E. Muls et al., CORONARY-HEART-DISEASE RISK-FACTORS AND LDL-CHOLESTEROL-LOWERING EFFICACY OF FIBRATES AND SIMVASTATIN, Clinical drug investigation, 14(2), 1997, pp. 98-108
The objective of this study was to assess the low-density lipoprotein
cholesterol (LDL-C) lowering efficacy of fibric acid derivatives (fibr
ates) and simvastatin as a function of coronary heart disease (CHD) ri
sk status, stratified according to National Cholesterol Education Prog
ram guidelines. Two independent databases were analysed retrospectivel
y The first data set originated from a consecutive sample of 6340 pati
ents with primary hypercholesterolaemia who completed the diet plus fi
brate treatment phase of the Belgian General Practitioners Trial, an o
pen-label, prospective study conducted in a primary care setting. The
second data set was derived from 782 participants in five randomised,
double-blind studies that each compared a specific fibrate with simvas
tatin. The main outcome measures were percentage of subjects reaching
LDL-C treatment goal, and mean percentage reduction in LDL-C across 5
(first data set) or 3 (second data set) CHD risk strata. In the Belgia
n General Practitioners Trial LDL-C lowering efficacy of fibrates was
inversely related to CHD risk status as 15.0% of patients with prior C
HD reached the LDL-C goal < 4.13 mmol/L (< 160 mg/dl) vs 30.2% of thos
e without CHD and no other risk factor (p < 0.0001 after adjustment fo
r baseline LDL-C and triglycerides). Adjusted mean percentage reductio
ns in LDL-C were 15.1 and 18.2 in these strata, respectively (p < 0.05
). Younger age, male gender, high blood pressure, low high-density lip
oprotein cholesterol, and history of prior CHD were significant (p < 0
.05) negative deter minants of both outcome measures in multivariate a
nalyses that adjusted for other risk factors. In the pooled analysis o
f five randomised trials, the percentage of fibrate-treated patients w
ith prior atherosclerotic disease reaching LDL-C goal < 4.20 mmol/L (<
162 mg/dl) was significantly lower when compared with those without C
HD and no risk factor other than LDL-C (adjusted odds ratio = 0.46; p
= 0.009), while simvastatin efficacy was similar across CHD risk strat
a. In conclusion, our results, derived from two independent databases,
suggest that the LDL-C lowering efficacy of fibrates, but not of simv
astatin, is inversely related to CHD risk status. This exploratory ana
lysis must be confirmed by future prospective studies.