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Differential effects of simvastatin and atorvastatin on high-density lipoprotein cholesterol and apolipoprotein A-I are consistent across hypercholesterolemic patient subgroups.
Davidson, Michael H; Ose, Leiv; Frohlich, Jiri; Scott, Russell S; Dujovne, Carlos A; Escobar, Ivan D; Bertolami, Marcelo C; Cihon, Frank; Maccubbin, Darbie L; Mercuri, Michele.
Afiliação
  • Davidson MH; Chicago Center for Clinical Research, Chicago, Illinois 60610, USA. mdavidson@protocare.com
Clin Cardiol ; 26(11): 509-14, 2003 Nov.
Article em En | MEDLINE | ID: mdl-14640465
BACKGROUND: In addition to lowering plasma levels of low-density lipoprotein cholesterol (LDL-C), statins also raise high-density lipoprotein cholesterol (HDL-C). HYPOTHESIS: Recent studies have shown that treatment with simvastatin results in larger increases in HDL-C than those seen with atorvastatin. The results of three clinical studies are analyzed, comparing the effects of simvastatin and atorvastatin on HDL-C and apolipoprotein A-I (apo A-I) in the total cohort and in several subgroups of hypercholesterolemic patients. The three studies were all multicenter, randomized clinical trials that included simvastatin (20-80 mg) and atorvastatin (10-80 mg) treatment arms. The subgroup analyses performed were gender; age (< 65 and > or = 65 years); baseline HDL-C (male: < 40 or > or = 40 mg/dl; female: < 45 or > or = 45 mg/dl), baseline LDL-C (< 160 or > or = 160 mg/dl), and baseline triglycerides (< 200 or > or = 200 mg/dl). RESULTS: Both drugs produced similar increases in HDL-C levels at low doses; however, at higher drug doses (40 and 80 mg), HDL-C showed a significantly greater increase with simvastatin than with atorvastatin (p < 0.05 to < 0.001). Therefore, while HDL-C remained consistently elevated across all doses of simvastatin, there appeared to be a pattern of decreasing HDL-C with an increasing dose of atorvastatin. A similar negative dose response pattern was also observed with apo A-I in atorvastatin-treated patients, suggesting a reduction in the number of circulating HDL particles at higher doses. Both drugs reduced LDL-C and triglycerides in a dose-dependent fashion, with atorvastatin showing slightly greater effects. The differential effects of atorvastatin and simvastatin on HDL-C and apo A-I were observed for both the whole study cohorts and all subgroups examined; thus, no consistent treatment-by-subgroup interactions were observed. CONCLUSION: The data presented show that, across different hypercholesterolemic patient subgroups, simvastatin increases HDL-C and apo A-I more than atorvastatin at higher doses, with evidence of a negative dose response effect on HDL-C and apo A-I with atorvastatin, but not simvastatin.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pirróis / Apolipoproteína A-I / Inibidores de Hidroximetilglutaril-CoA Redutases / Sinvastatina / Ácidos Heptanoicos / Hipercolesterolemia / HDL-Colesterol Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Ano de publicação: 2003 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pirróis / Apolipoproteína A-I / Inibidores de Hidroximetilglutaril-CoA Redutases / Sinvastatina / Ácidos Heptanoicos / Hipercolesterolemia / HDL-Colesterol Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Ano de publicação: 2003 Tipo de documento: Article