OBJECTIVE: The goal of this study was to compare the effectiveness of fish oil, fenofibrate, gemfibrozil, and atorvastatin on reducing triglyceride (TG) levels among a large cohort of HIV-infected patients in clinical care. DESIGN: Retrospective observational cohort study. METHODS: The primary endpoint was absolute change in TG levels measured using the last TG value pretreatment and the first TG value posttreatment. A pre-post quasi-experimental design was used to estimate the change in TG because of initiating fish oil. Linear regression models examined the comparative effectiveness of treatment with fish oil versus gemfibrozil, fenofibrate, or atorvastatin for TG reduction. Models were adjusted for baseline differences in age, sex, race, CD4⁺ cell count, diabetes, body mass index, protease inhibitor use, and time between TG measures. RESULTS: A total of 493 patients (mean age, 46 years; 95% male) were included (46 patients receiving gemfibrozil; 80, fenofibrate; 291, atorvastatin; and 76, fish oil) with a mean baseline TG of 347 mg/dL. New use of fish oil decreased TG [ΔTG, -45 mg/dL; 95% confidence interval (CI): -80 to -11] in the pre-post study. Compared with fish oil (reference), fibrates were more effective (ΔTG, -66; 95% CI: -120 to -12) in reducing TG levels, whereas atorvastatin was not (ΔTG, -39; 95% CI: -86 to 9). CONCLUSIONS: In HIV-infected patients in routine clinical care, fish oil is less effective than fibrates (but not atorvastatin) at lowering TG values. Fish oil may still represent an attractive alternative for patients with moderately elevated TGs, particularly among patients who may not want or tolerate fibrates.
OBJECTIVE: The goal of this study was to compare the effectiveness of fish oil, fenofibrate, gemfibrozil, and atorvastatin on reducing triglyceride (TG) levels among a large cohort of HIV-infectedpatients in clinical care. DESIGN: Retrospective observational cohort study. METHODS: The primary endpoint was absolute change in TG levels measured using the last TG value pretreatment and the first TG value posttreatment. A pre-post quasi-experimental design was used to estimate the change in TG because of initiating fish oil. Linear regression models examined the comparative effectiveness of treatment with fish oil versus gemfibrozil, fenofibrate, or atorvastatin for TG reduction. Models were adjusted for baseline differences in age, sex, race, CD4⁺ cell count, diabetes, body mass index, protease inhibitor use, and time between TG measures. RESULTS: A total of 493 patients (mean age, 46 years; 95% male) were included (46 patients receiving gemfibrozil; 80, fenofibrate; 291, atorvastatin; and 76, fish oil) with a mean baseline TG of 347 mg/dL. New use of fish oil decreased TG [ΔTG, -45 mg/dL; 95% confidence interval (CI): -80 to -11] in the pre-post study. Compared with fish oil (reference), fibrates were more effective (ΔTG, -66; 95% CI: -120 to -12) in reducing TG levels, whereas atorvastatin was not (ΔTG, -39; 95% CI: -86 to 9). CONCLUSIONS: In HIV-infectedpatients in routine clinical care, fish oil is less effective than fibrates (but not atorvastatin) at lowering TG values. Fish oil may still represent an attractive alternative for patients with moderately elevated TGs, particularly among patients who may not want or tolerate fibrates.
Authors: Cynthia A Jackevicius; Jack V Tu; Joseph S Ross; Dennis T Ko; Daniel Carreon; Harlan M Krumholz Journal: JAMA Date: 2011-03-23 Impact factor: 56.272
Authors: Sudershan Singh; James H Willig; Michael J Mugavero; Paul K Crane; Robert D Harrington; Robert H Knopp; Bradley W Kosel; Michael S Saag; Mari M Kitahata; Heidi M Crane Journal: Clin Infect Dis Date: 2010-12-28 Impact factor: 9.079
Authors: J M McKenney; D Swearingen; M Di Spirito; R Doyle; C Pantaleon; D Kling; R A Shalwitz Journal: J Clin Pharmacol Date: 2006-07 Impact factor: 3.126
Authors: Min Jun; Celine Foote; Jicheng Lv; Bruce Neal; Anushka Patel; Stephen J Nicholls; Diederick E Grobbee; Alan Cass; John Chalmers; Vlado Perkovic Journal: Lancet Date: 2010-05-10 Impact factor: 79.321
Authors: A Keech; R J Simes; P Barter; J Best; R Scott; M R Taskinen; P Forder; A Pillai; T Davis; P Glasziou; P Drury; Y A Kesäniemi; D Sullivan; D Hunt; P Colman; M d'Emden; M Whiting; C Ehnholm; M Laakso Journal: Lancet Date: 2005-11-26 Impact factor: 79.321
Authors: Peter H Jones; Michael H Davidson; Evan A Stein; Harold E Bays; James M McKenney; Elinor Miller; Valerie A Cain; James W Blasetto Journal: Am J Cardiol Date: 2003-07-15 Impact factor: 2.778
Authors: Sharon A Riddler; Ellen Smit; Stephen R Cole; Rui Li; Joan S Chmiel; Adrian Dobs; Frank Palella; Barbara Visscher; Rhobert Evans; Lawrence A Kingsley Journal: JAMA Date: 2003-06-11 Impact factor: 56.272