A comparison of pravastatin and gemfibrozil in the treatment of dyslipoproteinemia in patients with non-insulin-dependent diabetes mellitus.

The effects of pravastatin (pravachol) compared with gemfibrozil on cholesterol-rich and trigylceride-rich lipoproteins were evaluated in this multi-centered trial. Following an 8-12 week prerandomization phase, 136 patients with NIDDM and hypercholesterolemia were randomized to receive either pravastatin 40 mg or gemfibrozil 1200 mg daily for 16 weeks. The reduction of total cholesterol (TC), betaquant LDL and LDL cholesterol (LDL-C) was significantly greater in patients treated with pravastatin than with gemfibrozil. However, gemofibrozil treatment resulted in a significantly greater reduction of triglyceride (TG) levels than did treatment with pravastatin. Pravastatin reduced the concentration of apoB (-19.3%, P<0.001) and cholesterol-rich Lp-B (Lp-B+Lp-B; E) particles (-19%, P<0.001) to a significantly greater extent (P<-0.001) than gemfibrozil (-4.1 and -1%, respectively). Both gemfibrozil and pravastatin reduced the concentrations of trigylceride-rich Lp-Bc (-12.2 and -13.3%, respectively) and Lp-A-II;B;C;D;E (-19 and -12.7%, respectively) particles and their characteristic apoC-III constituent (-10.0 and -7.0%, respectively). In contrast, gemfibozil has a greater lowering effect compared with pravastatin on TG levels (-29.6 vs. -6.3%, respectively). Both pravastatin and gemfibrozil significantly increased the levels of apoA-I and, with both drugs, the elevated concentrations of apoA-I were due to significantly increased levels of Lp-A-I;A-II particles. By decreasing both cholesterol-rich Lp-B and triglyceride-rich Lp-Bc particles and increasing HDL-C and Lp-A-I;A-II particles in addition to proven efficacy in decreasing coronary events in NIDDM patients, pravastatin appears to be an appropriate choice for monotherapy in a broad range of diabetic patients with Type IIA and Type IIB hyperlipoproteinemias. These results also showed that direct measurement of lipoprotein family of particles provides important information not only about the composition but also the type and number of apoA- and apoB-containing lipoprotein particles.