Treatment of familial hypercholesterolaemia: A controlled trial of the effects of pravastatin or cholestyramine therapy on lipoprotein and apoliprotein levels

O. Wiklung, B. Angelin, G. Fager, M. Eriksson, S. O. Olofsson, Lars Berglund, T. Linden, A. Sjoberg, G. Bondjers

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

The efficacy and safety of a new, selective inhibitor of cholesterol synthesis, pravastatin, and the bile acid-binding resin, cholestyramine, were compared in a randomized, double-blind study of 120 patients with familial hypercholesterolaemia. After a run-in period of 8-10 weeks with assessment of dietary habits, the patients were treated with pravastatin + placebo, placebo + cholestyramine, or placebo alone. Active pravastatin therapy was initiated with 10 mg b.i.d. for 6 weeks, and was increased to 20 mg b.i.d. for the following 6 weeks. Cholestyramine was given at 24 g d-1, or the highest tolerable dose. After 6 weeks of therapy, serum total and LDL cholesterol levels were reduced by 17% and 21%, respectively, on pravastatin treatment, whereas the corresponding reductions with cholestyramine treatment were 24% and 30%, respectively. With an increased dose of pravastatin, serum and LDL cholesterol concentrations were reduced by 23% and 28%, respectively, after 12 weeks; the effect of cholestyramine was unchanged. HDL cholesterol levels increased in response to pravastatin, by 7% and 9% after 6 and 12 weeks, respectively. Concomitant changes in the concentrations of apolipoproteins B and AI were observed. Three patients discontinued the study because of side-effects: two subjects were treated with pravastatin and one was given placebo. The prevalence of side-effects (including laboratory abnormalities) was 35% for pravastatin, 30% for placebo, and 53% (significantly higher) for cholestyramine. We conclude that pravastatin, in a 40 mg daily dose, is as effective as cholestyramine in lowering LDL cholesterol in familial hypercholesterolaemia. Since the frequency of side-effects is higher with cholestyramine pravastatin offers a promising alternative for the therapy of this genetic disease.

Original languageEnglish (US)
Pages (from-to)241-247
Number of pages7
JournalJournal of Internal Medicine
Volume228
Issue number3
StatePublished - 1990
Externally publishedYes

Keywords

  • apolipoproteins
  • cholesterol
  • cholestyramine
  • familial hypercholesterolaemia
  • HMG-CoA reductase inhibitors
  • lipoproteins
  • pravastatin

ASJC Scopus subject areas

  • Internal Medicine

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  • Cite this

    Wiklung, O., Angelin, B., Fager, G., Eriksson, M., Olofsson, S. O., Berglund, L., Linden, T., Sjoberg, A., & Bondjers, G. (1990). Treatment of familial hypercholesterolaemia: A controlled trial of the effects of pravastatin or cholestyramine therapy on lipoprotein and apoliprotein levels. Journal of Internal Medicine, 228(3), 241-247.