No abstract available.
Gemfibrozil* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory*

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 300mg/dL or TG level over 200mg/dL and a high density lipoprotein cholesterol level below 40mg/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+/-15.2 mg/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.
Cholesterol ; Cholesterol, HDL ; Gemfibrozil ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoprotein(a)* ; Lipoproteins ; Triglycerides

A 64-year-old woman with ischemic heart disease was admitted to our hospital because of both leg pain and difficulty to walk for 5 days. She had taken cerivastatin and gemfibrozil for atherosclerosis and ischemic heart disease. One year ago, she had been admitted to our hospital because of acute renal failure due to rhabdomyolysis of unknown origin and was improved after conservative therapy. Laboratory studies revealed serum creatinine 1.2 mg/dL, creatine kinase 23,700 IU/L, serum myoglobin >500 ng/mL, urine myoglobin >3,000 ng/mL. (99m)Tc-HDP whole body Bone scan showed multiple increased uptakes of the soft tissue, especially both calf. With supportive care, she was recovered and discharged with normal creatinine(0.8 mg/dL) and creatine kinase(260 IU/L).
Acute Kidney Injury ; Atherosclerosis ; Creatine ; Creatine Kinase ; Creatinine ; Female ; Gemfibrozil ; Humans ; Leg ; Middle Aged ; Myocardial Ischemia ; Myoglobin ; Rhabdomyolysis*

We report a case of type IV hyperlipoproteinemia associated with xanthoma tuberosum and xanthoma eruptivum, which improved by treatment with gernfibrozil and procetofene. A 46-year-old male patient visited our clinic for evaluation of multiple orange-yellow colored nodules on the elbows and multiple papules on the knees, buttocks and back. Laboratory examination showed an abnormal elevation of serun cholesterol and triglyceride. Lipoprotein electrophoresis showed an increase of pre-b band and plasma standing test showed turbid plasma. Analysis of lipoprotein revealed increase of VLDL level in his plasma. The biopsy specimens from the nodule on the elbow and the papule on the back revealed characteristic findings of xanthoma. We diagnosed the patient as type IV hyperlipoproteinemia. After 5 months of treatment with diet restriction, gemfibrozil, and procetofene, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesions of the both back and buttock showed marked improvement and the skin lesions on the elbows and knee were much improved.
Biopsy ; Buttocks ; Cholesterol ; Diet ; Elbow ; Electrophoresis ; Fenofibrate ; Gemfibrozil ; Humans ; Hyperlipoproteinemia Type IV* ; Knee ; Lipoproteins ; Male ; Middle Aged ; Plasma ; Skin ; Triglycerides ; Xanthomatosis*

We report a case of type V hyperlipoproteinemia with xanthoma eruptivum associated with diabetes mellitus. An 18-year-old female patient presented with multiple, erythematous papules on the trunk, buttocks, and both extremities and multiple orange-yellow colored, conglomerated nodules on the elbows and knees. Laboratory examination showed increased serum blood glucose, cholesterol and triglyceride. Lipoprotein electrophoresis showed increased pre-beta and chylomicron bands. Analysis of lipoprotein revealed increase of very low density lipoprotein (VLDL) and triglyceride levels in the plasma. A skin biopsy from the papule on the trunk revealed a xanthoma. We diagnosed the patient as type V hyperlipoproteinemia. After 10 months of treatment with insulin and gemfibrozil, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesions showed marked improvement without scar.
Adolescent ; Biopsy ; Blood Glucose ; Buttocks ; Cholesterol ; Cicatrix ; Diabetes Mellitus ; Elbow ; Electrophoresis ; Extremities ; Female ; Gemfibrozil ; Humans ; Hyperlipoproteinemia Type V* ; Insulin ; Knee ; Lipoproteins ; Plasma ; Skin ; Triglycerides ; Xanthomatosis*

We report a case of type III hyperlipoproteinemia associated with xanthoma eruptivum. Xanthoma tuberosum, and xanthoma striatum palmare whose clinical symptoms have been improved by the treatment of gemfibrozil. A 31-year-old male patient visited our clinic for evaluation of multiple yellowish nodules on the elbows, multiple yellowish plaques on the buttocks and linear yellowish plaques along with the palmar creases on both palms. The blood chemistry showed an elevation of cholesterol and triglyceride. Lipoprotein electrophoresis showed broad betazone and plasma standing test showed turbid plasma. Lipoprotein ultracentrifugation showed that the ratio of VLDL cholesterol and plasma triglyceride was 0.38. According to the above findings, we diagnosed this patient as type III hyperlipoproteinemia. After 4 months of treatment with diet and gemfibrozil, the serum level of cholesterol and triglyceride were reduced to normal range. The skin lesions of both palms showed marked improvement but the skin lesions on elbows and buttocks were not much improved.
Adult ; Buttocks ; Chemistry ; Cholesterol ; Cholesterol, VLDL ; Diet ; Elbow ; Electrophoresis ; Gemfibrozil ; Humans ; Hyperlipoproteinemia Type III* ; Lipoproteins ; Male ; Plasma ; Reference Values ; Skin ; Triglycerides ; Ultracentrifugation ; Xanthomatosis*

Most currently available statins are associated with an increase with risk of myositis, including rhabdomyolysis. Myopathy is believed to be caused by interference in the cytochrome P450 3A4 enzyme system, which results in a marked increase in reductase activity. Cerivastatin, a new synthetic HMG-CoA reductase inhibitor, is a safe, well-tolerated effective drug for the treatment of patients with dyslipidemia. The drug is metabolized by the cytochrome P450 3A4 and cytochrome P450 2C8 hepatic isoenzymes. Because of this dual metabolic pathway, it has been suggested that cerivastatin is less subject to drug-todrug interactions. We describe a 60-year-old woman with rhabdomyolysis and localized myositis, after she had taken cerivastatin(lipobay, 0.3 mg/day) and gemfibrozil(lopid, 500 mg/day) for 1month.
Cytochrome P-450 Enzyme System ; Dyslipidemias ; Female ; Gemfibrozil ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Isoenzymes ; Metabolic Networks and Pathways ; Middle Aged ; Muscular Diseases ; Myositis ; Oxidoreductases ; Rhabdomyolysis*

OBJECTIVE: To determine the histopathological effect of statins, fibrates and its combination in rat nerves
METHODOLOGY: This is a pilot experimental study. Four male albino rats were used in this study. Each rat was given therapeutic doses of simvastatin alone, gemfibrozil alone, gemfibrozil and simvastatin combination and placebo. On day 21, the sciatic nerve was harvested for histopathologic examination
RESULTS: Although not marked, the combination of simvastatin and gemfibrozil produced more axonal degeneration than did simvastatin alone or gemfibrozil alone. Axonal degeneration was documented on teased nerve fibers and epon cross sections
CONCLUSION: The use of lipid lowering agents may induce peripheral neuropathy Recommendation: This pilot study serves as rationale to proceed with an experiment not only to document neuropathy but also correlate the possible association of the pathomechanism of myotoxicity and neurotoxicity of lipid lowering agents.

Animal ; Rats ; Simvastatin ; Gemfibrozil ; Hydroxymethylglutaryl-coa Reductase Inhibitors ; Fibric Acids ; Hypolipidemic Agents ; Sciatic Nerve ; Peripheral Nervous System Diseases ; Epon ; Epoxy Resins ; Nerve Fibers

Fenofibrate is one of PPAR-alpha (peroxisome proliferator activated receptor alpha) agonists. Fenofibrate decreases effectively triglyceride and increases high density lipoprotein cholesterol level through the effect on lipoprotein lipase, hepatic production and degradation of lipoproteins. Fenofibrate was recommended as the drug for hypertriglyceridemia treatment in European guideline released in 2011. But American heart association guideline in 2013 did not recommend non-statin therapy including fibrate for the prevention of atherosclerotic cardiovascular disease. But fenofibrate is still considered as the important drug for the management of atherogenic dyslipidemia especially in patients with metabolic syndrome and diabetes to reduce the residual risk after statin therapy from the evidence of many studies. Fibrates including bezafibrate, gemfibrozil, and fenofibrate increased serum creatinine level in several studies. But the mechanism of change in renal function is not clear till now. And the reversibility of renal function with drug discontinuation is dependent on the kinds of fibrate. Fenofibrate increased serum creatinine level, decreased albuminuria and renal function was reversible with the drug discontinuation in large clinical trials. In these days renal function change with fenofibrate therapy in Korean patients with hypertriglyceridemia was investigated. Fenofibrate treatment for 2 months increased serum creatinine level significantly and old age was associated with the change of renal function in multivariate analysis. Short-term therapy significantly increased serum creatinine level even within normal range, and this change may be important in some groups especially old age.
Albuminuria ; American Heart Association ; Bezafibrate ; Cardiovascular Diseases ; Cholesterol, HDL ; Creatinine ; Dyslipidemias ; Fenofibrate* ; Fibric Acids ; Gemfibrozil ; Glomerular Filtration Rate ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertriglyceridemia ; Lipoprotein Lipase ; Lipoproteins ; Multivariate Analysis ; Reference Values ; Triglycerides

PURPOSE: To determine the relationship of illnesses and medical drug consumption with the occurrence of traffic accidents among truck and bus drivers. METHODS: This is a cross-sectional study on truck and bus drivers in Tehran, Iran. The criteria for participating in this study were: married males over 30 years old, driving license in grade one, five years of job experience, mental health and non-addiction license. The criterion for not participating in this study was the lack of cooperation in responding to the questions. Six months was spent to collect the latest five years data of driving accidents from 2011 to 2016. A total of 323 truck and bus drivers in Tehran city and the suburbs, Iran were chosen. Among them, 112 were responsible for accidents (accident group) while 211 were not responsible for any accidents or involved in an accident in the last five years (non-accident group). A specially designed questionnaire was used to investigate the demographic information, medical drug consumption, medical backgrounds and history of accidents. RESULTS: The results revealed that compared with healthy subjects, the occurrence of accidents among people with diabetes (OR = 2.3, p = 0.001) and vision weakness (OR = 1.7, p = 0.020) was significantly higher, while that among people with cardiac (OR = 0.5, p = 0.002) and hypertension (OR = 0.9, p = 0.048) problems was remarkably lower. Moreover, consumption of Gemfibrozil (OR = 1.8, p = 0.010) and Glibenclamide (OR = 2.2, p = 0.002) drugs resulted in significantly higher incidence of accidents than those without. CONCLUSION Frequencies of illnesses like cardiovascular and hypertension were not higher in accident drivers than in non-accident drivers; but diabetes, vision weakness and consumption of Gemfibrozil and Glibenclamide lead to more traffic accidents.
Accidents, Traffic ; statistics & numerical data ; Adult ; Automobile Driving ; statistics & numerical data ; Cross-Sectional Studies ; Diabetes Mellitus ; epidemiology ; Drug Utilization ; statistics & numerical data ; Gemfibrozil ; administration & dosage ; Glyburide ; administration & dosage ; Humans ; Hypolipidemic Agents ; administration & dosage ; Incidence ; Iran ; epidemiology ; Male ; Middle Aged ; Surveys and Questionnaires ; Vision Disorders ; epidemiology