EFFECT OF SIMVASTATIN ON LP(A) CONCENTRATIONS

The effect of HMG-CoA reductase inhibitors on Lp(a) concentrations is controversial, with some studies showing an increase and others showin g no effect on Lp(a) concentrations. Many of these studies have been l imited by small sample size and the lack of a prospective design. We e valuated the effect of four treatments: (1) placebo, (2) simvastatin 1 0 mg PO QPM, (3) simvastatin 20 mg PO QAM, and (4) simvastatin 20 mg P O QPM on Lp(a) concentrations in a prospective, randomized, controlled clinical trial of 24 weeks in 343 subjects in 28 clinical sites in th e United States. Simvastatin was not associated with a change in Lp(a) concentrations relative to placebo. These results were not affected b y controlling for race, initial Lp(a) level, or urinary albumin excret ion. Simvastatin significantly reduced low-density lipoprotein (LDL) c holesterol levels (10 mg PO QPM: -27.6%; 20 mg PO QAM: -28.1%; and 20 mg PO QPM: -34.3%, all p<0.001). It was concluded that in a large, ran domized, controlled trial, simvastatin does not affect Lp(a) levels bu t markedly lowers LDL cholesterol levels.