Low-dose simvastatin for the treatment of hypercholesterolaemia in recipients of cardiac transplantation

There is increasing evidence that hypercholesterolaemia is an important contributor to the development of accelerated coronary arterial disease in the cardiac allograft. The optimal drug therapy of hypercholesterolaemia in recipients after cardiac transplantation, however, has not been defined. Simvastatin (an inhibitor of hydroxy-methyl glutaryl-coenzyme A reductase), at a dose of 10 mg/day, was administered to 12 recipients with serum total cholesterol ≥ 7.8 mmol/l and serum triglyceride ≤ 4.5 mmol/l refractory to dietary measures during a follow-up period of 1-5 yearsafter cardiac transplantation. All patients received maintenance doses of cyclosporin A and, in some instances, azathioprine and prednisolone. After 2 months treatment with simvastatin, serum total cholesterol was significantly reduced from 8.8 ± 0.3 mmol/l (mean ± SEM) to 5.5 ± 0.5 mmol/l, P < 0.001, low density cholesterol from 6.6 ± 0.4 to 3.8 ± 0.3 mmol/l, P < 0.001 and triglycerides from 2.4 ± 0.2 mmol/l to 1.8 ± 0.2 mmol/l, P < 0.005. These changes were maintained after a period of treatment of 8 months. Serum high density cholesterol, hepatic transaminase levels, serum creatinine, creatine kinase and cyclosporin A blood levels were not altered by treatment with simvastatin. It is concluded that, in this study group, low-dose simvastatin appears to be well tolerated and has favourable lipid modifying properties.