Objective: The pathogenesis of coronary artery disease is influenced by several risk factors, of which one of the most prominent is hypercholesterolaemia. The aim of this study was to compare the effect of fluvastatin, lovastatin and simvastatin on lipid levels in the same patients following a standard lipid-lowering diet. Patients: This was a comparative study in 25 patients with primary hypercholesterolaemia Fredrickson type IIb, 18 of whom completed the study. Design: After a 6-week washout period, patients were treated for 1 month with fluvastatin 20 mg/day, after which the dosage was increased to 40 mg/day. Lipid parameters were measured at baseline and after 1 and 2 months. The study drug was then continued for a further 8.5 months until the beginning of the next wash out period. At that time (i.e. 1 year after the first study) the same pattern was followed using lovastatin 20 and 40 mg/day; finally, the treatment pattern was repeated in the third year with simvastatin 10 and 20 mg/day. Results: All three agents significantly decreased low density lipoprotein and total cholesterol levels (p < 0.001). Simvastatin had the most pronounced cholesterol-lowering effect. Lovastatin and fluvastatin caused no significant change in the level of high density lipoprotein (p = 0.74 and p = 0.19), whereas simvastatin increased it significantly by 8% (p = 0.029). In contrast with fluvastatin, lovastatin and simvastatin significantly decreased apolipoprotein B-100 (p = 0.81 vs 0.039 and < 0.001, respectively). Apolipoprotein A was not changed significantly by any drug (p = 0.06, 0.59 and 0.28, respectively). Conclusions: Simvastatin was a more effective lipid-lowering drug than fluvastatin or lovastatin in this study of the sequential administration of the three drugs to the same group of patients over a 3-year period. This internally controlled study supports the results of previous parallel-group studies showing simvastatin to be the most effective of these three drugs.
ASJC Scopus subject areas
- Pharmacology (medical)