EFFECTS OF NICOTINIC-ACID AND LOVASTATIN IN RENAL-TRANSPLANT PATIENTS- A PROSPECTIVE, RANDOMIZED, OPEN-LABELED CROSSOVER TRIAL

Lipid abnormalities are seen frequently in renal transplant patients. Cardiovascular disease is an important cause of morbidity and mortalit y in these patients. We assessed the efficacy and safety of the lipid- lowering drugs, nicotinic acid (short acting) and lovastatin, the 3-hy droxy-3-methylglutaryl coenzyme A reductase inhibitor. Twelve renal tr ansplant patients who had persistent hyperlipidemia despite 6 weeks of dietary treatment participated in this prospective, randomized, open- labeled crossover trial. At 16 weeks, when compared with control value s, nicotinic acid (greater than or equal to 1.5 g twice a day) signifi cantly reduced the total cholesterol (from 312 +/- 18 [+/-SEM] mg/dL t o 229 +/- 19 mg/dL; P = 0.03) and the low-density lipoprotein choleste rol (from 218 +/- 15 mg/dL to 142 +/- 13 mg/dL; P = 0.03) and signific antly increased the high-density lipoprotein cholesterol (from 44 +/- 3 mg/dL to 58 +/- 5 mg/dL; P = 0.03). The triglyceride level was reduc ed from 255 +/- 40 mg/dL to 150 +/- 23 mg/dL (P = 0.09). At 16 weeks, lovastatin therapy (40 mg/d) significantly reduced the total cholester ol (from 285 +/- 13 mg/dL to 233 +/- 10 mg/dL; P = 0.005) and the low- density lipoprotein cholesterol (from 201 +/- 11 mg/dL to 147 +/- 7 mg /dL; P = 0.001). There were no significant changes in the triglyceride and high-density lipoprotein cholesterol levels. Although flushing de veloped in 67% of patients treated with nicotinic acid, this was not a reason for any of the study dropouts. During this short-term study pe riod no adverse biochemical effects were noted with either of the drug s. These findings indicate that both nicotinic acid and lovastatin red uce the total and low-density lipoprotein cholesterol levels. In addit ion, nicotinic acid significantly alters the triglyceride and high-den sity lipoprotein cholesterol levels. Nicotinic acid is an effective an d inexpensive lipid-lowering agent in patients who tolerate the drug. Therapy with nicotinic acid could potentially reduce the risk of cardi ovascular events in this group of high-risk patients. (C) 1995 by the National Kidney Foundation, Inc.