EFFECTS OF LONG-TERM TREATMENT WITH LOW-DOSE PRAVASTATIN ON BILIARY LIPID AND BILE-ACID COMPOSITION IN PATIENTS WITH NONFAMILIAL HYPERLIPOPROTEINEMIA

We tested the possibility that pravastatin, a competitive inhibitor of hepatic hydroxymethyl glutaryl coenzyme A (HMG CoA) reductase, would alter cholesterol saturation of gallbladder bile by decreasing its cho lesterol saturation index and/or degree of fatty acyl chain unsaturati on in lecithin. Eighteen patients with type lla hyperlipoproteinemia w ere treated with pravastatin 10 mg/d for 12 months. Gallbladder bile s amples were aspirated with a duodenal tube by stimulating gallbladder contraction with intramuscular administration of cerulein before and a fter treatment. Serum cholesterol level was significantly reduced by 2 0% after 3 months, and this level was maintained after 12 months. In c ontrast, the cholesterol saturation index of gallbladder bile was not altered after 3 months (1.52 +/- 0.20 v1.70 +/- 0.24), but it decrease d significantly after 12 months (0.95 +/- 0.11, P <.01). The degree of fatty acyl chain unsaturation tended to decrease, although this was n ot statistically significant except for the decrease in molar percent of linoleate after 3 months. These findings suggest that long-term tre atment with an inhibitor of HMG CoA reductase improves bile lithogenic ity even at a comparatively low dose, and can decrease the incidence a nd complications of cholesterol gallstones. Copyright (C) 1995 by W.B. Saunders Company