Role of statins in the management of dyslipidemia after cardiac transplant: randomized controlled trial comparing the efficacy and the safety of atorvastatin with pravastatin.

BACKGROUND Cardiac transplant patients are at increased risk of dyslipidemia, a known pathogenetic factor in chronic rejection. The aim of this study was to compare the efficacy and the safety of treatment with atorvastatin (AT) and treatment with pravastatin (PV) in a population of dyslipidemic transplant patients. METHODS Thirty-nine transplant patients were randomized to receive a 4-month cycle of therapy with AT or PV, in a cross-over sequence. We analyzed the effects on their lipid profiles using Student t-test for paired data. RESULTS AND CONCLUSION Atorvastatin was significantly more effective than PV in reducing total cholesterol (33% vs 21%, p < 0.001), LDL cholesterol (45% vs 30%, p = 0.001), and triglycerides (24% vs 7.7%, p < 0.001), at lower doses and with comparable tolerability and safety.

[1]  A. Yeung,et al.  The impact of cyclosporine dose and level on the development and progression of allograft coronary disease. Sandoz/CVIS Investigators. , 1995, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[2]  J. Thompson,et al.  Hypercholesterolemia in long-term survivors of heart transplantation: an early marker of accelerated coronary artery disease. , 1991, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[3]  V. Starnes,et al.  Eight-year results of cyclosporine-treated patients with cardiac transplants. , 1990, The Journal of thoracic and cardiovascular surgery.

[4]  S. Katznelson.  Immunosuppressive and antiproliferative effects of HMG-CoA reductase inhibitors. , 1999, Transplantation proceedings.

[5]  R. Novick,et al.  The Registry of the International Society for Heart and Lung Transplantation: sixteenth official report--1999. , 1999, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[6]  H. O. Andersen.  Heart allograft vascular disease: an obliterative vascular disease in transplanted hearts. , 1999 .

[7]  B. McManus,et al.  Prominence of coronary arterial wall lipids in human heart allografts. Implications for pathogenesis of allograft arteriopathy. , 1995, The American journal of pathology.

[8]  D. Renlund,et al.  Task force 5: Complications , 1993 .

[9]  L. Yeatman,et al.  Effect of pravastatin on outcomes after cardiac transplantation. , 1995, The New England journal of medicine.

[10]  D. Renlund,et al.  Hypercholesterolemia after heart transplantation: amelioration by corticosteroid-free maintenance immunosuppression. , 1989, The Journal of heart transplantation.

[11]  J. Mckenney,et al.  Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) , 1993, JAMA.

[12]  S. Katznelson,et al.  Dual roles of HMG-CoA reductase inhibitors in solid organ transplantation: lipid lowering and immunosuppression. , 1995, Kidney international. Supplement.

[13]  G. Steinbeck,et al.  Simvastatin reduces graft vessel disease and mortality after heart transplantation: a four-year randomized trial. , 1997, Circulation.

[14]  M. Billingham.  Pathology and etiology of chronic rejection of the heart. , 1994, Clinical transplantation.

[15]  D. Hunninghake,et al.  Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatin in patients with hypercholesterolemia (the CURVES study) , 1998, The American journal of cardiology.

[16]  D. Illingworth,et al.  Myolysis and acute renal failure in a heart-transplant recipient receiving lovastatin. , 1988, The New England journal of medicine.