Efectos de las estatinas en el transplante renal / Effects of HMG-CoA reductase inhibitors in renal transplantation

Realizamos un análisis retrospectivo en 97 pacientes transplantados renales con seguimiento mínimo de 1 año para evaluar la actividad inmunosupresora de estatinas. El Grupo A (38 pacientes) recibió estatinas el Grupo B (59 pacientes) fue nuestro grupo control. El Grupo A fue luego subdividido en 4 subgrupos de acuerdo al tiempo en el cual se prescribieron las estatinas. Los niveles de colesterol inicial y final en el Grupo A no fueron diferentes (218 más menos 7.8 mg/dl vs. 222 más menos 7.5 mg/dl). Sin embargo, los niveles finales fueron más altos que los iniciales en el Grupo B (216 más menos 6 mg/dl vs. 189 más menos 6.4 mg/dl; P=0.0021). Los niveles de triglicéridos iniciales fueron más altos que los finales en el Grupo A (305 más menos 25.5 mg/dl vs. 188 más menos 10.6 mg/dl; P<0.0001). El Grupo A mostró una mejor sobrevida del injerto (P=0.0350), una reducción en episodios de rechazo agudo (1 vs. 38; P>0.0001) y un nivel de creatinina más baja que en el Grupo B (1.96 más menos 0.21 mg/dl vs. 2.77 más menos 0.27 mg/dl; P=0.0374). En los subgrupos del Grupo A, la función renal fue superior en los pacientes que recibieron estatinas en forma temprana contra aquellos que las recibieron más tardíamente (1.33 más menos 0.1 mg/dl vs. 3.26 más menos 0.7 mg/dl; P=0.0064). Estos resultados sugieren que en los receptores de transplante renal las estatinas reducen en forma significativa el número de episodios de rechazo agudo, mejoran significativamente la sobrevida del injerto y la función renal. Estos efectos se correlacionan con una disminución en el nivel de triglicéridos pero son independientes de una acción hipocolesterolémica (AU)

[Comparative effects of policosanol and two HMG-CoA reductase inhibitors on type II hypercholesterolemia]. / Efecto comparativo de policosanol con dos inhibidores de la HMG-CoA reductasa en el tratamiento de la hipercolesterolemia tipo II.

BACKGROUND: Policosanol is a new cholesterol lowering agent derived from sugar cane. AIM: To compare the cholesterol lowering efficacy of policosanol with HMG CoA inhibitors. PATIENTS AND METHODS: Patients with a LDL cholesterol over 160 mg/dl were studied. If, after 6 weeks of diet, cholesterol persisted elevated, they were doubly blind randomized to receive policosanol 10 mg/day (55 patients), lovastatin 20 mg/day (26 patients) or simvastatin 10 mg/day (25 patients). Serum cholesterol was measured again after 8 weeks of therapy. RESULTS: Initial demographic and laboratory data were similar among treatment groups. A 24% LDL cholesterol reduction was obtained with policosanol, compared with a 22% reduction with lovastatin and a 15% reduction with simvastatin. HDL cholesterol significantly increased in patients on policosanol and did not change in the other treatment groups. Adverse effects of policosanol were mild and unspecific. No changes in hepatic enzymes were observed. CONCLUSIONS: Policosanol is a safe and effective cholesterol reducing agent.

Effects of simvastatin, bezafibrate and gemfibrozil on the quantity and composition of plasma lipoproteins.

Simvastatin, 10-40 mg/d (n = 11), bezafibrate, 600 mg/d (n = 6), and gemfibrozil, 1200 mg/d (n = 5) were administered for 12 weeks after a 4-week placebo period to subjects with initial plasma levels (mg/100 ml. mean +/- SD) of cholesterol (346 +/- 77), and of triglycerides (180 +/- 54). Total LDL-C plasma concentration was lowered 32% by simvastatin and 35% by bezafibrate, but only bezafibrate diminished the triglyceride (41%) and increased HDL-C plasma levels (35%). Plasma lipoprotein fractions obtained by discontinuous gradient ultracentrifugation, namely, VLDL, lighter LDL (LDL-1), heavier LDL (LDL-2) and bulk HDL were chemically analyzed. Simvastatin and bezafibrate significantly diminished the quantity of VLDL and LDL-1 particles, although barely modifying their composition. Neither drug influenced the LDL-2 plasma concentration. Bezafibrate increased the total plasma HDL level little interfering with its chemical composition. Gemfibrozil was the least effective of all drugs but decreased the lipid and protein contents and their ratios in VLDL and LDL-2.

[Simvastatin (MK-733), a new HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients with atherosclerosis]. / Sinvastatina (MK-733), novo inibidor da HMG-CoA redutase no tratamento da hipercolesterolemia do idoso com doença aterosclerótica.

PURPOSE: To evaluate the efficacy and tolerability of simvastatin, a new and potent HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients. PATIENTS AND METHODS: Twenty patients, 14 female and 6 male, aged 65 to 72 years (x = 69 +/- 3), with total cholesterol (TC) above 260 mg/dl and triglycerides below 350 mg/dl were studied. All patients presented clinical evidences of atherosclerotic disease and were followed up for 6 months. Monthly visits were required for clinical and laboratory evaluation. The initial dosage of simvastatin was 10 mg/day; dosage was titrated up to 10 mg/day or to a minimum of 5 mg/day in intervals of at least 4 weeks, in order to maintain LDL-cholesterol below 140 mg/dl. To evaluate the changes on plasma lipid levels, the mean value of determinations during the placebo baseline period was compared to the mean value of determinations during the active treatment period. RESULTS: There were significant reductions of total cholesterol (-26.4%), triglycerides (-16.0%), LDL-cholesterol (-35.2%), VLDL-cholesterol (-15.4%), TC/HDL-C (-30.7%), and LDL/HDL-C (-39.5%). There was significant elevation of HDL-cholesterol (+5.2%), although this response was not uniform. The drug was well tolerated: only five patients reported transient clinical adverse experiences that subsided spontaneously. Two patients had elevation of CPK and one of TGP. The drug did not have to be discontinued in any case. Ophthalmological examinations performed before treatment compared to examinations at the end of the study showed no signficant alterations. CONCLUSION: Simvastatin in elderly patients appeared to be a potent TC and LDL-C lowering drug and presented mild but significant effect on the elevation of HDL-C. There was good tolerability, with low incidence of adverse experiences. This fact is important when one considers drug therapy for hypercholesterolemia in this age group.

Sinvastatina (MK-733), novo inibidor da HMG-CoA redutase no tratamento da hipercolesterolemia do idoso com doença aterosclerótica / Simvastatin (MK-733), a new HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients with atherosclerosis

Objetivo: Avaliação da eficácia e tolerabilidade da sinvastatina, um novo e potente inibidor da HMGCoA redutase, no tratamento da hipercolesterolemia em pacientes idosos. Casuística e Métodos: Foram estudados 20 pacientes com idades entre 65 e 72 anos (x = 69 ± 3), sendo 14 mulheres e 6 homens, com colesterolemia total acima de 260 mg/dl e trigliceridemia abaixo de 350 mg/dl. Todos os pacientes apresentavam evidência clínica de doença aterosclerótica e foram observados durante 6 meses, com visitas mensais para avaliações clínica e laboratorial. A dose inicial de sinvastatina foi de 10 mg dia, ajustada a intervalos de pelo menos 4 semanas, até o máximo de 40 mg dia e mínimo de 5 mg/dia com o objetivo de manter os niveis de LDL-colesterol abaixo de 140 mg/dl. Para avaliaçao das variáveis lipídicas, foram comparadas as médias dos valores do período placebo e do período de tratamento medicamentoso...

Purpose: To evaluate the efficacy and tolerability of simvastatin, a new and potent HMG-CoA reductase inhibitor, in the treatment of hypercholesterolemia in elderly patients. Patients and Methods: Twenty patients,14 female and 6 male, aged 65 to 72 years (x = 69 ± 3), with total cholesterol (TC) above 260 mg/dl and triglycerides below 350 mg/dl were studied. All patients presented clinical evidences of atherosclerotic disease and were followed up for 6 months. Monthly visits were required for clinical and laboratory evaluation. The initial dosage of simvastatin was 10 mg/ day; dosage was titrated up to 10 mg/day or to a minimum of 5 mg/day in intervals of at least 4 weeks, in order to maintain LDL-cholesterol below 140 mgldl. To evaluate the changes on plasma lipid levels, the mean value of determinations during the placebo baseline period was compared to the mean value of determinations during the active treatment period...