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Double-Blind Comparison of Apolipoprotein and Lipoprotein Particle Lowering Effects of Atorvastatin and Pravastatin Monotherapy in Patients With Primary Hypercholesterolemia

INSERM U 325, Département d'Atherosclerose, Université Lille

Jean-Charles Fruchart

INSERM U 325, Département d'Atherosclerose, Université Lille

Pascal Maigret

Département Médical, Parke-Davis, France

Stefano Bertolini

Dipartimento di Medicina Interna, Genoa, Italy

Gabriele Bittolo Bon

Ospedali Cicili Riuniti, Venice, Italy

M. Malcom Campbell

Southbank Surgery, Glasgow, UK

Michel Farnier

Point Médical, Dijon, France

John Langan

Baillieston Health Centre, Glasgow, UK

Gerhard Mahla

Kirchweg 7, Feldafing, Germany

Paolo Pauciullo

Lipid Glinde of the University of Naples, Italy

Cesare Sirtori

Universita Di Milano, Milan, Italy

Methods and Results: A total of 305 subjects with primary hypercholesterolemia were ran domized in a 3:1 ratio to receive either atorvastatin 10 mg daily or pravastatin 20 mg daily according to a 16-week double-blind comparative study of the effect on apolipoprotein and lipoprotein particle levels. All patients had low-density lipoprotein (LDL)-cholesterol levels between 4.2 and 6.6 mM and triglyceride concentrations below 4.5 mM at baseline. After 16 weeks of treatment, apoB (-27% and -16%; P < .001), apoE (-13.3% and -5.6%; P < .05) and the triglyceride-rich LpC-III:B particle (-33% and -26%; P < .05) levels were reduced to a significantly greater extent in the atorvastatin than in the pravastatin treatment group. Both atorvastatin and pravastatin increased apoA-I levels, an effect that was more pronounced in the pravastatin group (+7% and + 11 %; P < .002). The increased apoA-I levels predominated on LpA-I in the atorvastatin group (+11%) and on LpA-I:A-II in the pravastatin group (+13%). ApoA-II levels were decreased with atorvastatin to a greater extent than with pravastatin (-1% and +2.8%; P <.05).

Conclusions: Although atorvastatin and pravastatin belong to the same therapeutic family, they produce different effects in apolipoprotein concentrations in hypercholesterolemic patients. Atorvastatin, an agent of the new generation, appears to efficiently reduce apoB- containing lipoprotein particles containing apoC-III.

Key Words: atorvastatin • HMGGRI • hypercholesterolemia • pravastatin • LDL-C • apolipo protein.

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 3, No. 2, 103-110 (1998)
DOI: 10.1177/107424849800300202


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