HMG-CoA reductase inhibitors have been proven effective in decreasing the plasma
cholesterol levels in patients affected with various forms of
hypercholesterolemia, familial dysbetalipoproteinemia, familial combined
hyperlipidemia and in nephrotic and diabetic
dyslipidemia. The purpose of this study was to monitor and evaluate the efficiency and safety of the
therapy with
simvastatin, an
HMG-CoA reductase inhibitor, in a group of patients treated by
continuous ambulatory peritoneal dialysis (
CAPD) with severe
hypercholesterolemia. Monitoring of the changes occurring in the various
lipids and
apolipoproteins in these patients included the measurements of the plasma
lipids and
apolipoproteins A-I, A-II, B, C-II, A-IV and Lp(a).
Lipoproteins were separated by gel filtration, on a Superose 6HR column, before and after 24 weeks of treatment. The patterns were compared to those observed in a group of primary hyperlipidemic patients treated with
Lovastatin, a compound of the same class. The
drug was well tolerated by the
CAPD patients and no adverse reaction was observed. In addition to the decrease of the total and
LDL cholesterol, similar to that reported in other groups of patients, we further observed a decrease of the
apo E concentration in both the
CAPD and the hyperlipidemic patients. This decrease was especially pronounced in the HDLE fraction and could involve an upregulation of the
apo B-E and/or
apo E receptor. These results should provide information about the mechanism of action of this
drug in patients with
end-stage renal disease.