Comparison of atorvastatin and simvastatin in the long-term treatment of hyperlipidemia after kidney transplantation

Abstract

Background: Hyperlipidemia is a common complication after kidney transplantation. However, there is little long-term data on the efficacy and tolerability of statin therapy in kidney transplant recipients. Methods: We performed a prospective 3-year study to investigate the effects of atorvastatin treatment in 15 hypercholesterolemic stable renal allograft recipients on maintenance immunosuppression with corticosteroid and cyclosporine. Results were compared with data from 15 historical controls matched for baseline hyperlipidemia and renal allograft function who had been treated with simvastatin. Results: Patients in the two treatment groups showed similar baseline characteristics. The average dosages of atorvastatin and simvastatin were 9.25 ± 2.82 mg and 8.38 ± 1.86 mg, respectively. Atorvastatin treatment reduced total cholesterol (TC) by 31.1%, 27.7%, 25.9% and 28.9%, and low-density lipoprotein (LDL) by 43.4%, 37.4%, 36.8% and 41.6%, after 3, 12, 24 and 36 months of treatment, respectively. A significant reduction in triglycerides (TG) was noted after 3 and 9 months, but was not sustained. High-density lipoprotein levels were unaltered. Reductions in TC and LDL after simvastatin treatment appeared less pronounced, although the differences did not reach statistical significance. At last follow-up, 90.9% of atorvastatin-treated patients achieved target LDL of less than 3.4 mmol/L, compared with 78.6% of the simvastatin group. No patients developed adverse reactions including abnormalities in liver enzyme or creatine kinase levels. Acute rejection was not observed, although one patient on simvastatin developed chronic allograft nephropathy. Conclusion: Atorvastatin and simvastatin demonstrated sustained efficacy in reducing the levels of TC and LDL in stable renal allograft recipients. While atorvastatin may be more potent than simvastatin in the treatment of hypercholesterolemia, its TG-lowering effect was not sustained with long-term treatment. The difference in the therapeutic efficacy between the two drugs might have been due to dose rather than to the drugs themselves.