Braina Ester Dereviacki

Simvastatin in the treatment of elderly patients with primary hypercholesterolemia

Abstract Twenty elderly patients (14 women, 6 men) with primary hypercholesterolemia (total cholesterol >260 mg/dl) were treated for 42 months with simvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor. Mean age was 69 ± 3 years (range, 65 to 72 years). Eighteen patients had coronary heart disease and two had transient cerebral ischemia; all patients were unresponsive to dietary changes. Clinical, ophthalmologic, and laboratory evaluations were performed periodically. Simvastatin dosages ranged from 2.5–20 mg/day initially, with maintenance doses from 5–40 mg/day (mean, 22 ± 12 mg/day). Total cholesterol (TC), plasma triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C) levels and TC:HDL-C and LDL-C:HDL-C ratios were determined during the placebo baseline period and active treatment period. When the placebo baseline period was compared with the final active treatment period significant reductions of TC levels (306.1 ± 22.7 and 213.1 ± 22.5; mean reduction = 30.2%) and LDL-C levels (223.3 ± 27.3 and 136.3 ± 20.3; mean reduction = 40.4%) were seen. There was a significant increase in HDL-C levels (49.9 ± 8.7 and 51.9 ± 8.9; mean increase = 5.1%). There were also significant reductions in TC:HDL-C and LDL-C:HDL-C ratios, of 6.2 ± 1.0 and 4.2 ± 0.8 (mean reduction = 34.0%) and 4.5 ± 0.9 and 2.7 ± 0.6 (mean reduction = 43.4%), respectively. Although a 20.4% reduction in TG levels (166.4 ± 53.7 to 117.5 ± 34.8) was seen, it was not statistically significant. In conclusion, simvastatin had significant effects on TC, LDL-C, and HDL-C levels as well as TC:HDL-C and LDL-C:HDL-C ratios compared with placebo and the reductions observed at the beginning of the study remained constant throughout the investigation. TG, VLDL-C, and HDL-C levels did not show uniform responses for all patients. There were no adverse effects requiring interruption of treatment. The present study confirms the validity of long-term therapy with simvastatin in the elderly.