Combined therapy of mixed dyslipidemia in patients with high cardiovascular risk and changes in the lipid target values and atherogenic index of plasma

Abstract Purpose To 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. Method A 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 1.7 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 0.21 (high risk). Results About 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 ( Conclusion The 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.