A clinical overview of dyslipidemias: treatment strategies

Clinical efficacy and safety of cerivastatin: summary of pivotal phase IIb/III studies

Cerivastatin is a new, third-generation 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor ("statin"), which is administered to hypercholesterolemic patients at doses equivalent to 1-3% of the doses of other statins. This report reviews the pivotal Phase IIb/III clinical trials in which the efficacy and safety of cerivastatin was compared with placebo and active comparator statins (lovastatin, simvastatin, and pravastatin) after both short- and long-term administration. Overall, the studies showed that at doses of 0.025-0.4 mg/day, cerivastatin produced dose-dependent reductions in low-density lipoprotein (LDL) cholesterol and total cholesterol, which were significantly greater than placebo. The greatest reductions were achieved with 0.4 mg/day cerivastatin. On this dose, >40% of patients achieved reductions in LDL cholesterol >40% and in a further 9% of patients, LDL cholesterol was decreased by >50%. At higher doses, cerivastatin also demonstrated potent triglyceride-lowering effects in a subgroup of patients with raised plasma triglycerides. Reductions in atherogenic lipids and lipoproteins were accompanied by significant increases in high-density lipoprotein (HDL) cholesterol, apolipoprotein A-I, and antiatherogenic lipoprotein A-I. Long-term administration of cerivastatin for periods of up to 2 years was associated with persistent reductions in LDL cholesterol, total cholesterol, triglycerides, and apolipoprotein B as well as increases in HDL cholesterol similar to those observed after initial administration. Long-term cerivastatin treatment was also well tolerated. There was no significant difference between the incidence of adverse effects with cerivastatin and comparator statins or between cerivastatin and other statins with respect to clinically significant increases in either hepatic enzymes or creatine phosphokinase. In conclusion, these studies indicate that cerivastatin is a safe and effective long-term treatment for patients with primary hypercholesterolemia and also suggest that higher doses should be investigated.

Red blood cell aggregation and primary hyperlipoproteinemia

Erythrocyte aggregation (EA) was determined in a Myrenne aggregometer at stasis (EAMo) and low shear (EAM1) in 102 patients suffering from primary hyperlipoproteinemia (PHLP)-46 with familial hypercholesterolemia (FH); 28 with familial combined hyperlipemia (FCHL); 28 with primary hypertriglyceridemia (PHTG)-and in a control group (CG) of healthy matched subjects. EA was also determined in FH after the autologous plasma had been replaced by a control plasma. The following parameters were also measured: fibrinogen (Fbg), plasmatic lipids, apolipoproteins, glucose, HbA1 c and membrane erythrocyte lipids: cholesterol (C) and phospholipids (PL). An increase in both EAMo and EAM1 was observed in all the studied groups of patients. When erythrocytes of FH were resuspended in control plasma, EA normalized, but only in 75% of them. Fbg was elevated only in FH and FCHL. Membrane C was increased mainly in FH and FCHL. EA correlates with both Fbg and apolipoproteins. In FH, EA also correlates with membrane C/PL. In addition, a high significant correlation exists between EA and HbA1 c in FCHL. The results obtained suggest that not only Fbg and apolipoproteins but also possible changes in erythrocyte membrane could encourage EA in PHLP.

Hyperlipoproteinemia in adults with renal disease

Hyperlipoproteinemia is common in patients with renal disease, but increased lipids are only one of several risk factors frequently identified for coronary artery disease. Before treatment options are instituted, renal disease status, current medications, and possible interactions between drugs must be considered. Hypertriglyceridemia is common in patients with renal failure; therapeutic options are influenced by the levels of serum triglycerides and high-density lipoprotein cholesterol. If nonsteroidal drugs improve renal function and decrease proteinuria in patients with renal disease, hyperlipidemia frequently abates. Interactions between drugs are important considerations when lipid-lowering drug treatment is prescribed in recipients of renal transplants.