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 .
A comparison between the effects of gemfibrozil and simvastatin on insulin sensitivity in patients with non-insulin-dependent diabetes mellitus and hyperlipoproteinemia.
In a double-blind , r and omized crossover study , 29 patients with non-insulin-dependent diabetes mellitus ( NIDDM ) and hyperlipoproteinemia were treated with gemfibrozil ( 1,200 mg/d ) or simvastatin ( 10 mg/d ) for 4 months . After gemfibrozil treatment , the insulin concentration was increased during the major part of the intravenous glucose tolerance test ( IVGTT ) and during the hyperinsulinemic euglycemic clamp . Similar but less pronounced elevations were caused by simvastatin .  Insulin sensitivity decreased by 27 % and 28 % during gemfibrozil and simvastatin treatment , respectively . Low-density lipoprotein ( LDL ) cholesterol was decreased with simvastatin treatment by 24 % . The LDL cholesterol level was not changed by gemfibrozil , but very-low-density lipoprotein ( VLDL ) cholesterol was reduced by 40 % . The VLDL triglyceride concentration was reduced to a significantly greater extent by gemfibrozil . After gemfibrozil treatment , lipoprotein(a ) [ Lp(a ) ] was decreased by 24 % , and the plasma free fatty acid ( FFA ) concentration was increased by 20 % and skeletal muscle lipoprotein lipase activity ( LPLA ) by 37 % . Although simvastatin more effectively decreased LDL cholesterol levels and the LDL to high-density lipoprotein ( HDL ) ratio , it can not be cl aim ed unreservedly that this drug is necessarily preferable in NIDDM patients . Gemfibrozil improved triglyceride removal and decreased VLDL concentrations , with qualitative changes in LDL . The apparent effects on insulin sensitivity are difficult to evaluate and need further study
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 .