Therapy of post-renal transplantation hyperlipidaemia: comparative study with simvastatin and fish oil

Background: Recipients of renal transplantation (RT)exhibit disturbances of serum lipids and apoproteins that may contribute totheir cardiovascular morbidity and mortality. In our renal transplantdepartment the hypercholesterolaemia prevalence at the first and fifth yearof RT is 70.0% and 81.2%, respectively. Lipid-lowering therapy has beenutilized in many Transplant Units. The aim of our study was to evaluatepost-RT hyperlipidaemia control with simvastatin or fish oil.Method: Forty-three RT patients (26 men and 17 women)with persistent hypercholesterolaemia and stable graft function which wereresistant to a lipid-lowering diet (American Heart Association Step Two)were randomized into two groups and treated for 3 months with simvastatin(S) (10 mg/day; n=25) and fish oil (F) (6 g/day; n=18). Total cholesterol(TC), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), lipoprotein a(Lp(a)), apolipoprotein A1 (Apo A1), and apolipoprotein B (Apo B) weremonitored and at the study baseline they were similar between the twogroups. Results: No side effects were detected after 3months of therapy. In group S, the concentrations of TC (271±46mg% vs 228±49mg%; P <0.001), TG (180±78 vs134±45; P<0.01), LDL-C (177& plusmn;40 vs144±43; P <0.01) and Apo B (96±18 vs82±16; P <0.001) were significantly reduced, and Apo A1concentration had increased (135±24 vs 149±30; P<0.01). In group F, the concentrations of TC (266±25 vs240±31; P <0.001), TG (203±105 vs156±72; P=0.02) and HDL-C (63±15 vs 53±12;P <0.01) were significantly reduced.Conclusion: We concluded that low-dose simvastatin andfish oil are both effective and safe in correcting post-RT hyperlipidaemia.Further prospective studies with larger follow-up are needed to clarifywhether this therapy has an impact on cardiovascular morbidity andmortality in RT patients.