Key result
Pravastatin lowers total cholesterol ~16% in primary hypercholesterolemia, underperforming probucol.
Why the study?
The effects of pravastatin and probucol on HDL-cholesterol levels and related lipolytic activities in primary hypercholesterolemia were not fully understood.
Does pravastatin compared to probucol improve plasma lipids and lipoproteins in patients with primary hypercholesterolemia?
RCT (n=14)
Does pravastatin compared to probucol improve plasma lipids and lipoproteins in patients with primary hypercholesterolemia?
Effect estimate: 16% reduction with pravastatin, 24% reduction with probucol
p-value: p=<0.05 for pravastatin, <0.01 for probucol
Pravastatin effectively lowers total cholesterol without the adverse reduction in HDL-cholesterol seen with probucol in patients with primary hypercholesterolemia.
Probucol lowers HDL-C unlike pravastatin; leaves open which HDL particle changes best prevent atherosclerosis.
Pravastatin is a new derivative of compactin and has been found to be a specific inhibitor of hydroxymethylglutaryl-coenzyme A reductase.In this study, the effectiveness of pravastatin and probucol was tested in patients with primary hypercholesterolemia in crossover design. Special attention was paid to the erects on HDL-cholesterol levels since they have been shown to be a major factor in predicting the risk of coronary heart disease. Because available evidence suggests that the activities of the lipoprotein lipase system and LCAT are related to the level of plasma HDL and the HDL subpopulation distribution, the effects of these drugs on postheparin lipolytic activity and LCAT activity were measured.HDL particles were also examined by gradient gel electrophoresis to determine the effects of these drugs on particle size distribution. We obtained the following results.1. Treatment with pravastatin reduced mean total plasma cholesterol, triglyceride and phospholipid levels by 16% (p<0.05), 30% (N. S.) and 13 (p<0.05), respectively.2. In the probucol group, mean total plasma cholesterol and phospholipid levels were decreased by 24% (p<0.01) and 20% (p<0.01), respectively.3. As for he effects on HDL-cholesterol before drug-cross ver (at period B), probucol reduced HDL-cholesterol levels significantly (p<0.01) while pravastatin had no significant effect on HDL-cholesterol.4. In contrast to the effects of these drugs on HDL, we noted a decrease in the activities of LPL, and no significant change in LCAT activities were seen in either group.5. Gradient gel electrophoretic profiles of HDL particles after probucol treatment showed a reduction of larger HDL2 particles and a prevalence of smaller HDL2 particles and HDL3 particles when compared with the controls.In the pravastatin group, HDL2 particles were larger than those of the controls.These results showed the effects of our test drugs on HDL particles.Further study is needed to find which HDL changes are favorable to prevent atherosclerosis.
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Kagami et al. (1989) conducted an RCT in Primary hypercholesterolemia (n=14). Pravastatin and Probucol vs. Baseline/Crossover was evaluated on Mean total plasma cholesterol (16% reduction with pravastatin, 24% reduction with probucol, p=<0.05 for pravastatin, <0.01 for probucol). Treatment with pravastatin reduced mean total plasma cholesterol by 16% and probucol reduced it by 24% in patients with primary hypercholesterolemia.
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