Combined statin and fibrate therapy is often imperative for the
improvement of the serum lipid profile in patients with mixed
hyperlipidemia. However, the potential risk of myopathy has limited the
widespread use of such therapy. Preferably this treatment should involve
low optimally tolerable doses of hypolipidemic drugs. Thus, we undertook
a study to determine the safety and efficacy of combination therapy with
fibrates and small doses of atorvastatin. Twenty-two patients with mixed
hyperlipidemia were started on a fibrate regimen (micronised fenofibrate
200 mg/day or ciprofibrate 100 mg/day). Because after 12 weeks of
therapy the fibrate failed to normalise the serum lipid profile, small
doses of atorvastatin (5 mg/day) were added for a further 12 weeks.
The administration of the fibrates resulted in a significant decrease in
total and LDL-cholesterol levels, as well as in triglycerides, and an
increase in HDL-cholesterol levels. The addition of atorvastatin (5
mg/day) resulted in a further decrease in total and LDL-cholesterol
levels. Consequently, the hypolipidemic therapy target was achieved in
most of the patients. Combination therapy was well tolerated and no
significant increases in serum liver and muscle enzymes were noticed.
We conclude that the careful administration of small doses of
atorvastatin in patients with mixed dyslipidemia receiving fibrates is
associated with a significant amelioration of lipid abnormalities
