CARDIOVASCULAR MEDICINE

Long term efficacy and safety of atorvastatin in the treatment of severe type III and combined dyslipidaemia

M van Dam¹, M Zwart¹, F de Beer², A H M Smelt², M H Prins¹, M D Trip¹, L M Havekes², P J Lansberg¹, J J P Kastelein¹

¹ Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, 1105 AZ Amsterdam, Netherlands
² Department of Internal Medicine, Leiden University Medical Centre, 2300 RC, Leiden, Netherlands

Correspondence to:
Correspondence to:
Dr JJP Kastelein, Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands;
e.vandongen{at}amc.uva.nl

Background: Fibric acid derivatives and HMG-CoA reductase inhibitors are effective in combination for treating patients with familial dysbetalipoproteinaemia and severe combined dyslipidaemia, but combination therapy affects compliance and increases the risk of side effects.

Aim: To evaluate the efficacy and safety of monotherapy with atorvastatin, an HMG-CoA reductase inhibitor with superior efficacy in lowering low density lipoprotein cholesterol and triglyceride concentrations, in patients with dysbetalipoproteinaemia and severe combined dyslipidaemia.

Methods: Atorvastatin was tested as single drug treatment in 36 patients with familial dysbetalipoproteinaemia and 23 patients with severe combined dyslipidaemia.

Results: After 40 weeks of 40 mg atorvastatin treatment decreases in total cholesterol, triglycerides, and apolipoprotein B of 40%, 43%, and 41%, respectively, were observed in the combined dyslipidaemia group, and of 46%, 40%, and 43% in the dysbetalipoproteinaemic patients. Target concentrations of total cholesterol (< 5 mmol/l) were reached by 63% of the patients, and target concentrations of triglycerides (< 3.0 mmol/l) by 66%. Treatment with atorvastatin was well tolerated and no serious side effects were reported.

Conclusions: Atorvastatin is very effective as monotherapy in the treatment of familial dysbetalipoproteinaemia and severe combined dyslipidaemia.

Keywords: familial dysbetalipoproteinaemia; apolipoprotein E; atorvastatin; severe combined dyslipidaemia

Abbreviations: apo E, apolipoprotein E; C, cholesterol; FD, familial dysbetalipoproteinaemia; HDL, high density lipoprotein; IDL, intermediate density lipoprotein (VLDL remnants); LDL, low density lipoprotein; TG, triglyceride; VLDL, very low density lipoprotein

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