Comparison of low-dose simvastatin and gemfibrozil in the treatment of elevated plasma cholesterol: a multicenter study

Article Abstract:

Although numerous studies have demonstrated the efficacy of simvastatin in the reduction of elevated serum cholesterol, there has not been a side-by-side comparison of simvastatin with gemfibrozil, a drug which is effective in reducing coronary heart disease in patients with elevated cholesterol. A multicenter study was undertaken in which 290 patients from Europe and South America were treated for primary hypercholesterolemia. Patients were assigned to Stratum I if their initial low-density lipoprotein (LDL) cholesterol was less than 195 milligrams per deciliter (mg/dl), and to Stratum II if their initial concentration was equal to or greater than 195 mg/dl. Within each stratum, patients were randomly assigned to either a gemfibrozil group or a simvastatin group. All patients receiving gemfibrozil received 600 milligrams (mg) twice daily. Stratum I patients were given 5 mg of simvastatin per day for six weeks. In the higher cholesterol Stratum II group, patients in the simvastatin group received 10 mg per day for six weeks. At the end of the six week period, patients in the simvastatin groups with LDL cholesterol above 140 mg/dl had their dose doubled for the next six weeks. In all cases, patients receiving simvastatin achieved a greater reduction in LDL cholesterol, though not all the observed differences were statistically significant. Gemfibrozil lowered triglycerides more than did simvastatin. Gemfibrozil may be regarded as a useful alternative in patients with type IIb hyperlipoproteinemia who also have elevated serum triglycerides. However, in the recommended dose range, simvastatin demonstrated itself to be more effective in lowering total cholesterol and LDL cholesterol. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gemfibrozil

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Cost effectiveness of cholesterol-lowering therapy in The Netherlands: simvastatin versus cholestyramine

Article Abstract:

Cholestyramine is currently recommended by the Dutch Cholesterol Consensus Conference as the drug of first choice in the treatment of elevated blood cholesterol. Because simvastatin was registered in Holland at the end of 1988, there should now be a re-evaluation of treatment recommendations. The cost effectiveness of treatment was calculated as the cost of cholesterol-lowering treatment minus savings in the cost of treating coronary heart disease, divided by the net change in life expectancy. Using results from the 24-year follow-up of participants in the Framingham Heart Study and the Dutch national mortality statistics, the cost effectiveness was calculated. Simvastatin proved to be significantly more cost effective than cholestyramine. Other studies have also demonstrated a superior freedom from side effects with simvastatin treatment. The cost of one year of life gained by simvastatin therapy is about 50,000 Guilders, which is five times more than one year of life gained by breast cancer screening or screening for cervical cancer, and less than one year of life gained by heart transplantation or treating end-stage renal disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cholestyramine

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