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 .
Treatment of primary hypercholesterolemia: fluvastatin versus bezafibrate.
The effects of fluvastatin and bezafibrate on lipids , lipoproteins , and apoproteins ( apo ) were investigated in a multicenter r and omized , double-blind , parallel-group study . After 8 weeks of strictly controlled ( computer-based assessment ) dietary stabilization , patients with primary hypercholesterolemia ( low-density lipoprotein cholesterol [ LDL-C ] > or = 160 mg/dL ; triglycerides < or = 300 mg/dL ) were enrolled into a 6-week placebo phase . Altogether , 131 patients were r and omized to receive either  fluvastatin at 40 mg once daily ( n = 64 ; mean age 53 years ) or  bezafibrate at 400 mg once daily ( n = 67 ; mean age 52 years ) for 12 weeks . Compliance with the diet was monitored ( 3-day food records ) after 6 and 12 weeks . Fluvastatin led to significant reductions in LDL-C ( -23 % ) , total cholesterol ( -17 % ) , LDL-C/high-density lipoprotein cholesterol ( HDL-C ) ( -24 % ) and apo B ( -19 % ) . Fluvastatin significantly increased LpA-I ( + 8 % ) and apo E ( + 20 % ) . Bezafibrate produced significant reductions in LDL-C ( -17 % ) , total cholesterol ( -13 % ) , LDL-C/HDL-C ( -24 % ) , triglycerides ( -28 % ) , apo B ( -15 % ) , and LpA-I ( -10 % ) and significantly increased HDL-C ( + 12 % ) , apo A-I ( + 9 % ) , apo A-II ( + 30 % ) , apo E ( + 14 % ) , and Lp(a ) ( + 3 % ) . No clinical ly notable increases in levels of liver enzymes or creatine phosphokinase were observed with either treatment . Both treatments were well tolerated . There was a low incidence of adverse events that tended to be mild and included headache , muscular pain , angina , and dyspepsia . The frequency of adverse events was similar in both treatment groups , and no significant differences in dietary behavior were observed . In conclusion , fluvastatin is a well tolerated 3-hydroxy-3-methylglutaryl-coenzyme A ( HMG-CoA ) reductase inhibitor for the treatment of primary hypercholesterolemia . Effects of fluvastatin on LpA-I occur irrespective of changes in
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 .