Comparison of the effectiveness of lovastatin therapy for hypercholesterolemia after heart transplantation between patients with and without pretransplant atherosclerotic coronary artery disease

With the aim of assessing the effectiveness and safety of lovastatin in patients with hypercholesterolemia after heart transplantation, as well as the potential differences in the lipid-lowering effect of lovastatin between patients with or without pretransplant coronary artery disease (CAD), we studied 63 heart transplant patients who had serum total cholesterol >250 mg/dl in spite of dietary therapy. Mean age of subjects was 47 ± 2 years. Triple-drug immunosuppressive therapy consisted of cyclosporine, azathioprine, and steroids. Thirty-nine patients (62%) had pretransplant CAD and 24 (38%) did not. Pretreatment serum lipid levels were: total cholesterol, 302 ± 32 mg/dl; low-density lipoprotein (LDL) cholesterol, 201 ± 35 mg/dl; high-density lipoprotein (HDL) cholesterol, 60 ± 19 mg/dl; triglycerides, 205 ± 86 mg/dl; and total/HDL cholesterol ratio, 5.4 ± 1.6. Patients received 10 to 40 mg/day of lovastatin (mean dose 17 ± 6) for 13 ± 4 months. There were no serious adverse events. At 3 months, lovastatin decreased total cholesterol by 15% (p < 0.001), LDL cholesterol by 21% (p < 0.001), triglycerides by 17% (p < 0.05), and total/HDL cholesterol ratio by 17% (p < 0.001), and increased HDL cholesterol by 3% (NS). Although lovastatin was effective in both patients with pretransplant CAD and non-CAD, analysis of its effect in each subgroup (CAD and non-CAD) revealed that its lipid-lowering effect was higher for non-CAD patients (−20% vs −12% for total cholesterol, and −27% vs −17% for LDL cholesterol, both p < 0.01). Thus, lovastatin was useful and safe for the treatment of hypercholesterolemia after heart transplantation, although it was more effective in patients without pretransplant CAD.