Alternate Day Statin and Fibrate Given Alone or in Combination for Postprandial Dyslipidemia in Patients with Type 2 Diabetes Mellitus: A Preliminary Report


Introduction: Postprandial lipemia represent an important risk factor for lifetime development of cardiovascular disease in patients with type 2 diabetes mellitus. Daily administration alone or combined statin and fibrate therapy has been shown to be an effective therapeutic approach but brings about serious logistics problem in our local setting. To address this concern, we report this observation where alternate day statin and fibrate treatment given alone or in combination in type 2 diabetes mellitus and similar effectiveness in lowering postprandial dyslipidemia has been obtained.

Methodology: This is a retrospective case study in an endocrine clinic involving 53 patients seen from April 2014 to October 2015. The patients were on statin and fibrate combination (atorvastatin 20-40mg and gemfibrozil 300-600 mg or fenofibrate 145-160mg), statin alone (atorvastatin 20-40mg) and fibrate alone (gemfibrozil 300-600mg/fenofibrate 145-160mg) given on alternate days. Percent reductions of cholesterol, triglycerides, LDL for combined statin and fibrate; cholesterol and LDL  for atorvastatin alone; and triglyceride for fibrate alone were determined.

Results: In this preliminary report, 26 patients have available data. Follow-up period range was 4 to 48 weeks (mean 22.76+ 11.8 weeks).  Alternate statin and fibrate (gemfibrozil) treatment yielded percent reductions from baseline as follows: cholesterol 7%, triglycerides 15%,  and LDL 37% (P values= 0.02, 0.10 and 0.019, respectively). On the other hand, alternate statin and fibrate (fenofibrate) yielded percent reduction from baseline as follows:  cholesterol 41% and LDL 20.4% (P=0.15 and 0.13, respectively). The population is small, the decrease did not yield significant difference from baseline, however there is a tendency for triglyceride to decrease (P=0.09) with the combined statin and fenofibrate. With statin alone the percent reduction from baselinewere as follows: cholesterol 39% and LDL 62% (P= 0.29 and 0.11, respectively). No percent reduction of triglyceride is seen with fibrate given on alternate day with P= 0.19 The monthly cost reduction with combined alternate statin and fibrate treatment is at 34-48% while alternate day administration of the statin reduced cost by 60%.

Conclusion: This study showed lowering of postprandial total cholesterol, triglyceride and LDL with alternate statin and fibrate treatment, and total cholesterol and LDL with alternate day statin. The cost of treatment was also significantly lowered with the alternate regimen. However, a follow through study with adequate sample size is recommended to support these observations.

Keywords: statin, fibrate and postprandial dyslipidemia

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