Effect of simvastatin on the lipid profile of hemodialysis patients

Background. Simvastatin, a 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, is used widely for treatment of hypercholesterolemia. Simvastatin may be a suitable treatment for dyslipidemia in hemodialysis (H D) patients. However, investigation of the side-effects and safety of long- term administration of simvastatin to HD patients has been limited. In this study, we investigated the effects and safety of simvastatin and its effec ts on lipoprotein metabolism in hypercholesterolemic patients on HD. Methods. Simvastatin was administered at a dosage of 5 mg/day for 24 weeks to 38 HD patients with high serum total cholesterol (TC) levels (200 mg/dl) or low high-density lipoprotein cholesterol (HDL-C) levels (35 mg/dl). Eve ry four weeks, serum lipids, apolipoprotein, lipoprotein(a) [Lp(a)] and mal ondialdehyde (MDA) levels were measured. In addition, lipid levels were det ermined in each lipoprotein fraction separated by ultracentrifugation. Results. After 24 weeks of simvastatin administration, TC significantly dec reased by 25.7%, and low-density lipoprotein cholesterol(LDL-C) was signifi cantly decreased by 33.6%. Triglyceride (TG) and HDL-C showed no significan t changes. Apolipoprotein (apo) B significantly decreased by 24.5% and apo E by 30.0%. No significant changes were observed in the other apolipoprotei ns. MDA was also significantly decreased, whereas Lp(a) was not significant ly altered. In the lipoprotein fractions, very LDL cholesterol (VLDL-C), in termediate-density lipoprotein cholesterol (IDL-C), LDL cholesterol (LDL1-C ), and LDL2 cholesterol (LDL2-C) showed significant decreases. No particula r side-effects were observed during the 12 months of simvastatin administra tion. Conclusions. These results suggest that simvastatin appears to be safe and effective in HD patients with hypercholesterolemia.