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Severe Hypoalphalipoproteinemia Induced by a Combination of Probucol and Clofibrate

  • Jean Davignon
  • A. Christine Nestruck
  • Petar Alaupovic
  • Daniel Bouthillier
Chapter
Part of the Advances in Experimetal Medicine and Biology book series (AEMB, volume 201)

Summary

Observation of a markedly depressed HDL-cholesterol (5 mg/dL) in a patient with familial hypercholesterolemia (FH) receiving probucol (1 g/day) and clofibrate (2 g/day) prompted a review of all cases treated by this combination at our lipid clinic. Hypoalphalipoproteinemia (HDL-C >15 mg/dL) developed in 19 of 28 (70%) hyperlipidemic subjects who received this combination for an average of 1.5 years. This effect was sustained and reversible; it did not occur on either drug alone and was manifested on average 17 weeks after the combination was started. Plasma triglycerides increased significantly in most of those patients susceptible to this reduction in HDL-C. Plasma apolipoprotein A-I was decreased 82%, in proportion to the HDL-C fall, whereas apo A-II was lowered 65%. Since apo C-III concentrations tended to be high, the apo A-I/C-III ratio was markedly depressed. Apo E levels were unchanged and apo B levels reflected the high LDL concentrations of the underlying disease. An intermediate response was observed in subjects whose HDL-C remained well above 15 mg/dL on the combination. No deleterious side-effects could be attributed directly to the administration of the combined drugs in this high-risk group. One patient actually showed complete regression of xanthelasma and extensor tendon xanthomas of the finger on the combination. A parallel is drawn with Fish-Eye disease and the presence of the apolipoprotein A-I Milano variant, where similar HDL-C levels are observed in the absence of an increased atherogenic risk. It is mandatory to monitor plasma HDL-C in hypercholesterolemic patients treated with this combination, otherwise the pronounced HDL-deficiency could go unnoticed.

Key words

High density lipoprotein cholesterol Apolipoprotein A-I Probucol Clofibrate Hyperlipidemia treatment 

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Copyright information

© Springer Science+Business Media New York 1986

Authors and Affiliations

  • Jean Davignon
    • 1
  • A. Christine Nestruck
    • 1
  • Petar Alaupovic
    • 2
  • Daniel Bouthillier
    • 1
  1. 1.Department of Lipid Metabolism and Atherosclerosis ResearchClinical Research Institute of Montreal MontrealCanada
  2. 2.Lipoprotein and Atherosclerosis Research ProgramOklahoma Medical Research FoundationOklahoma CityUSA

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