Biliary lipids in familial combined hyperlipidaemia: effects of acipimox therapy

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Abstract
Biliary lipid composition and plasma lipoprotein levels were determined in nine gallstone-free male patients with familial combined hyperlipidaemia (FCHL). In the basal situation, stimulated fasting duodenal bile from the patients contained a higher relative concentration of cholesterol than bile obtained from age- and sex-matched normal controls (n = 22), 6.5 .+-. 0.3 (SEM) vs. 4.7 .+-. 0.2 mol % (P < 0.01). This resulted in a higher cholesterol saturation of bile from FCHL patients, 85 .+-. 6 vs. 70 .+-. 2% (P < 0.05). After 6 weeks of treatment with acipimox, 750 mg day-1, total plasma triglycerides were lowered from 7.5 .+-. 1.5 to 4.6 .+-. 0.7 mmol l-1 (P < 0.05) and plasma cholesterol decreased from 8.0 .+-. 0.1 to 7.1 .+-. 0.3 mmol l-1 (P < 0.05) in the FCHL patients. These changes were mainly due to a decrease in very low density lipoprotein concentration while low density lipoprotein levels remained unaltered. The relative proportion of cholesterol in stimulated fasting duodenal bile was reduced from 6.5 .+-. 0.3 to 4.3 .+-. 0.5 mol % (P < 0.01), resulting in ''normalization'' of biliary cholesterol saturation, from 85 .+-. 6 to 58 .+-. 6% (P < 0.005). No correlations between the changes in biliary lipid composition and those in plasma lipoprotein levels were observed. The results indicate that treatment with acipimox in patients with FCHL, a disorder commonly associated with supersaturated bile, does not increase biliary cholesterol, and presumably not the risk for gallstone formation.