COMPARATIVE-STUDY OF ACIPIMOX AND PRAVASTATIN IN PATIENTS WITH COMBINED HYPERLIPIDEMIA

The aim of this study was to evaluate the lipid-lowering effect of aci pimox as compared to pravastatin in patients with combined hyperlipide mia. One hundred and six subjects, all males, aged 18-60 years, with t otal cholesterol (TC) greater than or equal to 200 mg/dl, TC/HDL-C rat io greater than or equal to 5, triglycerides (TG) greater than or equa l to 200 and greater than or equal to 350 mg/dl were randomized to rec eive acipimox 250 mg thrice daily or pravastatin 20 mg once daily for 3 months, according to a double-blind, double-dummy design. After a 1- month wash-out period patients were crossed to the alternative regimen for further 3 months. Prior to and at the end of each treatment perio d, TC, LDL-C, HDL-C, TG, blood glucose, and fibrinogen were evaluated. Both acipimox and pravastatin significantly decreased TC, LDL-C, TC/H DL-C ratio and TG and increased HDL-C, without affecting plasma glucos e. However, at the dosages employed in the study acipimox was more eff ective in reducing TG and increasing HDL-C levels, whereas pravastatin was more efficient in decreasing TC and LDL-C. There was no differenc e between the 2 treatments in their effects on TC/HDL-C ratio. Unlike pravastatin acipimox caused a slight but significant reduction in fibr inogen plasma levels. No serious adverse event was observed with eithe r drug, but a major incidence of side-effects was reported during trea tment with acipimox. Our findings suggest that, although both drugs at the standard dose employed in the study were effective in improving t he lipid profile; in the treatment of combined hyperlipidemia acipimox might be preferable in the presence of more pronounced hypertriglycer idemia with low levels of HDL-C, whereas pravastatin might be more use ful when hypercholesterolemia is predominant.