Simvastatin and pravastatin: a daily dose of 40 mg in the long-term treatment of primary hypercholesterolemia.

This study was conducted to evaluate whether an increase in simvastatin and pravastatin dosage can produce a further reduction in plasma total cholesterol (TC) in patients who do not show adequate responses to lower doses. The efficacy and tolerance of long-term treatment (12 months) were also evaluated. Full doses of simvastatin and pravastatin were given to a group of 25 patients with primary hypercholesterolemia. Fourteen patients were given a daily dose of 40 mg of simvastatin and 11 patients were given the same daily dose of pravastatin. All patients were affected by heterozygous familial hypercholesterolemia (lipoprotein phenotype IIa). These patients showed poor reduction of plasma apolipoprotein B-containing lipoprotein levels when treated with simvastatin and pravastatin at lower doses (20 to 30 mg/day). After 6 and 12 months there were statistically significant decreases in plasma non-high-density lipoprotein cholesterol (non-HDL-C) levels. The ratio, HDL-C/TC-HDL-C, named HDL-C ratio, increased following treatment with simvastatin and pravastatin. As expected, the results indicated more significant decreases in plasma HDL-C levels with simvastatin than with pravastatin. Both drugs were well tolerated at a dose of 40 mg/day.