Gemfibrozil is sometimes used with a statin to lower excessive triglyceride and VLDL levels.

• A. Found to increase overall mortality, so rarely used
• B. Sometimes used in conjunction with a statin to lower excessive triglyceride and VLDL levels
• C. Avoid with anticoagulants as they compete for binding sites
• D. Raises HDL levels only

Answer: (B)

Gemfibrozil is a fibrate that activates PPAR-alpha, increasing lipoprotein lipase activity and reducing hepatic production of VLDL, which lowers triglycerides and VLDL (with a modest rise in HDL). Because of this lipid-lowering effect, it can be used with a statin in some cases to tackle very high triglycerides and VLDL, though this combination requires caution due to a higher risk of myopathy and rhabdomyolysis from increased statin exposure. The other statements don’t fit: it doesn’t universally increase mortality, it’s not primarily avoided because of anticoagulant binding competition, and it doesn’t raise HDL levels alone to the exclusion of lowering triglycerides.