Background Raised plasma lipoprotein(a ) ( Lp(a ) ) concentration is an independent and causal risk factor for atherosclerotic cardiovascular disease .
Several types of pharmacological approaches are under evaluation for their potential to reduce plasma Lp(a ) levels .
There is suggestive evidence that statins and fibrates , two frequently employed lipid-lowering drugs , can lower plasma Lp(a ) .
The present study aims to compare the efficacy of fibrates and statins in reducing plasma concentrations of Lp(a ) using a meta- analysis of r and omized head-to-head trials .