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Atorvastatin compared with simvastatin in patients with severe LDL hypercholesterolaemia treated by regular LDL
H C Geiss1, K G Parhofer, P Schwandt
1Department of Internal Medicine II, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Insights
Atorvastatin therapy significantly reduced LDL cholesterol in patients with severe hypercholesterolaemia undergoing LDL apheresis, outperforming simvastatin. However, atorvastatin use was linked to a high incidence of subjective side effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Severe hypercholesterolaemia poses risks for coronary heart disease.
- Low-density lipoprotein (LDL) cholesterol reduction is crucial for managing cardiovascular risk.
- Existing therapies like simvastatin and LDL apheresis may not achieve treatment goals in all patients.
Purpose of the Study:
- To evaluate the efficacy of atorvastatin in patients with severe hypercholesterolaemia and coronary heart disease.
- To compare atorvastatin with simvastatin in patients undergoing regular LDL apheresis.
- To assess the benefit of atorvastatin in patients with insufficient LDL cholesterol reduction.
Main Methods:
- A study involving 21 patients with severe hypercholesterolaemia on LDL apheresis and simvastatin.
- Simvastatin was replaced with atorvastatin (40 mg/day), with doses increased to 60 and 80 mg/day if needed.
- Patient response and side effects were monitored over time.
Main Results:
- Atorvastatin achieved significant LDL cholesterol reduction in 95% of patients compared to simvastatin.
- Increased atorvastatin dosage (60 mg/day) provided further LDL reduction in non-responders.
- LDL apheresis treatment time was reduced during atorvastatin therapy.
- Subjective side effects led to discontinuation or dose reduction in a significant proportion of patients.
Conclusions:
- Atorvastatin is more effective than simvastatin in severe hypercholesterolaemia patients undergoing LDL apheresis.
- Despite superior efficacy, atorvastatin is associated with a high rate of subjective side effects.
- Further research may be needed to optimize atorvastatin use and manage side effects.
Objectives:
Atorvastatin is a new potent HMG-CoA reductase inhibitor. We evaluated whether patients with coronary heart disease and severe hypercholesterolaemia showing insufficient LDL (low-density lipoprotein) cholesterol reduction despite combined therapy with simvastatin and regular LDL apheresis will benefit from atorvastatin therapy.
Setting:
Tertiary care centre, university hospital.
Methods:
In 21 patients treated by LDL apheresis, concomitant simvastatin therapy (40 mg day-1) was replaced by atorvastatin (40 mg day-1) and increased to 60 and 80 mg day-1 (each for 3 months) if no side-effects were reported and NCEP treatment goals were not reached.
Results:
In 20 of 21 patients (95%), atorvastatin resulted in significant reduction of LDL cholesterol compared with simvastatin (by 10%, additional 8% and additional 1%, with 40, 60 and 80 mg day-1, respectively). In four patients, NCEP treatment goals were reached (in three by atorvastatin alone, and in one by atorvastatin and apheresis). Patients with little reduction in LDL cholesterol to 40 mg day-1 atorvastatin benefited most by increasing the dose to 60 mg day-1 (additional 13% reduction), whilst those responding to atorvastatin 40 mg day-1 benefited less (additional 1.9% reduction). During atorvastatin therapy, significantly less plasma had to be treated during apheresis resulting in shorter apheresis time. Eight patients (38%) reported side-effects, resulting in discontinuation of atorvastatin in three (14%) and dose reduction in five patients (24%), whilst no elevation of biochemical markers was observed.
Conclusion:
Concomitant atorvastatin therapy is superior to simvastatin therapy in patients with severe hypercholesterolaemia treated with regular LDL apheresis, but is associated with a high rate of subjective side-effects.