José Paulo Novazzi

Terapia combinada de colestiramina e inibidores da HMG-CoA redutase na prevenção secundária da doença coronária

PURPOSE: To evaluate lipid profile changes associated with cholestyramine addition in hypercholesterolemic patients with established coronary heart disease under treatment with HMG-CoA reductase inihibtors that had not achieved the ideal value of LDL-cholesterol. METHODS: Twenty patients with coronary heart disease, (12 submitted to coronary artery bypass grafts, 3 to coronary angioplasty and 5 maintened under clinical management) with mean age of 60.78 years old, who were under hypolipemic diet and were medicated with lovastatin 20mg/d or simvastatin 10mg/d, received cholestyramine, doses ranging from 8 to 16g/day during 8 weeks, aiming to reduce LDL-cholesterol to values less than 100mg/dL. RESULTS: There was a significant reduction of total cholesterol, from initial mean value of 239.52mg/dL to final mean value of 199.00mg/dL, with a mean reduction of 16.92%. The mean value of LDL-cholesterol was also reduced significantly from 172.73mg/dL to 118.26mg/dL, with a mean reduction of 31.53%. Mean triglyceridemia increased, still within the normal reference values, from 145.05mg/dL to 162.00mg/dL, and the mean difference was 11.69%. There was a significant increase of HDL-cholesterol fraction from an initial mean value of 38.00mg/dL to a final mean value of 48.21mg/dL, mean difference of 26.87%. Side effects were not frequent, and did not interfere in the duration of the study. CONCLUSION: The association of cholestyramine to HMG-CoA reductase inihibtors, both in low doses, in patients with primary hypercholesterolemia and high coronary risk is a good therapeutic option that can reach benefits on the lipid profile similar to those obtained when these drugs are used in association or separately in higher doses.