Comparison of Statins in Hypertriglyceridemia

• Published in: The American journal of cardiology 1998-02, Vol.81 (4), p.66B-69B
• Main Authors: Stein, Evan A, Lane, Michael, Laskarzewski, Peter
• Format: Article
• Language: English
• Subjects: Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - therapeutic use; Atorvastatin; Biological and medical sciences; Cardiology; Cholesterol; Cholesterol, LDL - blood; Clinical trials; Clinical Trials as Topic; Enzymes; General and cellular metabolism. Vitamins; Heptanoic Acids - administration & dosage; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertriglyceridemia - blood; Hypertriglyceridemia - drug therapy; Medical sciences; Pharmacology. Drug treatments; Pravastatin - administration & dosage; Pravastatin - therapeutic use; Pyrroles - administration & dosage; Pyrroles - therapeutic use; Randomized Controlled Trials as Topic; Simvastatin - administration & dosage; Simvastatin - therapeutic use; Triglycerides - blood
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00041-1

In 1996, the first 2 studies using 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor (“statin”) therapy in hypertriglyceridemic subjects were published. In subjects with isolated triglyceride elevations who were treated with atorvastatin 5, 20, and 80 mg/day, large and dose-related reductions were noted. In subjects with combined hyperlipidemia treated with 10 mg simvastatin, triglyceride reduction similar to that reported for the 5 mg atorvastatin dose was seen. In response to these findings, we conducted comparative assessments to determine whether all statins are effective in lowering triglyceride levels and whether their effect on triglycerides is related to factors such as drug, dose, and baseline triglyceride levels. To standardize these assessments, we devised a ratio that related changes in triglyceride levels to the known predictable response of low-density lipoprotein (LDL) cholesterol to statins. This triglyceride/LDL cholesterol ratio was obtained by dividing the percent change from baseline in the triglyceride level by the percent change from baseline in the LDL cholesterol level. The triglyceride/LDL cholesterol ratio was initially applied to several published studies, and found to be approximately 1.0 and 0.5 in hypertriglyceridemic and nonhypertriglyceridemic populations, respectively. We then assessed the effect of various statins on triglycerides using a pooled laboratory database of 2,689 subjects who had participated in 7 separate studies with similar designs. All of the studies had a placebo run-in followed by a randomized, double-blind, active treatment phase of at least 4 weeks with a statin. Entry into these studies required a triglyceride level of 250 mg/dL, significant and dose-dependent reductions in triglyceride of 22–45% were seen with all statins. When baseline triglyceride was