Effect of Fibrate on Lipoprotein(a) Level in Hypertriglyceridemic Patients

Background and Objectives：The responses of lipoprotein (a) [Lp(a)] to lipid-lowering drugs are different from those of other lipids and lipoproteins.Most reports on the effect of fibrate on the Lp (a) level have only a few cases, with inconsistent results.This study was designed to evaluate the effect of fibrate on the Lp (a) level in hypertriglyceridemic patients.Subjects and Methods：Patients with either a triglyceride (TG) level over 300 mg/dL or TG level over 200 mg/dL and a high density lipoprotein cholesterol level below 40 mg/dL, were enrolled.They were treated with either fibrate (Fibrate group, n=29) or general measures (Control group, n=29).Gender and age matched patients with hypercholeste-rolemia were adopted and treated with statin (Statin group, n=29).The lipid and lipoprotein levels were measured before and after the medication for 2 months.Results：The baseline Lp (a) levels were similar between the Fibrate and Control groups (p=0.19).Fibrate therapy increased the Lp (a) level from 10.3±16.4 to 15.1±15.2mg/dL (p=0.003),but there were no changes in the Lp (a) levels in the Statin and Control groups.Before the treatment, the Lp (a) levels were negatively associated with the TG levels (r=-0.36,p=0.001).The relationship became weaker and insignificant after the medication.The more the TG level was decreased, the more the Lp (a) level was increased in all of the cases (r=-0.35,p=0.001) as well as in the Fibrate group (r=-0.46,p=0.013).Conclusion：Fibrate increased the Lp (a) level, and this elevation was associated with the reduction in the TG level.This finding might be related with a lesser cardioprotective effect of fibrate than that of statin in addition to the effect on the cholesterol level.(Korean Circulation J 2005; 35:30-36) KEY WORDS：Fenofibric acid；Gemfibrozil；lipoprotein(a)；Lipids；Lipoproteins.서 론 Lipoprotein(a)[Lp(a)]는 저밀도지단백(LDL)에 아포지 단백(a)가 disulfide 결합에 연결되어 있는 지단백이다.하지 만 다른 지단백과는 전혀 다른 대사 과정을 가지고 있어, 혈 중 농도가 주로 유전적 다형성에 의해 결정되고, 나이, 성별, 식이 및 비만도 등과 같이 일반적으로 지질 농도에 관여하 는 인자들과의 관계는 미미하다.1)2) Lp(a) 농도는 비록 매 우 약하지만 중성지방과 역상관관계가 있으며, 총콜레스테 롤 및 그 분획들과도 양의 상관관계가 있다. 3) Lp(a)는 급성 반응물질(acute phase reactant)로써 급성심근경색이나 수 술