Lovastatin vs Cholestyramine Therapy for Primary Hypercholesterolemia

To the Editor.— Lovastatin is a remarkable drug. Better than any other medication yet available, lovastatin promptly lowers low-density lipoprotein cholesterol levels, with few apparent side effects. When I and my internist colleagues in west central Maine began prescribing lovastatin in October 1987, we were struck soon by what seemed like an unusual incidence of chest pain in patients recently started on therapy with the drug. In November 1987 one of 18 and in December 1987 seven of 20 admissions to Franklin Memorial Hospital for chest pain involved patients taking lovastatin. In three cases (two individual patients), starting lovastatin therapy did not seem to have changed the previous tempo of coronary symptoms. However, five patients with severe coronary atherosclerosis experienced a distinct acceleration of coronary symptoms between five and 49 days after starting lovastatin therapy; four developed newly unstable angina and one suffered an acute myocardial infarction. Was this a