[Therapy of hypercholesterolemia after heart transplantation with the HMG-CoA reductase inhibitor simvastatin in long-term follow-up].

The problem of hypercholesterolemia following heart transplantation (HTx) is often underestimated. Up to now there is no concept of therapy allowing an optimal adjustment of lipid parameters. Therapeutical trials using ion exchange resins, derivates of nicotinic acids and fibrates were not successful due to Cyclosporin A interaction, hepatotoxicity and limited efficacy of the applied substances. In a prospective, randomized and controlled trial, we investigated the effects of monotherapy with the HMG-CoA-reductase inhibitor Simvastatin in heart transplant recipients. The study included 70 patients (Simvastatin n = 37, control group n = 33). Eight patients died within the first 3 month postoperatively following HTx. Purpose of the study was adjustment of LDL-cholesterol-values in the Simvastatin-treated group to < 110 mg/dl. Following 24 months of treatment a mean LDL-cholesterol-plasma level of 110 mg/dl was obtained. The corresponding mean value of the control group was 150 mg/dl. The difference between both groups was significant (p < .001). In the same period the mean HDL-cholesterol values increased by approximately 15% in both groups. The ratio of LDL-/HDL-cholesterol was significantly lower in the Simvastatin treated group (2.28) than in the control group (2.94) (p < .01). There was no significant difference in Lp(a)-values. No adverse effects were observed within the following period of 24 months, particularly no increase in the frequency of rejection episodes. The drug induced hypercholesterolemia following HTx could be treated safely and effectively by low-dose Simvastatin.