מתוך medicontext.co.il
NEW YORK (Reuters Health) – For patients with combined hyperlipidemia, simvastatin or atorvastatin, which lower remnant lipoprotein in addition to LDL cholesterol and triglycerides, are better choices than pravastatin which does not significantly reduce remnant lipoprotein.
That is the advice of Dr. Ishwarlal Jialal, from the University of Texas Southwestern Medical Center at Dallas, and colleagues, who compared the effects of these three commonly used statins on remnant lipoprotein cholesterol in a randomized crossover trial in 22 patients with combined hyperlipidemia.
"We know a lot about the effects of statins on HDL and LDL, but the effects of statins on triglycerides have not been well studied," Dr. Jialal said in a telephone interview with Reuters Health. Certain triglyceride particles, like remnant lipoprotein, are as atherogenic as LDL cholesterol if not more so, he added.
The study began with a 6-week lead-in dietary phase where subjects were instructed by a dietitian to follow an American Heart Association step-1 diet. They were then randomized to pravastatin 40 mg per day, simvastatin 20 mg per day, or atorvastatin 10 mg per day for 6 weeks with a 3-week washout period between crossover.
Pravastatin, simvastatin and atorvastatin were equally effective in lowering LDL cholesterol, with reductions of 21%, 29% and 32%, respectively. Simvastatin and atorvastatin also significantly reduced triglycerides and remnant lipoprotein cholesterol, but pravastatin did not. A new immunoassay the team developed has proven to be a "very valid measure of remnant lipoprotein," Dr. Jialal said.
He and his colleagues believe that part of the benefit of statins in reducing cardiovascular events is in the reduction of remnant lipoprotein levels.
As for pravastatin, Dr. Jialal said, "it's a great statin for LDL lowering and it's safe. But for combined hyperlipidemia, it would not be my statin of choice. I would choose simvastatin or atorvastatin because they lower remnant lipoprotein."
He and his colleagues report their findings in the December 2001 issue of Arteriosclerosis Thrombosis and Vascular Biology: Journal of the American Heart Association.
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