Hypertriglyceridemia gemfibrozil

A 76-year-old woman with type 2 diabetes taking gemfibrozil for pronounced hypertriglyceridemia had recurrent episodes of hypoglycemia her insulin requirements fell by 65 % and her HbAic concentration fell from 9 to 6.5% over 5 months (7). 

Although bilberry s effect on triglycerides is similar to that of the fibric acid derivatives (e.g., gemfibrozil, fenofibrate) used therapeutically to treat hypertriglyceridemia, bilberry did not affect thrombus size or composition, suggesting that it does not possess antithrombotic activity, as has been demonstrated with some fibric acid derivatives (1). 

Hypertriglyceridemia usually responds well to niacin, gemfibrozil, or high-dose/potency statins (e.g., atorvastatin or simvastatin) niacin should be used cautiously in diabetics because of worsening glycemic control. 

Yang CY, Gu ZW, Xie YH, et al. Effects of gemfibrozil on very-low-density lipoprotein composition and low-density lipoprotein size in patients with hypertriglyceridemia or combined hyperlipidemia. Atherosclerosis 1996 126 105—116. 

Type V Familial hypertriglyceridemia (T VLDL production 4 lipoprotein lipase) Increased VLDL and chylomicrons nicotinic acid, gemfibrozil... 

Gemfibrozil is indicated in the treatment of hypertriglyceridemia in adult patients with type IV or V hyperlipidemia that presents risk of pancreatitis and does not respond to diet and reduction of coronary heart disease risk in type Ilb patients who have low HDL levels (in addition to elevated LDL and triglycerides) and have not responded to other measures. 

B. Clinical Use Gemfibrozil and other fibrates are used to treat hypertriglyceridemia (Table 35-2). Because these drugs ha"e only modest effects on LDL cholesterol, they often are combined with other cholesterol-lowering drugs for treatment of patients with elevated concentrations of both LDL and VLDL. 

Overall, fibrates decrease plasma triglyceride levels much more dramatically than they decrease plasma cholesterol levels. They significantly decrease VLDL levels, cause a moderate Increase In HDL levels, and have variable effects on LDL concentrations. As an example of this latter point, gemfibrozil will raise LDL levels In patients with hypertriglyceridemia but lower LDL levels in patients with normal triglyceride levels. The exact mechanisms for these actions have not been fully elucidated however, studies have shown that this class of compounds can produce a variety of beneficial effects on lipoprotein metabolism. Many of these effects have been proposed to be mediated through the activation of peroxisome proliferator-activated receptors (PPARs) and an alteration of gene expression. Specifically, fibrates bind to PPARa (7,15,27,44). 

Interest in fenofibrate has re-emerged with the near demise of gemfibrozil in some countries, once it became apparent that a statin+fenofibrate combination was highly likely to be safe. It is currently by far the preferred fibrate for the management of hypertriglyceridemia or in combination with a statin for treating combined hyperlipidemia. Different studies with a variety of statins have uniformly found no greater incidence of serious adverse reactions when fenofibrate is added compared with placebo. 

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