Effect of ciprofibrate treatment on biliary lipids in patients with hyperlipoproteinaemia

Abstract

Treatment with hypolipidemic drugs such as clofibrate secretion of biliary cholesterol and induces supersaturation of bile, leading to an increased risk of gallstone formation, Ciprofibrate is a phenoxyisobutyrate derivative with lipid-lowering effects in hyperlipoproteinemia. Serum lipid levels and biliary lipid composition and cholesterol saturation of gallbladder bile were analyzed in 19 hyperlipoproteinemic patients before and after 6 wk treatment with ciprofibrate, 100 mg/day. Hepatic secretion rates of biliary lipids were determined in 8 of the patients. Ten of the patients were also studied after 1 yr of treatment. Short-term treatment reduced the serum cholesterol levels by about 20% (P < 0.001) and the serum triglycerides by about 40% (P < 0.001). The relative cholesterol concentration and cholesterol saturation of bile were not significantly increased for the group as a whole, nor in patients with familial hypercholesterolemia (n = 9), or with other types of hyperlipidemia (n = 10). During treatment, 14 patients had saturated bile compared with 9 before treatment. An increase in cholesterol saturation was the consequence of an increased hepatic secretion of cholesterol whereas the secretion rates of bile acids and phospholipids were unaffected. After 1 yr of treatment the serum lipid concentrations were reduced to about the same level as after 6 wk, whereas biliary lipid composition and cholesterol saturation had retured to pre-treatment values. In contrast to clofibrate, ciprofibrate exerts hypolipidemic effects without consistently increasing the relative cholesterol concentration in bile. In some patients it leads to a transient rise in cholesterol saturation of gallbladder bile. This effect is due to an enhanced secretion of cholesterol probably because of a mobilization of tissue cholesterol.