EFFECT OF TREATMENT WITH SIMVASTATIN ON SERUM CHOLESTERYL ESTER TRANSFER IN PATIENTS ON DIALYSIS

Background. Plasma cholesteryl ester transfer activity is increased in patients with chronic renal failure on dialysis who have elevated lev els of apolipoprotein B (apoB)-containing lipoproteins. Simvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitor, reduces levels of these lipoproteins but the effect of treatment on ch olesteryl ester transfer activity in patients on dialysis remains to b e determined. Methods. We measured serum newly synthesized cholesteryl ester transfer (NCET) activity, lecithin:cholesterol acyltransferase (LCAT) activity and serum lipid, lipoprotein and apolipoprotein concen trations before and immediately after 6 months treatment with simvasta tin (10 mg daily, n=24) or placebo (n=29) in 53 patients with chronic renal failure receiving haemodialysis or continuous ambulatory periton eal dialysis (CAPD). Results. Simvastatin therapy significantly reduce d serum cholesterol, LDL cholesterol, apoB concentrations, and both NC ET (P=0.001) and LCAT (P= 0.012) rates. The decrease in NCET activity was correlated significantly with the corresponding decrease in apoB c oncentration (r=0.715, P<0.001) and LCAT activity (r=0.715, P<0.001) d uring simvastatin therapy and was no longer significant when apoB conc entration (P=0.14) or LCAT activity (P=0.07) were controlled. Conclusi ons. These data show that simvastatin therapy reduces serum NCET rates , and suggest that this may be linked to the concomitant decrease in l evels of apoB-containing lipoproteins which are accepters of transferr ed cholesteryl esters, and to the decrease in serum LCAT rates in pati ents with chronic renal failure with treatment.