Pravastatin vs gemfibrozil in the treatment of primary hypercholesterolemia: the Italian Multicenter Pravastatin Study I

Article Abstract:

There is a link between low-density-lipoprotein (LDL) cholesterol level and illness and death from coronary heart disease (CHD). A tendency to have a high cholesterol level is inherited (familial hypercholesterolemia, FH) in less than 5 percent of the cases; for the rest the origin is unknown, and there are probably several different causes. Patients with mild or moderate elevations of LDL cholesterol are at risk for CHD. Cholesterol-lowering drugs such as lovastatin and simvastatin are now in use. Pravastatin is in the same class of drugs, and has been found to have very few side effects in both humans and research animals. This is a report of a six-month segment of a two-year, multicenter study of 360 patients with high blood cholesterol who took either pravastatin or gemfibrozil, another lipid-lowering drug. Pravastatin lowered total cholesterol by 23 percent, primarily by lowering LDL cholesterol, which was reduced by 30 percent. Patients with primary hypercholesterolemia had a greater reduction in LDL cholesterol than those with FH, but both effects were significant. There were no significant side effects reported during the trial. Gemfibrozil reduced total cholesterol by only 14 percent and LDL cholesterol by 17 percent, but this smaller benefit was somewhat offset because gemfibrozil raised the level of high-density-lipoprotein (HDL) cholesterol by 13 percent, compared with a 5 percent increase in HDL with pravastatin (higher levels of HDL are thought to protect against heart disease). Pravastatin reached its maximum effect after four weeks, and this effect remained stable until the end of the trial (at 24 weeks). Because of differences in methodology and dosage used in other studies, it has not been possible to compare pravastatin to lovastatin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pravastatin

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Comparative study of a microporous cholestyramine analogue (filicol) and gemfibrozil for treatment of severe primary hypercholesterolemia: short- and long-term results

Article Abstract:

Lipids, or fats, in the blood are a risk factor for coronary heart disease (CHD), and this risk increases as levels of total cholesterol and low-density lipoprotein cholesterol (LDLc) increase. Long-term dietary intervention, sometimes with the addition of drugs, can lower total and low-density lipoprotein cholesterol levels, and decrease the risk of heart disease. Lipid-lowering therapy can help prevent death after a heart attack, and can stop the progress of coronary artery disease (atherosclerosis). Health agencies have made policy statements recommending the use of drugs to lower high cholesterol when LDLc levels exceed 3.9 mmol per liter (150 mg. per deciliter). Two drugs, gemfibrozil and filicol, were tested in 50 patients with high cholesterol and high-risk profiles. Both drugs were well tolerated, and after 12 weeks they reduced the levels of total cholesterol by 14 percent, LDLc and apolipoprotein B by almost 20 percent, and these effects continued for 12 months in those patients on long-term therapy. Small doses of filicol were safe and effective. This is true also for cholestyramine (filicol's parent compound), but side effects such as digestive problems limit its usefulness. Cholestyramine and filicol both produced a small increase in triglyceride levels, while gemfibrozil lowered triglycerides by 35 percent, but this may not be clinically important. However, gemfibrozil also raised HDLc levels, and the importance of raising HDLc is becoming clearer as the importance of the LDLc to HDLc ratio is better appreciated. Gemfibrozil is more effective in altering in the blood lipid profile than filicol. Other new drugs are now available, but their long-term safety is still in question. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Substituting Walnuts for Monounsaturated Fat Improves the Serum Lipid Profile of Hypercholesterolemic Men and Women

Article Abstract:

Using walnuts as part of the monounsaturated fat content of a Mediterranean diet can lower cholesterol levels even more than the diet itself. Researchers asked 49 men and women with high cholesterol levels to substitute walnuts for about 35% of the monounsaturated fat content in a Mediterranean diet over a six-week period. After this change, cholesterol levels dropped an average of 4% overall, LDL, or 'bad' cholesterol dropped an average of 6%, and lipoprotein(a) levels dropped 6%.

Health aspects, Diet therapy, Walnut, Walnuts

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