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Abstract
120 patients (64 men, 56 women) aged 19–66 years with primary hypercholesterolaemia (mean serum total cholesterol 10.1 mmol/1, range 6.5–16.3 mmol/1) with normal or moderately raised concentrations of serum triglycerides were randomised after four weeks' diet and four weeks' diet + placebo phase either to cholestyramine (40 patients) or lovastatin (80 patients) treatments for the succeeding 12 weeks. The maximal daily doses were 24 g of cholestyramine and 80 mg of lovastatin. The baseline data of the treatment groups were comparable with the exception of HDL-cholesterol concentrations, which were lower in the lovastatin group. The mean reductions in total serum cholesterol concentrations were 24.3 % for cholestyramine (P < 0.01) and 33.4 % for lovastatin (P < 0.01) (P < 0.01 between the treatment groups), in LDL-cholesterol 32.1 % (P < 0.01) and 40.7 % (P < 0.01) (P < 0.05 between the treatment groups) and in apolipoprotein B 23.3 % (P < 0.01) and 33.3 % (P < 0.01) (P < 0.01 between the treatment groups), respectively. Lovastatin was the only drug to reduce serum triglyceride concentrations, it did so by 26.0 %. HDL-cholesterol increased by 7.7 % (P = NS) when cholestyramine was taken and by 13.5 % (P < 0.05) with lovastatin (P = NS between the treatment groups). Apolipoprotein A1 remained unchanged. Adverse clinical effects were more frequent in the cholestyramine group (88 % vs 35 %, P < 0.01). In the subgroup analyses, serum total cholesterol concentration declined to a similar extent with lovastatin in subjects with normal and moderately raised serum triglyceride concentrations as well as in those with familial and non-familial hypercholesterolaemia; this was also true with cholestyramine.
In conclusion, lovastatin is more effective, has a more favourable effect on the lipid profile and is better tolerated than cholestyramine in the treatment of familial and non-familial hypercholesterolaemia. The hypocholesterolaemic response was similar in patients with normal and moderately raised concentrations of serum triglyceride levels.