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Simvastatin Increases HDL-C And Apo A-I More Than Atorvastatin in Patients With Hypercholesterolemia

Simvastatin appears to increase high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-I significantly more than does atorvastatin in patients with hypercholesterolaemia; furthermore, the benefit appears to be independent of HDL-C level or the presence of the metabolic syndrome.

Previous studies have shown that statins may have differential effects on HDL-C; however, in contrast to earlier trials, this study was designed to include more patients with low HDL-C.

Christie M. Ballantyne, MD, Baylor College of Medicine, Houston, Texas, United States, and colleagues conducted a multi-centre, randomised, double-blind, parallel-dose study with 917 hypercholesterolaemic patients. The researchers compared the efficacy of 80 mg/d simvastatin versus 80 mg/d atorvastatin on HDL-C and apo A-I for 24 weeks.

They found that simvastatin increased HDL-C and apo A-I values significantly more than did atorvastatin for the mean of weeks 6 and 12 (8.9% versus 3.6% and 4.9% versus -0.9%, respectively) and the mean of weeks 18 and 24 (8.3% versus 4.2% and 3.7% versus -1.4%).

These differences were observed across both baseline HDL-C subgroups (<40 mg/dL, 40 mg/dL or more) and in patients with the metabolic syndrome. By comparison, low-density lipoprotein cholesterol and triglyceride reductions were greater with atorvastatin.

Liver toxicity occurred in significantly fewer patients treated with simvastatin compared to atorvastatin, with most elevations observed in women taking atorvastatin.

"These findings confirm previous studies comparing simvastatin and atorvastatin," the researchers conclude.

They point out that the clinical relevance of the differential effect of simvastatin versus atorvastatin on the lipid profile has not been tested with regard to cardiovascular outcomes; however, "the importance of even small increases in HDL-C on CHD event rate has been demonstrated" in large prospective trials of lipid-modulating therapy.

According to the researchers, increased HDL-C may result from inhibition of cholesterol ester transfer protein activity by statins, although additional clinical studies are required to determine the mechanisms by which statins modulate HDL-C and apo A-I levels.

Am Heart J 2003;146:5:862-869. "Effect on high-density lipoprotein cholesterol of maximum dose simvastatin and atorvastatin in patients with hypercholesterolemia: results of the Comparative HDL Efficacy and Safety Study (CHESS)"

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