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Lovastatin versus bezafibrate for hyperlipemia treatment after heart transplantation
L Hidalgo1, J L Zambrana, A Blanco-Molina
1Lipid Unit, University Reina Sofia Hospital, Unviersity of Cordoba, Spain.
Insights
This study found that both lovastatin and bezafibrate effectively lowered cholesterol in heart transplant patients. Bezafibrate showed a greater benefit in improving lipid ratios and increasing high-density lipoprotein cholesterol.
Area of Science:
- Cardiology
- Pharmacology
- Transplantation Medicine
Background:
- Heart transplant recipients frequently experience dyslipidemia, including elevated total and LDL cholesterol and reduced HDL cholesterol.
- The complexity of hyperlipidemia post-transplant and adverse interactions of standard lipid-lowering drugs with immunosuppressants pose treatment challenges.
Purpose of the Study:
- To evaluate the safety and efficacy of lovastatin and bezafibrate in managing hyperlipidemia in heart transplant patients.
Main Methods:
- A crossover study involving 18 heart transplant recipients with hyperlipidemia.
- Patients received 8 weeks of lovastatin (10 mg/day) followed by 8 weeks of bezafibrate (400 mg/day), or vice versa, separated by an 8-week washout period, after an initial 3-month dietary intervention.
Main Results:
- Both lovastatin and bezafibrate reduced total cholesterol, LDL cholesterol, and apoprotein B.
- Bezafibrate uniquely increased HDL cholesterol and demonstrated greater improvements in total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios.
- Both agents were well-tolerated, with stable liver enzymes, creatine kinase, and renal function.
Conclusions:
- Lovastatin and bezafibrate are safe and effective options for treating hyperlipidemia in heart transplant recipients.
- Bezafibrate offers additional benefits in improving HDL cholesterol and lipid ratios compared to lovastatin in this patient population.
Background:
Elevation in total and low-density lipoprotein cholesterol levels and a decrease in high-density lipoprotein cholesterol plasma concentrations are common in heart transplant recipients. The pathogenesis of this hyperlipemia after heart transplantation is complex. Currently available antilipemic agents are difficult to use because their adverse effects are potentiated by immunosuppressor treatment. The present investigation was carried out to test the safety and efficacy of lovastatin and bezafibrate in 18 patients with hyperlipemia after heart transplantation.
Methods:
In this crossover study, after 3 months of dietary recommendations, the subjects were randomly assigned to an 8-week period of lovastatin treatment (10 mg/day) followed by an additional 8-week period of treatment with bezafibrate (400 mg/day) or vice versa. The two treatments were separated by an 8-week washout period.
Results:
Both drugs reduced total and low-density lipoprotein cholesterol and apoprotein B concentrations. High-density lipoprotein cholesterol was only increased with bezafibrate. The total cholesterol/high-density lipoprotein cholesterol and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios were decreased under both treatments, but these changes were greater with bezafibrate. Apo AI levels increased with lovastatin. Bezafibrate produced a rise in high-density lipoprotein cholesterol and reduced total and very low-density lipoprotein triglycerides and very low-density lipoprotein cholesterol. Both drugs decreased intermediate density lipoprotein cholesterol and triglyceride levels, but the effect of bezafibrate on intermediate-density lipoprotein triglycerides was significantly greater. The two drugs were well tolerated and liver enzymes, creatine kinase, and renal function remained stable.