Adrenocorticotrophic hormone exerts marked lipid-lowering effects in simvastatin-treated patients

Objective. Recently, it was reported that treatment with adrenocorticotroph ic hormone (ACTH) has a strong lipid-lowering effect in healthy individuals . The mechanism behind this has not been established. The aim of the presen t investigation was to study the effect of ACTH on the plasma lipoprotein p attern in patients treated with a 3-hydroxy-3-methylglutaryl-coenzyme A red uctase inhibitor. Design. The ACTH treatment was given to 10 patients who were on long-term t reatment with simvastatin 40 mg daily. ACTH(1-24) was administered at the d ose of I mg daily for four consecutive days. Blood samples for analyses of lipids, lipoproteins and apolipoproteins were collected before and after tr eatment. Second baseline was obtained 2 weeks after the end of treatment. Results. The serum concentrations of cholesterol, triglycerides, low densit y lipoprotein (LDL) cholesterol, apolipoprotein B and lipoprotein(a) fell s ignificantly by 16, 23. 23, 10 and 38%, respectively. The serum apolipoprot ein E concentration increased significantly by 39%; the fraction that was n ot associated with apolipoprotein B increased by 47%, whereas the fraction that was did not change significantly. There were no changes in the serum c oncentrations of high density lipoprotein (HDL) cholesterol and apolipoprot ein AI. AC the second baseline, the lipid variables had generally returned to previous levels. Conclusions. In patients on long-term simvastatin treatment, ACTH had marke d lowering effects on the lipoproteins that contain apolipoprotein B. Moreo ver, the serum apolipoprotein E concentration increased significantly in re sponse to ACTH treatment.