Comparison of simvastatin and cholestyramine in the treatment of primary hypercholesterolaemia

R. C. O'Brien, L. A. Simons, P. Clifton, M. E. Cooper, G. L. Jennings, G. Jerums, P. J. Nestel, D. Sullivan

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The effects of simvastatin, a competitive inhibitor of the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase, on plasma lipid levels were compared with those of the bile acid sequestrant cholestyramine in a randomized parallel study of 60 subjects with primary hypercholesterolaemia. After a 12-week direct comparison period 37 subjects with inadequate cholesterol reduction received a combination of both drugs and all subjects were followed for a further 40 weeks. Simvastatin was more effective than cholestyramine in lowering total and LDL cholesterol levels and the LDL/HDL ratio (-31.7% v. -19.7% [P < 0.01], -41.0% v. -31.8% [P < 0.05] and -46.7% v. -33.6% [P < 0.01], respectively at Week 12). Only simvastatin significantly increased the HDL cholesterol concentration (+13.3% [P < 0.01] v. +6.4%). Cholestyramine increased plasma triglyceride levels by 37.5% (P < 0.01) whereas simvastatin caused a slight non-significant reduction. Combined therapy produced a further decrease in total and LDL cholesterol levels, and in the LDL/HDL ratio, which was sustained for the duration of the study. Simvastatin was better tolerated than cholestyramine (P < 0.01), and combining the two drugs enhanced efficacy without increasing the frequency of side effects.

Original languageEnglish
Pages (from-to)480-483
Number of pages4
JournalThe Medical Journal of Australia
Issue number9
Publication statusPublished - 1 Jan 1990
Externally publishedYes

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