Comparison of Lovastatin and Bezafibrate on Lipoprotein(a) Plasma Levels in Cardiac Transplant Recipients

Abstract

Both bezafibrate and lovastatin decrease serum lipid levels through different mechanisms. Lovastatin increases low-density lipoprotein (LDL) fractional catabolic rate by enhancing tissue uptake and clearance, whereas bezafibrate decreases very-low-density lipoprotein triglycerides by stimulating lipoprotein lipase activity and enhancing catabolism of triglyceride-rich lipoproteins.¹,² A recent study showed that fibrate therapy can reduce lipoprotein(a) [Lp(a)] plasma levels in patients with primary hyperlipidemia.³ This prospective crossover study evaluated the effect of bezafibrate and lovastatin on Lp(a) concentrations in cardiac transplant recipients with hypercholesterolemia despite a National Cholesterol Education Program step I diet. Twenty heart transplant patients were enrolled; 18 completed the protocol. Patients received lovastatin 10 mg/day and bezafibrate 400 mg/day for 8 weeks each, in randomized sequence, separated by an 8-week washout period, while immunosuppressive therapy remained unchanged. Both drugs improved the overall lipid profile, but only bezafibrate significantly reduced Lp(a) plasma levels (mean decrease 37%), with the greatest effect in patients with baseline Lp(a) >30 mg/dl, whereas lovastatin did not significantly modify Lp(a) levels. Bezafibrate may therefore be useful for the treatment of elevated Lp(a) in heart transplant patients receiving immunosuppressive therapy.

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