Effects of simvastatin and fenofibrate on serum lipoproteins and apolipoproteins in primary hypercholesterolaemia

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Abstract
Sixteen patients with primary hypercholesterolaemia received double-blind either fenofibrate (n=8; 200 mg bid) or the HMG-CoA reductase inhibitor simvastatin (n=8; 20 mg qid or 40 mg qid if LDL-cholesterol did not fall below 3.6 mmol·l−1 after 4 weeks of treatment). Simvastatin reduced total cholesterol from 9.7 to 7.0 mmol·l−1 after 10 weeks (−28%), and fenofibrate reduced it from 9.2 to 7.7 mmol·l−1 (−15%). The decrease was less during fenofibrate than during simvastatin treatment (time × drug:p=0.02). Serum LDL-cholesterol fell from 8.3 to 5.3 mmol·l−1 (−36%) during simvastatin and from 7.2 to 6.0 mmol·l−1 (−16%) during fenofibrate administration. Again, the effect of simvastatin was more pronounced than that of fenofibrate (time × drug:p=0.03). HDL-cholesterol increased significantly from 1.1 to 1.2 mmol·l−1 (+13%) during fenofibrate administration and it did not change significantly during simvastatin. Serum triglycerides fell from 1.3 to 1.1 mmol·l−1 (−16%) during simvastatin, and even more significantly from 2.2 to 1.1 mmol·l−1 (−51%) during fenofibrate (time × drug:p=0.002). Apolipoprotein B fell on simvastatin from 1.9 to 1.4 g·l−1 (−24%) and from 1.8 to 1.4 g·l−1 (−22%) during fenofibrate. Both drugs were well tolerated and had no significant adverse effects. Simvastatin lowered total and LDL-cholesterol concentrations more than fenofibrate, while the latter had more effect on triglycerides, suggesting specific indications for the two drugs in the treatment of hyperlipoproteinaemias.