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Effect of simvastatin treatment on the dyslipoproteinemia in CAPD patients
E Matthys1, M Schurgers, G Lamberigts
1Department of Internal Medicine, A.Z. St-Jan, Bruges, Belgium.
Insights
Simvastatin effectively lowers cholesterol in patients on continuous ambulatory peritoneal dialysis (CAPD) without adverse effects. This HMG-CoA reductase inhibitor also reduced apo E levels, suggesting a potential mechanism for treating hypercholesterolemia in end-stage renal disease.
Area of Science:
- Cardiology
- Nephrology
- Biochemistry
Background:
- HMG-CoA reductase inhibitors are effective for hypercholesterolemia.
- Patients with end-stage renal disease often have severe hypercholesterolemia.
- Continuous ambulatory peritoneal dialysis (CAPD) patients require safe and effective lipid-lowering therapies.
Purpose of the Study:
- To evaluate the efficacy and safety of simvastatin in CAPD patients with severe hypercholesterolemia.
- To monitor changes in plasma lipids and apolipoproteins during simvastatin treatment.
- To compare simvastatin's effects with lovastatin in primary hyperlipidemic patients.
Main Methods:
- Simvastatin therapy administered for 24 weeks.
- Plasma lipids and apolipoproteins (A-I, A-II, B, C-II, A-IV, Lp(a)) measured.
- Lipoprotein separation using Superose 6HR gel filtration.
Main Results:
- Simvastatin was well-tolerated with no observed adverse reactions in CAPD patients.
- Significant reduction in total and LDL cholesterol observed.
- A decrease in apo E concentration was noted in both CAPD and hyperlipidemic patients, particularly in the HDLE fraction.
Conclusions:
- Simvastatin is a safe and effective treatment for severe hypercholesterolemia in CAPD patients.
- The observed decrease in apo E may involve upregulation of the apo B-E/apo E receptor.
- Findings offer insights into simvastatin's mechanism in end-stage renal disease.
Abstract:
HMG-CoA reductase inhibitors have been proven effective in decreasing the plasma cholesterol levels in patients affected with various forms of hypercholesterolemia, familial dysbetalipoproteinemia, familial combined hyperlipidemia and in nephrotic and diabetic dyslipidemia. The purpose of this study was to monitor and evaluate the efficiency and safety of the therapy with simvastatin, an HMG-CoA reductase inhibitor, in a group of patients treated by continuous ambulatory peritoneal dialysis (CAPD) with severe hypercholesterolemia. Monitoring of the changes occurring in the various lipids and apolipoproteins in these patients included the measurements of the plasma lipids and apolipoproteins A-I, A-II, B, C-II, A-IV and Lp(a). Lipoproteins were separated by gel filtration, on a Superose 6HR column, before and after 24 weeks of treatment. The patterns were compared to those observed in a group of primary hyperlipidemic patients treated with Lovastatin, a compound of the same class. The drug was well tolerated by the CAPD patients and no adverse reaction was observed. In addition to the decrease of the total and LDL cholesterol, similar to that reported in other groups of patients, we further observed a decrease of the apo E concentration in both the CAPD and the hyperlipidemic patients. This decrease was especially pronounced in the HDLE fraction and could involve an upregulation of the apo B-E and/or apo E receptor. These results should provide information about the mechanism of action of this drug in patients with end-stage renal disease.