Switch from Gemfibrozil to Lovastatin (Mevinolin) Therapy in Patients with Primary Hypercholesterolaemia

This comparative study was designed to evaluate the changes in lipids and lipoprotein profiles in 141 hypercholesterolaemic patients with normal or moderately elevated triglycerides who were switched to lovastatin (mevinolin) therapy after 12 weeks of treatment with gemfibrozil 600mg twice daily. In stratum 1 (serum cholesterol 6.2–7.79 mmol/ L [n = 43]), patients started with lovastatin 20 mg/day and in stratum 2 (serum cholesterol ≥ 7.8 mmol/L [n = 98]) with lovastatin 40 mg/day. If serum cholesterol remained above 5.0 mmol/L after 6 weeks, the dose was doubled. Lovastatin produced a significantly greater fall in low density lipoprotein cholesterol both with the initial doses at 6 weeks (stratum 1: 29%; stratum 2: 35%) and with the increased doses at 12 weeks (stratum 1: 35%; stratum 2: 42%), compared with gemfibrozil (stratum 1: 13%; stratum 2: 17%). Although both drugs decreased serum triglyceride levels, gemfibrozil was much more effective. Both drugs increased high density lipoprotein (HDL)-cholesterol concentrations, the increases during gemfibrozil therapy ranging from 18% (stratum 1) to 11% (stratum 2) and during lovastatin therapy from 10% (stratum 1) to 8% (stratum 2). The total cholesterol: HDL-cholesterol ratio was reduced significantly more by lovastatin than by gemfibrozil, except with the smallest lovastatin dose.