Comparison of the efficacy and safety of pravastatin and simvastatin in heart transplantation.

AIMS: Data on the safety and efficacy of HMG CoA reductase inhibitors in managing dyslipidemia in heart transplant recipients is inadequate. We undertook this study to evaluate the comparative safety and efficacy of simvastatin and pravastatin in lowering lipids in heart transplant recipients. METHODOLOGY: Forty eight patients (38 males) who received heart transplantation between 1995 and 1997, and who had no contraindications to statin therapy or history of myopathy were randomized to receive either pravastatin (n=24) or simvastatin (n=24) for six months. Detailed fasting lipid profiles, hepatic function tests, and serum creatinine phosphokinase were obtained regularly. Baseline and six month characteristics were compared using the unpaired student t test for continuous variables and Chi-square analysis or Fisher's exact test, as appropriate. RESULTS: Baseline total cholesterol levels, LDL cholesterol levels, HDL cholesterol levels, and triglyceride levels were similar in the two groups. At six months, the total cholesterol, LDL cholesterol, and triglyceride levels were greatly reduced in both groups, with greater reductions in the simvastatin group than in the pravastatin group. Only modest increases were noted in HDL cholesterol levels in the two groups. No significant adverse effects were noted, and no complications with drug withdrawals occurred. Patient compliance exceeded 97%. CONCLUSION: Simvastatin and pravastatin are safe and very effective in total cholesterol and LDL cholesterol lowering in heart transplant recipients, with simvastatin being more efficacious than pravastatin in lipid lowering in this group of patients.

Vasculopatía del injerto cardíaco: conceptos actuales / Cardiac allograft vasculopathy

La causa principal de muerte tardía en los receptores de trasplante cardíaco es la vasculopatía del injerto, también llamada ateroesclerosis del trasplante cardíaco, la cual ocurre en el 15 por ciento a 20 por ciento de los trasplantes de corazón. Difiere de la ateroesclerosis convencional en que es un proceso de hiperplasia de la íntima concéntrico y difuso, rara vez con calcificación y con la lámina elástica interna intacta. La porción distal de los vasos coronarios es la que primero se ocluye, ocurriendo en forma rápida. Con alguna frecuencia se asocia a vasculitis leve. Aunque no hay una razón definida para la ocurrencia de esta vasculopatía, se han involucrado causas inmunológicas y no inmunológicas que afectan a las células endoteliales y llevan a la proliferación de la mioíntima. El ultrasonido intravascular y la angioscopía parecen ser medidas diagnósticas más sensibles para su detección que la angiografía coronaria. Actualmente se estima que el único tratamiento definitivo es el retrasplante, pero con resultados regulares