Lovastatin Versus Bezafibrate for Hyperlipemia Treatment After Heart Transplantation

Abstract

Background: Elevation in total and low-density lipoprotein (LDL) cholesterol levels and a decrease in high-density lipoprotein (HDL) cholesterol plasma concentrations are common in heart transplant recipients. Currently available antilipemic agents are difficult to use because their adverse effects are potentiated by immunosuppressive therapy. This study evaluated the safety and efficacy of lovastatin and bezafibrate in treating hyperlipemia after heart transplantation. Methods: In this prospective crossover study, 18 heart transplant recipients with hyperlipemia were studied. After 3 months of dietary recommendations (American Heart Association Step 1 diet), patients were randomly assigned to 8 weeks of lovastatin (10 mg/day) followed by 8 weeks of bezafibrate (400 mg/day), or vice versa, with an 8-week washout period between treatments. Results: Both drugs reduced total cholesterol and LDL cholesterol and apoprotein B concentrations. HDL cholesterol increased only with bezafibrate. Total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios decreased with both treatments but were more favorably affected by bezafibrate. Apolipoprotein AI levels increased with lovastatin. Bezafibrate produced greater increases in HDL cholesterol and greater reductions in triglycerides and very-low-density lipoprotein (VLDL) cholesterol. Both drugs decreased intermediate-density lipoprotein (IDL) cholesterol and triglyceride levels. Both drugs were well tolerated with stable liver enzymes, creatine kinase, and renal function. Conclusions: Both lovastatin and bezafibrate effectively improve lipid abnormalities in heart transplant recipients. The differential effects on HDL cholesterol and triglycerides suggest complementary roles in managing post-transplant dyslipidemia.

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