Effect Of Diet And Clofibrate On Increased Platelet Function In Hyperlipoproteinemia
We have previously reported shortened template bleeding times (BT) in patients with type IIb and IV-hyperlipoproteinemia (HLP) and increased platelet coagulant activity (PF3a) in patients with types IIa, IIb and IV-HLP. We now report on a randomized, double-blind crossover study designed to assess the efficacy of lipid lowering diets appropriate for the respective type of HLP and Clofibrate versus placebo in reversing platelet hypersensitivity. 8 patients with IIa, 9 patients with IIb, and 9 patients with IV-HLP completed the study which included (a) baseline study (regular diet), (b) controlled diet (2 months), (c) controlled diet and Clofibrate (6 months), (d) controlled diet and placebo (6 months) (crossover design). In IIa-HLP patients the mean BT remained significantly shortened throughout all study periods whereas PF3a had reversed to normal at the end of the diet period without significant further changes thereafter. In IIb- and IV-HLP patients both shortened BT and increased PF3a observed at baseline normalized at the end of the diet period with a continuous further decline of PF3a thereafter regardless of Clofibrate or placebo. A small but significant decrease in total and LDL-cholesterol in serum was observed during the diet period in IIa-HLP patients and this decrease was not enhanced by Clofibrate. In IV-HLP patients, serum triglycerides had declined by 50% at the end of the diet period and stabilized at 25% of the initial value at the end of the first 6 month treatment period irrespective of Clofibrate or placebo treatment. No significant changes in triglyceride levels were observed in IIa- or IIb-HLP patients throughout the 14 month observation period. The findings indicate that lipid lowering diets may reverse platelet hypersensitivity in HLP patients and that Clofibrate has no effect on platelet function in HLP patients on a controlled lipid lowering diet.