Efficacy and Safety of a New HMG-CoA Reductase Inhibitor, Atorvastatin, in Patients With Hypertriglyceridemia

Abstract

<h3>Objective.</h3> —To assess the lipid-lowering effect of atorvastatin (a new 3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase inhibitor) on levels of serum triglycerides and other lipoprotein fractions in patients with primary hypertriglyceridemia, determine if atorvastatin causes a redistribution of triglycerides in various lipoprotein fractions, and assess its safety by reporting adverse events and clinical laboratory measurements. <h3>Design.</h3> —Randomized double-blind, placebo-controlled, parallel-group, multicenter trial. <h3>Setting.</h3> —Community- and university-based research centers. <h3>Patients.</h3> —A total of 56 patients (aged 26 to 74 years) with a mean baseline triglyceride level of 6.80 mmol/L (603.3 mg/dL) and a mean baseline low-density lipoprotein cholesterol (LDL-C) level of 3.07 mmol/L (118.7 mg/dL). <h3>Interventions.</h3> —Cholesterol-lowering diet (National Institutes of Health National Cholesterol Education Program Step I Diet) and either 5 mg, 20 mg, or 80 mg of atorvastatin, or placebo. <h3>Main Outcome Measures.</h3> —Percent change from baseline in total triglycerides for three dose levels of atorvastatin compared with placebo. <h3>Results.</h3> —Mean reductions in total triglycerides between 5 mg, 20 mg, and 80 mg of atorvastatin and placebo after 4 weeks of treatment were —26.5%, —32.4%, —45.8%, and —8.9%, respectively. Mean reductions in LDL-C were —16.7%, —33.2%, —41.4%, and —1.4%, respectively, and very low-density lipoprotein cholesterol (VLDL-C) were —34.3%, —45.9%, —57.7%, and —5.5%, respectively. Similar mean changes in total apolipoprotein B (apo B) (—16.9%, —32.8%, —41.7%, and + 1.0%), apo B in LDL (—14.8%, —29.8%, —42.0%,and —3.1%),and apo B in VLDL (—23.8%, —35.8%, —34.4%, and +11.7%) were observed. In addition, comparable mean changes in LDL triglycerides (—22.5%, —30.7%, —39.9%, and +3.9%) and VLDL triglycerides (—28.1%, —34.0%, —47.3%, and —10.8%) were seen. <h3>Conclusions.</h3> —In atorvastatin treatment groups, total serum triglyceride levels decreased in a dose-dependent manner; reductions in the 20-mg and 80-mg groups were statistically significant (<i>P</i>&lt;.05) compared with placebo. Atorvastatin did not cause a redistribution of triglycerides but consistently lowered triglycerides in all lipoprotein fractions. Atorvastatin was well tolerated. (<i>JAMA</i>. 1996;275:128-133)