Effects of low doses of simvastatin and atorvastatin on high-density lipoprotein cholesterol levels in patients with hypercholesterolemia

• Published in: Clinical therapeutics Vol. 23; no. 6; pp. 851 - 857
• Main Authors: Branchi, Adriana, Fiorenza, Anna M., Torri, Adriana, Muzio, Fulvio, Berra, Cristina, Colombo, Emanuela, Valle, Elena Dalla, Rovellini, Angelo, Sommariva, Domenico
• Format: Journal Article
• Language: English
• Published: Belle Mead, NJ EM Inc USA 01.06.2001; Excerpta Medica
• Subjects: Adult; Aged; Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - adverse effects; Anticholesteremic Agents - therapeutic use; atorvastatin; Atorvastatin Calcium; Biological and medical sciences; Cholesterol, HDL - blood; Female; General and cellular metabolism. Vitamins; Heptanoic Acids - administration & dosage; Heptanoic Acids - adverse effects; Heptanoic Acids - therapeutic use; high-density lipoprotein cholesterol; Humans; Hypercholesterolemia - blood; Hypercholesterolemia - drug therapy; Lipids - blood; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pyrroles - administration & dosage; Pyrroles - adverse effects; Pyrroles - therapeutic use; serum lipids; simvastatin; Simvastatin - administration & dosage; Simvastatin - adverse effects; Simvastatin - therapeutic use; simvastatin; serum lipids; atorvastatin; high-density lipoprotein cholesterol; Human; Enzyme; Cholesterolemia; Low dose; Simvastatin; Enzyme inhibitor; Metabolic diseases; Lipids; Hyperlipoproteinemia; Statin derivative; Chemotherapy; Hypercholesterolemia; Treatment; Cholesterol HDL; Atorvastatin; Hydroxymethylglutaryl-CoA reductase; Oxidoreductases; Dyslipemia; Comparative study; Antilipemic agent
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/S0149-2918(01)80073-4

Background: Simvastatin 40 to 80 mg/d has been found to increase high-density lipoprotein cholesterol (HDL-C) levels significantly more than atorvastatin at equipotent doses (ie, 20–80 mg/d). Data on the effects of lower doses of the 2 drugs on HDL-C levels are conflicting. Objective: The purpose of this study was to investigate the effects of simvastatin 20 mg/d and atorvastatin 10 mg/d on HDL-C levels in patients with hypercholesterolemia. Methods: Patients with primary hypercholesterolemia (total cholesterol [TC] >250 mg/dL) who were not taking any lipid-lowering agents and who were following a low-fat diet were randomized to receive 1 of 2 treatments: simvastatin 20 mg/d or atorvastatin 10 mg/d. Serum TC, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and HDL-C levels were measured using standard methods after 2 months of therapy. In a secondary analysis, lipids and lipoprotein cholesterol were measured after 1 year in patients who continued treatment. Results: Of the 240 patients enrolled (108 men and 132 women; age range, 23–77 years, mean [SEM] 56.7 [0.69]), 235 completed the study. After 2 months of therapy, TC, LDL-C, and serum TG levels decreased significantly versus baseline in both groups ( P < 0.001), with no significant differences between treatment groups. HDL-C levels increased by 9.0% ( P < 0.001 vs baseline) in the simvastatin group and by 4.3% ( P < 0.02) in the atorvastatin group. The difference between the 2 groups in the percentage increase in HDL-C was statistically significant ( P < 0.05). In 113 patients who continued treatment, HDL-C levels at 1 year were still significantly higher than baseline levels in the simvastatin group (6.3%, P = 0.034), but not in the atorvastatin group (2.8%, P = 0.587). Conclusions: The findings from this study suggest that the HDL-C—increasing effect of simvastatin 20 mg is significantly greater than that of atorvastatin 10 mg. Since increasing HDL-C levels is thought to lower the risk for atherosclerosis and coronary heart disease, these results warrant further investigation.