Marked removal of bezafibrate-induced high-density lipoprotein-cholesterol by low-density lipoprotein apheresis.

Background: A case of marked reduction of the bezafibrate-induced increase of high-density lipoprotein (HDL)-cholesterol by low-density lipoprotein apheresis (LDL-apheresis) has not been previously reported. Methods: A 68-year-old Japanese man with arteriosclerosis obliterans (ASO), diabetes mellitus, and hyperlipidemia underwent LDL-apheresis, followed by the concomitant bezafibrate administration. Plasma lipids of pre- and post-LDL-apheresis were measured and apolipoprotein E (apoE) localization of the pre- and post-LDL-apheresis was detected by agarose gel electrophoresis. Results: Plasma concentrations of the total cholesterol, LDL-cholesterol, triglyceride, and HDL-cholesterol of pre-LDL-apheresis were 4.78±0.36, 2.74±0.24, 2.44±0.52, and 0.92±0.10 mmol/l, respectively; those of the post-LDL-apheresis were 1.94±0.31, 0.72±0.13, 0.81±0.38, and 0.86±0.11 mmol/l, respectively. LDL-apheresis reduced HDL-cholesterol by 6.4% (p=0.346). During the bezafibrate administration, plasma concentrations of the above of pre-LDL-apheresis were 5.24±0.34, 3.28±0.22, 1.26±0.25, and 1.39±0.21 mmol/l, respectively; those of the post-LDL-apheresis were 2.25±0.44, 0.80±0.12, 0.58±0.19, and 1.18±0.16 mmol/l, respectively. LDL-apheresis reduced HDL-cholesterol by 15.2% (p<0.01). Plasma apolipoprotein E detected between the preβ- and α-mobility was markedly lower after the LDL-apheresis in the agarose gel electrophoresis. Conclusions: The removal of the bezafibrate induced an increase of the HDL-cholesterol by LDL-apheresis.