Effects of fluvastatin on biliary lipids in subjects with an elevated cholesterol saturation index

Objective: 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibi tors have been suggested as agents to reduce the biliary cholesterol satura tion index (CSI) in duodenal bile and therefore might be supportive in prim ary or secondary prevention of gallstones. However, the efficiency of the t herapy seems to depend on both the HMG-CoA reductase inhibitor used and the study population selected. Methods: We therefore investigated the effect of a high-dose application of fluvastatin on biliary lipid composition in 21 subjects exhibiting mild hy percholesterolaemia and a history of current gallstones or cholecystectomy due to gallstone disease. Subjects were treated either with 40 mg fluvastat in twice per day over a 3-month period (n = 14) or with placebo (n = 7). Bi le samples were aspirated during endoscopy after intravenous ceruletid stim ulation before and after therapy. Results: Both groups were comparable in CSI (mean +/- SD) at baseline (1.78 +/- 0.2 placebo vs. 1.97 +/- 0.4 verum). CSI significantly decreased in th e verum group to 1.45 +/- 0.4 (P = 0.003) mainly due to increased phospholi pid levels, whereas no difference was observed in the placebo group (1.85 /- 0.7, n.s.). In addition, the verum group exhibited a significant reducti on of hydrophobic deoxycholic acid, which has been reported to induce chole sterol crystal precipitation, and an increase of hydrophilic cholic acid. Conclusion: Fluvastatin might decrease the risk of cholesterol gallstone fo rmation in patients with elevated biliary CSI during long-term treatment by reduction of biliary cholesterol saturation and percentage change in deoxy cholic acid content.