Comparison of Effects of Atorvastatin and Fenofibrate on Plasma Homocysteine, Folic Acid and Vitamin B12 Levels in Patients With Mixed Hyperlipidemia

Öz

Objectives: Hyperhomocysteinemia is an independent cardiovascular risk factor. Lipid lowering agents such as fenofibrate have been reported to elevate plasma homocysteine levels. Atorvastatin is another kind of lipid lowering agent and there is not enough study investigating its effects on plasma homocysteine. In the present study we aimed to compare the effects of atorvastatin and fenofibrate on plasma homocysteine, folic acid and vitamin B12 levels. Materials and Methods: Total of 43 patients were randomized into one of 2 groups: One of them (n=20) treated with atorvastatin, other (n=23) with fenofibrate for 3 months. After 1 and 3 months of treatment with these drugs, blood samples were collected and plasma lipids, folic acid, vitamin B12 and homocysteine levels were determined. Results: Both of the lipid lowering agents significantly decreased plasma lipid levels. Atorvastatin group showed a significant reduction in total cholesterol and LDL-C than those in fenofibrate group. On the other hand, fenofibrate caused a greater reduction in triglyceride levels compared to the atorvastatin. There was no change in plasma folic acid and vitamin B12 levels after treatment with both of these hypolipidemic drugs. There was a significant increase in homocysteine levels after treatment with fenofibrate and atorvastatin, although fenofibrate was more effective than atorvastatin (36 and 15% respectively). Conclusions: We conclude that increases in plasma homocysteine levels are a result of the known impairment of renal function caused by fenofibrate and a result of impairment of liver function caused by atorvastatin.©2006, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

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Hiperlipidemik hastalarda atorvastatin ve fenofibratın plazma homosistein, folik asit ve B12 vitamin düzeylerine etkilerinin karşılaştırılması

Öz

Amaç: Hiperhomosisteinemi bağımsız bir kardiyovasküler risk faktörüdür. Fenofibrat gibi lipit düşürücü ilaçların plazma homosistein miktarını arttırdığı bildirilmiştir. Atorvastatin diğer bir tip lipit düşürücü olup plazma homosistein üzerindeki etkileri yeterince çalışılmamıştır. Bu çalışmada atorvastatin ve fenofibratın plazma homosistein, folik asit ve B12 vitamin değerlerine olan etkilerini karşılaştırmayı amaçladık. Gereç ve yöntem: Toplam 43 hiperlipidemik hasta iki gruba ayrıldı. Bir grup (n=20) atorvastatin ile, diğeri (n=23) fenofibrat ile 3 ay tedavi edildi. Tedavinin 1. ve 3. aylarında kan örnekleri alındı ve plazma lipitleri, folik asit, B12 vitamini ve homosistein düzeyleri ölçüldü. Bulgular: Her iki lipid düşürücü ilaç plazma lipit düzeylerini önemli oranda düşürdü. Atorvastatin grubunda total kolesterol ve LDL-C miktarları fenofibrat grubundan daha fazla düşüş gösterdi. Diğer taraftan fenofibrat atorvastatinle karşılaştırıldığında trigliserid düzeyinde daha belirgin düşüşe neden oldu. Her iki lipit düşürücü ilaç tedavisinden sonra folik asit ve B12 vitamin miktarlarında herhangi bir değişiklik gözlenmedi. Homosistein düzeyleri hem fenofibrat hem de atorvastatin tedavisinden sonra artış göstermekle beraber fenofibrat atorvastatinden daha etkili bulundu (sırasıyla, %36 ve %15). Sonuç: Sonuç olarak plazma homosistein miktarındaki artışın fenofibratın neden olduğu renal fonksiyon bozukluğundan ve atorvastatinin neden olduğu muhtemel karaciğer fonksiyon bozukluğundan ileri geldiğini düşünmekteyiz. ©2006, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Atorvastatin, fenofibrat, homosistein, folik asit, B12 vitamini

Kaynakça

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27. Kabul Tarihi: 25.12.2005