Lovastatin (mevinolin) in the treatment of heterozygous familial hypercholesterolemia. A multicenter study.

STUDY OBJECTIVE

To evaluate the efficacy and tolerability of lovastatin under controlled conditions in heterozygous familial hypercholesterolemia.

DESIGN

Randomized, double-blind, placebo-controlled, multicenter trial.

SETTING

Five lipid clinics with a central laboratory and coordinating center.

PATIENTS

101 adult patients with heterozygous familial hypercholesterolemia.

INTERVENTIONS

Patients were on a lipid-lowering diet throughout the study. After a 4-week placebo baseline period, patients were randomized to five equal treatment groups. Each group received a different sequence of placebo or lovastatin 5 to 40 mg twice daily or 20 to 40 mg once daily in the evening, during three consecutive 6-week periods.

MEASUREMENTS AND MAIN RESULTS

The mean reductions in total plasma cholesterol and low-density lipoprotein cholesterol across the dosage ranges were 14% to 34% and 17% to 39%, respectively (p compared with zero and placebo less than 0.01). High-density lipoprotein cholesterol and apolipoproteins AI and AII rose slightly. Apolipoprotein B fell substantially at the higher dosage levels (-23% at 40 mg twice daily, p less than 0.01), indicating a reduction in the concentration of circulating low-density lipoprotein particles. Maximum response was achieved in 4 to 6 weeks. Twice-daily dosing was slightly more efficient than once-daily dosing. Of those patients receiving 40 mg twice a day, 89% had a fall in low-density lipoprotein cholesterol of at least 20%, and 61% had a fall of at least 40%. Adverse effects attributable to lovastatin were minimal, and no patient was withdrawn from the study.

CONCLUSION

Lovastatin was well tolerated and effective in the treatment of familial hypercholesterolemia.