HMG CoA reductase inhibitors as lipid-lowering agents: five years experience with lovastatin and an appraisal of simvastatin and pravastatin.

The HMG CoA reductase inhibitors are the most effective drugs for treating hypercholesterolaemia currently available. They inhibit cholesterol synthesis and thus stimulate receptor-mediated uptake and degradation of low-density lipoprotein cholesterol by the liver. In 30 patients with severe hypercholesterolaemia administration of lovastatin alone or in combination with other lipid-lowering manoeuvres maintained reductions of 25 to 31 per cent in serum cholesterol over five years. The drug was easy to take and well tolerated, the only significant side effect being a reversible myopathy. Two similar compounds, simvastatin and pravastatin, exert comparable effects on serum lipids, including modest reductions in triglycerides and increases in high-density lipoprotein cholesterol. The use of these drugs seems likely to exert a beneficial effect on atherosclerosis.