Effects of bezafibrate therapy on subfractions of plasma low-density lipoprotein and high-density lipoprotein, and on activities of lecithin: cholesterol acyltransferase and cholesteryl ester transfer protein in patients with hyperlipoproteinemia

We investigated the effects of 12 weeks of bezafibrate treatment on plasma lipoprotein subfraction levels and on activities of LCAT and CETP in 25 patients with hyperlipoproteinemia. Bezafibrate reduced plasma levels of VLDL-TC and VLDL-TG by 69% and 66% ( P < 0.001) and plasma levels of IDL-TC and IDL-TG were decreased by 37% and 31% ( P < 0.01). Bezafibrate had no significant effects on plasma levels of LDL 1(1.019 < d < 1.045)-TC and LDL 1-TG in the study population as a whole but significantly increased the plasma level of LDL 1-TC in the subgroup of 9 patients with type IV hyperlipoproteinemia. Bezafibrate reduced plasma levels of LDL 2 (1.045 < d < 1.063)-TC, LDL 2-TG by 48% and 44% ( P < 0.001) in both type II and type IV hyperlipoproteinemic patients. Gradient polyacrylamide gel electrophoresis revealed a decrease in small LDL particles. Bezafibrate did not affect the plasma level of HDL 2-TC but reduced the HDL 2-TG concentration significantly ( P < 0.001). Bezafibrate increased the plasma level of HDL 3-TC by 37% and reduced the HDL 3-TG level significantly by 20% ( P < 0.001). Gradient polyacrylamide gel electrophoresis revealed an increase in HDL 3a and a decrease in HDL 2a. Bezafibrate suppressed the activities of LCAT and CETP by 21% ( P < 0.001) and 17% ( P < 0.01), respectively. The bezafibrate-induced decrease in plasma levels of small, heavy LDL might be related to its inhibition of LCAT and CETP activities which resulted in suppression of heteroexchange of HDL-EC with triglyceride in large, light LDL. The bezafibrate-induced increase in large HDL 3 (HDL 3a) could not be explained solely by its suppression of LCAT and CETP activities. The decrease of plasma small, heavy LDL as well as TG-rich lipoproteins by bezafibrate seems to be beneficial for prevention of atherosclerotic diseases.