Baseline lipid values partly determine the response to high-dose simvastatin in patients with familial hypercholesterolemia. The examination of probands and relatives in Statin studies with familial hypercholesterolemia (ExPRESS FH).
Statins decrease low-density lipoprotein cholesterol (LDL-C), and additionally, reduce triglycerides (TG) and raise high-density lipoprotein cholesterol (HDL-C) levels. This study evaluated the frequency of abnormal TG and HDL-C levels in patients with classical familial hypercholesterolemia (FH) and assessed therapeutic response at different baseline levels of these lipoproteins after 1 year of statin therapy. A total of 508 FH patients were included and mean LDL-C levels (8.37+/-2.12 mmol l(-1)) were severely elevated. After a washout period of 6 weeks, all patients started monotherapy with 80 mg simvastatin. Remarkably, LDL-C reduction was dependent on baseline LDL-C levels ranging from 51.1 to 45.5% in the top versus the bottom third of the LDL-C distribution. Unexpected in FH, elevated baseline TG levels were seen in 30% and low HDL-C levels in 15% of all patients. Also, changes in these lipoproteins were dependent on baseline levels; TG reduction was 40.7 versus 22.2% in patients with elevated versus normal levels, while HDL-C increase was 29.1 versus 11.4% in patients with low versus normal HDL-C levels. In conclusion, FH patients with the worst lipoprotein profile showed the greatest benefit from high-dose simvastatin treatment, since changes in these parameters were partly determined by baseline lipid levels.
Department of Vascular Medicine G1-114, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. p.desauvagenolting@amc.uva.nl
Pernette R W
PR
de Sauvage Nolting
Rudolf J A
RJ
Buirma
Barbara A
BA
Hutten
John J P
JJ
Kastelein
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects*; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D012720:Severity of Illness Index; D019821:Simvastatin / Q000008:administration & dosage*; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D019821:Simvastatin