COMPARISON OF THE EFFECTIVENESS OF LOVASTATIN THERAPY FOR HYPERCHOLESTEROLEMIA AFTER HEART-TRANSPLANTATION BETWEEN PATIENTS WITH AND WITHOUT PRETRANSPLANT ATHEROSCLEROTIC CORONARY-ARTERY DISEASE

With the aim of assessing the effectiveness and safety of lovastatin i n patients with hypercholesterolemia after heart transplantation, as w ell as the potential differences in the lipid-lowering effect of lovas tatin between patients with or without pretransplant coronary artery d isease (CAD), we studied 63 heart transplant patients who had serum to tal cholesterol > 250 mg/dl in spite of dietary therapy. Mean age of s ubjects was 47 +/- 2 years. Triple-drug immunosuppressive therapy cons isted of cyclosporine, azathioprine, and steroids. Thirty-nine patient s (62%) had pretransplant CAD and 24 (38%) did not. Pretreatment serum lipid levels were: total cholesterol, 302 +/- 32 mg/dl; low-density l ipoprotein (LDL) cholesterol, 201 +/- 35 mg/dl; high-density lipoprote in (HDL) cholesterol, 60 +/- 19 mg/dl; triglycerides, 205 +/- 86 mg/dl ; and total/HDL cholesterol ratio, 5.4 +/- 1.6. Patients received 10 t o 40 mg/day of lovastatin (mean dose 17 +/- 6) for 13 +/- 4 months. Th ere were no serious adverse events. At 3 months, lovastatin decreased total cholesterol by 15% (p < 0.001), LDL cholesterol by 21% (p < 0.00 1), triglycerides by 17% (p < 0.05), and total/HDL cholesterol ratio b y 17% (p < 0.001), and increased HDL cholesterol by 3% (NS). Although lovastatin was effective in both patients with pretransplant CAD and n on-CAD, analysis of its effect in each subgroup (CAD and non-CAD) reve aled that its lipid-lowering effect was higher for non-CAD patients (- 20)% vs -12% for total cholesterol, and -27% vs -17% for LDL cholester ol, both p < 0.01). Thus, lovastatin was useful and safe for the treat ment of hypercholesterolemia after heart transplantation, although it was more effective in patients without pretransplant CAD.