SIMVASTATIN IN THE TREATMENT OF ELDERLY PATIENTS WITH PRIMARY HYPERCHOLESTEROLEMIA

Twenty elderly patients (14 women, 6 men) with primary hypercholestero lemia (total cholesterol >260 mg/dl) were treated for 42 months with s imvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductas e inhibitor. Mean age was 69 +/- 3 years (range, 65 to 72 years). Eigh teen patients had coronary heart disease and two had transient cerebra l ischemia; all patients were unresponsive to dietary changes. Clinica l, ophthalmologic, and laboratory evaluations were performed periodica lly. Simvastatin dosages ranged from 2.5-20 mg/ day initially, with ma intenance doses from 5-40 mg/day (mean, 22 +/- 12 mg/day). Total chole sterol (TC), plasma triglyceride (TG), high-density lipoprotein choles terol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very l ow-density lipoprotein cholesterol (VLDLC) levels and TC:HDL-C and LDL -C:HDL-C ratios were determined during the placebo baseline period and active treatment period. When the placebo baseline period was compare d with the final active treatment period significant reductions of TC levels (306.1 +/- 22.7 and 213.1 +/- 22.5; mean reduction = 30.2%) and LDL-C levels (223.3 +/- 27.3 and 136.3 +/- 20.3; mean reduction = 40. 4%) were seen. There was a significant increase in HDL-C levels (49.9 +/- 8.7 and 51.9 +/- 8.9; mean increase = 5.1%). There were also signi ficant reductions in TC:HDL-C and LDL-C:HDL-C ratios, of 6.2 +/- 1.0 a nd 4.2 +/- 0.8 (mean reduction = 34.0%) and 4.5 +/- 0.9 and 2.7 +/- 0. 6 (mean reduction = 43.4%), respectively. Although a 20.4% reduction i n TG levels (166.4 +/- 53.7 to 117.5 +/- 34.8) was seen, it was not st atistically significant. In conclusion, simvastatin had significant ef fects on TC, LDL-C, and HDL-C levels as well as TC:I-IDL-C and LDL-C:H DL-C ratios compared with placebo and the reductions observed at the b eginning of the study remained constant throughout the investigation. TG, VLDL-C, and HDL-C levels did not show uniform responses for all pa tients. There were no adverse effects requiring interruption of treatm ent. The present study confirms the validity of long-term therapy with simvastatin in the elderly.