[Comparison of 2 cholesterol synthesis inhibitors (simvastatin and pravastatin)]

Inhibitors of cholesterol synthesis (HMG-CoA reductase) are the most effective cholesterol-lowering drugs. Comparison of several studies in the literature suggests that simvastatin is approximately twice as effective as pravastatin on a milligram basis. These results are confirmed by the present study, which compares treatment with simvastatin (10 mg/d) with pravastatin (20 mg/d) in the same hypercholesterolemic patients (n = 17). The reduction in LDL cholesterol is the same with twice the dose of pravastatin as with simvastatin (26 +/- 3% vs 27 +/- 2% respectively). The reductions in atherogenic ratios, total cholesterol, HDL cholesterol and ApoB/ApoA1 are similar. Undesirable effects are rare and comparable. The differences between the two inhibitors appear to be on the molecular level, in tissue selectively and regarding in vivo efficacy.