Discussions that mention gemfibrozil

High Cholesterol board

This throws a monkey wrench into my plans to lower both triglycerides and LDL by taking fish oil supplements. It is more important to me to get my LDL down as my triglycerides are barely over the norm.

These patients were on a diet rich in saturated fat. A change in diet to lower saturated fat intake at the same time will effect a decrease in LDL.

Effects of Omega-3 Fatty Acids and Lipoproteins
The addition of omega-3 fatty acids to the diet lowers triglyceride levels, an effect that is pronounced in those with marked hypertriglyceridemia.3 The triglyceride-lowering effect is not seen with plant sources of n-3 PUFA.4 In those patients with type V hyperlipidemia, the use of fish oil supplements is an important therapeutic option.5 Connor6 listed the following putative mechanisms of dietary n-3 PUFA on lipoprotein metabolism in humans: (1) inhibition of VLDL triglyceride synthesis, (2) decreased apoprotein B synthesis, (3) enhancement of VLDL turnover with an increased fractional catabolic rate of VLDL, (4) depression of LDL synthesis, and (5) reduction of postprandial lipemia.

A critical review by Harris2 has clarified the discrepancy among fish oil studies reporting effects on LDL cholesterol (LDL-C). He noted that in the majority of studies reporting reductions in LDL-C levels, the saturated fat intake was lowered when subjects switched from the control diet to the fish oil diet. When fish oil is consumed and saturated fat intake is constant, LDL-C levels either do not change or may increase.

Although fish oil is not recommended in the treatment of hypercholesterolemia, it does have a role in the treatment of lipoprotein disorders characterized by severe hypertriglyceridemia. It can be quite useful in those severely hypertriglyceridemic (triglyceride >1000 mg/dL) patients for whom attempts to correct secondary causes (through diet, exercise, and gemfibrozil) have proved inadequate.7 Although a negative aspect is the concomitant elevation in LDL-C that occurs when fish oils are given to these patients with lower plasma levels of triglyceride, this is usually not a problem for those with severe hypertriglyceridemia, because LDL-C values are usually quite low. It can be a problem for those with more modest elevations of triglycerides in whom the elevation of LDL-C will actually move the patient away from the desired LDL-C goal.