Biliary lipid composition during treatment with different hypolipidaemic drugs

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Abstract
In an attempt to clarify the possible lithogenic effects of commonly used hypolipidemic drugs [used to prevent atherosclerosis], gall-bladder bile was obtained from patients with primary hyperlipoproteinemia before and during treatment with nicotinic acid (n = 13), cholestyramine (n = 19), clofibrate (n = 11) and a combination of cholestyramine and clofibrate (n = 11). Each treatment period lasted a minimum of 6 wk and standardized dietary conditions were observed. Nicotinic acid and clofibrate treatment caused an increase in biliary cholesterol concentration relative to biliary total lipids (bile acids, phospholipids and cholesterol). During cholestyramine medication the relative cholesterol concentration fell. A combination of cholestyramine with clofibrate medication led to a decrease of bile saturation to pretreatment levels in 9 of the 11 subjects. In the other 2, a further increase in the cholesterol saturation of the bile occurred. Treatment with nicotinic acid and clofibrate but not with cholestyramine is probably associated with an increased risk for development of cholesterol gallstones. Addition of cholestyramine may be a possible way to prevent the lithogenic effect of clofibrate in patients with hyperlipoproteinemia when not only hypocholesterolemic but also hypotriglyceridemic effects are desired.