Original research article - Special issue: Cardiovascular PreventionCombined therapy of mixed dyslipidemia in patients with high cardiovascular risk and changes in the lipid target values and atherogenic index of plasma

PurposeTo evaluate the safety and efficacy of combined lipid-modifying agents (statin + fenofibrate) on plasma lipid profile including the atherogenic index of plasma (AIP = log[TG/HDL-C]) in patients at high and very high cardiovascular (CV) risk and mixed dyslipidemia.MethodA total of 81 patients (53 males, 28 females; 60 ± 9.8 years) were included. Mixed dyslipidemia was defined as having 2 of the following 3 lipid abnormalities: LDL-cholesterol (C) >2.5 mmol/l, HDL-C <1.0 mmol/l in males and <1.3 mmol/l in females, triglycerides (TG) >1.7 mmol/l. Global CV risk was estimated according to the current European guidelines. Management with fenofibrate (160-267 mg) + atorvastatin (10-20 mg) or simvastatin (20-40 mg) was indicated for 6 months. Males and females were stratified according to the AIP risk categories: AIP <0.11 (low risk), AIP >0.21 (high risk).ResultsAbout 3/4 of high or very high CV risk patients with mixed dyslipidemia (n = 81) suffer from impaired glucose metabolism (44% had type 2 diabetes, 30% had impaired fasting glucose). Six-months combined therapy reduced LDL-C (by 29%) and TG (by 40%) significantly, but the increase of HDL-C (by 3%) was not significant. There were 47% of males and 57% of females who achieved the target LDL-C levels (<25 or <1.8 mmol/l) and 14% of males and 37% of females who received non-HDL-C <2.6 mmol/l at the end of the study. Also AIP was decreased significantly in majority of the patients (high risk AIP decreased from 87% to 47% of males and from 71% to 25% of females).ConclusionThe combined lipid-modifying therapy led to a significant improvement of the plasma lipid profile, particularly of LDL-C, TG, non-HDL-C and AIP. Atherogenic index of plasma seems to be a very useful marker of CV risk in high and very high CV risk patients with mixed dyslipidemia and glucose abnormalities. More intensive management is needed in those patients.