EFFECTS OF SIMVASTATIN AND ENALAPRIL ON SERUM-LIPOPROTEIN CONCENTRATIONS AND LEFT-VENTRICULAR MASS IN PATIENTS ON DIALYSIS

A randomised trial of simvastatin and enalapril in patients with chron ic renal failure on dialysis: effects on serum lipoprotein concentrati ons and left ventricular mass, Left ventricular hypertrophy and abnorm alities of lipoprotein metabolism are both possible contributors to th e high risk of cardiovascular death in patients with chronic renal fai lure on dialysis. We investigated the effects of simvastatin on lipid and lipoprotein concentrations and the effects of enalapril on left ve ntricular mass in 107 patients receiving haemodialysis or continuous a mbulatory peritoneal dialysis. Patients were randomised in a factorial design to receive simvastatin (10 mg daily) or placebo and enalapril (2.5-5 mg daily) or placebo. During follow-up, there was a significant excess of patients withdrawn from enalapril because of hypotension (2 p=0.002), and after 6 months only 55% of those assigned enalapril were -still on treatment. From baseline to 6 months, there were no statisti cally significant differences in left ventricular mass or left ventric ular dimensions between patients assigned enalapril and those assigned placebo, Among the patients assigned simvastatin, total cholesterol w as reduced by 13% (2p=0.001), LDL cholesterol was reduced by 17% (2p=0 .003) and apolipoprotein B was reduced by 12% (2p=0.005) compared to p atients assigned placebo. There were borderline significant (2p=0.05 t o 0.08) reductions in VLDL cholesterol, total triglyceride and VLDL tr iglycerides of 26%, 12% and 17% respectively. Large-scale trials are n ow required to determine whether reductions in lipid and lipoprotein c oncentrations confer a reduction in coronary heart disease morbidity a nd mortality in patients on dialysis.