being worthless caught my eye as I take Lopid (for very high
triglyceride levels associated with non-diabetic kidney disease). Is it

just worthless for cholesterol control? My triglyclerides have dropped
from over 4,000 mg/dL to 150 mg/dL - not great, but much better. <<

COMMENT:

Lopid certainly brings triglycerides down very well. That is the place
where it shines best (rather than as a treatment for high cholesterol
or LDL per se).

Whether this prevents death from heart disease in the small subset of
people who have VERY high triglycerides (like you) is an open question.
Nobody has looked. In the largest studies on Lopid, they gave it to a
broad range of people and did not succeed in showing decrease in
mortality. Perhaps if they'd restricted it to a subset, they might
have. We don't know!

YOU do have an unusual problem, for which no endpoint data from fibrate
treatment are known. 4000 is a VERY high triglyceride level-- high
enough to cause worry of other problems, like pancreatitis. For you, I
think a fibrate is reasonable. However, if I were you, I would
recommend you do the 10 grams of fishoil a day and see if you can then
cut down your fibrate dose.

Here's a very large trial of gemfibrozole in men with coronary disease
where they were unable to show a decrease in heart disease death, or
death from any cause. They had to fold in total non-fatal events to get
anything significant. But since fibrates are carcinogens, a 24%
decrease in non-fatal events is not enough. Note, however, that these
men did not have really high triglycerides and weren't chosen for that.
It's still possible that gemfibrozil would have done better for them,
if they had been. These are NOT the same group as you, though. We
really have no good data for people with your problem, and that's the
problem.

N Engl J Med. 1999 Aug 5;341(6):410-8.

Gemfibrozil for the secondary prevention of coronary heart disease in
men with
low levels of high-density lipoprotein cholesterol. Veterans Affairs
High-Density Lipoprotein Cholesterol Intervention Trial Study Group.

Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, Faas FH,
Linares
E, Schaefer EJ, Schectman G, Wilt TJ, Wittes J.

Center for Chronic Disease Outcomes Research, Veterans Affairs Medical
Center,
Minneapolis, MN 55417, USA. bloom013@tc.umn.edu

BACKGROUND: Although it is generally accepted that lowering elevated
serum
levels of low-density lipoprotein (LDL) cholesterol in patients with
coronary
heart disease is beneficial, there are few data to guide decisions
about therapy
for patients whose primary lipid abnormality is a low level of
high-density
lipoprotein (HDL) cholesterol. METHODS: We conducted a double-blind
trial
comparing gemfibrozil (1200 mg per day) with placebo in 2531 men with
coronary
heart disease, an HDL cholesterol level of 40 mg per deciliter (1.0
mmol per
liter) or less, and an LDL cholesterol level of 140 mg per deciliter
(3.6 mmol
per liter) or less. The primary study outcome was nonfatal myocardial
infarction
or death from coronary causes. RESULTS: The median follow-up was 5.1
years. At
one year, the mean HDL cholesterol level was 6 percent higher, the mean
triglyceride level was 31 percent lower, and the mean total cholesterol
level
was 4 percent lower in the gemfibrozil group than in the placebo group.
LDL
cholesterol levels did not differ significantly between the groups. A
primary
event occurred in 275 of the 1267 patients assigned to placebo (21.7
percent)
and in 219 of the 1264 patients assigned to gemfibrozil (17.3 percent).
The
overall reduction in the risk of an event was 4.4 percentage points,
and the
reduction in relative risk was 22 percent (95 percent confidence
interval, 7 to
35 percent; P=0.006). We observed a 24 percent reduction in the
combined outcome
of death from coronary heart disease, nonfatal myocardial infarction,
and stroke
(P< 0.001). There were no significant differences in the rates of
coronary
revascularization, hospitalization for unstable angina, death from any
cause,
and cancer. CONCLUSIONS: Gemfibrozil therapy resulted in a significant
reduction
in the risk of major cardiovascular events in patients with coronary
disease
whose primary lipid abnormality was a low HDL cholesterol level. The
findings
suggest that the rate of coronary events is reduced by raising HDL
cholesterol
levels and lowering levels of triglycerides without lowering LDL
cholesterol
levels.

Publication Types:
   Clinical Trial
   Multicenter Study
   Randomized Controlled Trial

PMID: 10438259 [PubMed - indexed for MEDLINE]