Efficacy of simvastatin compared with atorvastatin in patients with hyperlipidaemia in Kurdistan

  • Showan D. Husain Department of Clinical Analysis, College of Pharmacy, Hawler Medical University, Erbil-Iraq
  • Wishyar Abbas Hamad Ministry of Health, Diabetic Center, Erbil-Iraq
  • Ari Aziz Salih Ministry of Health/Department of Medical supply, Erbil-Iraq
Keywords: hyperlipidaemia, atherogenic index, atorvastatin, simvastatin, alanine aminotransferase


Background and objectives: Lowering the blood cholesterol and low density lipoprotein levels may reduce the risk of coronary heart disease. This study was designed to evaluate the effect of lipid-lowering therapy by simvastatin 20 mg versus atorvastatin 20mg on patients suffering from hyperlipidemia.

Method: This study is 16-weeks duration included 75 patients with hyperlipidemia. Patients were assigned randomly to receive either simvastatin 20 mg/day group (1), or atorvastatin 20 mg/day group (2). After 12 hours fasting, lipid profile, atherogenic index and alanine aminotransferase were assessed for the patients at baseline, 8-weeks and at the end of 16-weeks of treatment.

Results: After therapy for both groups of patients, as compared to the levels at the baseline, the serum total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) were significantly reduced while high density lipoprotein cholesterol (HDL-C) was significantly increased. Serum alanine aminotransferase (ALT) increased by both groups of treatment with no significant differences between the two modes of treatment.

Conclusion: After treatment with simvastatin 20 mg and atorvastatin 20 mg, there were a reduction in total cholesterol, triglyceride, LDL-C, and VLDL-C, and an increase in HDL-C in both groups. Comparing the two types of treatment, atorvastatin 20 mg was more effective in lowering triglyceride and VLDL-C than simvastatin 20 mg while Simvastatin led to greater reduction in LDL-C. Both modes of treatment were well tolerated by the patients.


- Ballantyne CM: Low-density lipoproteins and risk for coronary artery disease. Am J Cardiol 1998; 82: 3Q-12Q.

- Group HPSC: MRC/BHF. Heart protection study of antioxidant vitamin supplementation in 20536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360:23-33.

- Larosa JC, Grundy SM, Waters DD: Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Eng J Med 2005, 352:1425-35.

- Sever PS, Daholf B, Poulter NR for the ASCOT investigators: Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the anglo-scandinavian cardiac outcomes trial lipid lowering arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet 2003; 361: 1149-58.

- De Backer G, Ambrosioni E, Borch-Johnsen K. European society of cardiology committee for practice guidelines: European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of european and other societies on cardiovascular disease prevention in clinical practice. Eur J Cardiovascular Prev Rehabil 2003; 10(4):S1-S10.

- Expert panel on detection evaluation and treatment of high blood cholesterol in adults: Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).JAMA 2001; 285: 2486-97.

- Group EUROASPIREIIS: Lifestyle and risk management and use of drug therapies in coronary patients from 15 countries. Principal results from EUROASPIRE II. Eur heart J 2001; 22: 554-72 .

- Pearson TA, Laurora I,Chu H, Kafonek S: The lipid treatment assessment project ( L-TAP): a multicenter survey to evaluate the percentage of dyslipidemic patients receiving lipid lowering therapy and achieving low-density cholesterol goals. Arch Intern Med 2000; 160: 459-67.

- Palanisamy P., Saravanan G, Rao Y.Y.,Farook J., Bakthavathsalam G. Effective analysis of atorvastatin versus in simvastatin in patients with hyperlipidemia. J.Pharm.Sci&Res.2009; 1(2):16-21.

- Bilheimer D, Grundy S, Brown M, Goldstein J. Mevinolin and colestipol stimulate receptor-mediated clearance of low-density lipoprotein from plasma in familial hypercholesterolemia heterozygotes. Proc Natl Acad Sci 1983; 80: 4124–8.

- Schaefer E, McNamara JR, Tayler T, Daly J, Gleason J. Comparisons of effects of statins (atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin) on fasting and postprandial lipoproteins in patients with coronary heart disease versus control subjects. Am J Cardiol 2004; 93:31-9 .

- Wierzbicki A, Lumb P, Semra Y, Chik G, Christ E, Crook M. Atorvastatin compared with simvastatin-based therapies in the management of severe familial hyperlipidaemia. Q J Med 1999; 92: 387-94 .

- Arja V, Merja R, Antti J, Jukka M, Risto H . Effects of diet and simvastatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men. JAMA 2002; 287:598-605.

-Osamu N, Masatoshi M, Motoshige M, Takahiro N, Iwao N. Effect of simvastatin on the lipid profile of hemodialysis patients. Kidney Int 1999;56: 219–21.

- Peter J, Stephanie K, Irene L, Donald H. Comparative dose efficacy study of atorvastatin versus simvastatin, paravastatin, lovastatin and fluvastatin in patients with hypercholesterolemia( The Curves Study). Am.J Cardiol 1998; 81: 582-7.

- Branchi A, Fiorenza A, Torri A, Muzio F, Rovellini A.. Effects of atorvastatin 10mg and simvastatin 20mg on serum triglyceride levels in patients with hypercholesterolemia. Curr Therap Res 2001;8:405-15.

- Fernando C, Ana c, Juan F, Jose P, Garcia-Otin. Comparison of the hypolipidemic effect of gimfibrozil versus simvavtatin in patients with type III hyperlipoproteinemia. Medscape Am J 1999; 138(1):156-62.

- Abdul-Basit A, Humaira R, Zafar H, Rubina H , Yakoob A . The effect of simvastatin on diabetic dyslipidemia. Journal of Baqai Medical University 2001; 2 :6-8.

- Emel A, Banu N, Canan O, Sema G, Sezer C. The effect of simvastatin treatment on plasma ubiquinone, blood ATP concentrations, total antioxidant capacity and muscle related markers. Turk J Med Sci 2002 ;32: 323-8.

- Kubota T, Fujisaki K, Itoh Y, Yano T, Sendo T. Apoptotic injury in cultured human hepatocytes induced by HMG-CoA reductase inhibitors. Biochem. Pharmacol. 2004; 67: 2175-86.

- Scott R, Lintott C, Wilson M . Simvastatin and side effects. N Z Med 1991; 104: 493-5.

- Darioli R, Bovet P, Brunner HR, Bercher L . Evaluation of tolerance, efficacy and safety of 3-year simvastatin use in the treatment of primary hypercholesterolaemia. Schweiz. Med. Wochenschr 1990 ; 120: 85-91.

- Zena A, Isam M . Comparative effects of lovastatin and simvastatin on liver function tests in hyperlipidemic patients The Medical Journal of Basrah University 2007 ; 25 (1):20-4.

- Nawrocki JW, Weiss SR, Davidson MH Sprecher DL, Schwartz SL. Reduction of LDL cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA reductase inhibitor. Arterioscler Thromb Vasc Biol 1995;15 : 678–82.

- Marian G, Soledad GV, Vicente L. Effects of atorvastatin on inflammatory and fibrinolytic parameters in patients with chronic kidney disease. J Am Soc Nephrol 2006; 17: S231–S5.

- Hing-Chung L, Chih-Hsun C, Mei-Chih W Hsiu-Man Keng, Chih-Chen Lu. The effects of different doses of atorvastatin on plasma endothelin-1 levels in type 2 diabetic patients with dyslipidemia. Exp Biol Med 2006; 231 :1010-15.

- Schrott H, Fereshetian AG, Knopp RH. A multicenter placebo-controlled dose-ranging study of atorvastatin. J Cardiovasc Pharmacol Ther 1998 ; 3:119–24.

- Athyros VG, Giouleme OI, Nikolaidis NL, Vasiliadis TV, Bouloukos VI. Long-term follow up of patients with acute hypertriglyceridemia-induced pancreatitis. J Clin Gastroenterol 2002B ; 34:472–7.

- Trifiletti A, Lasco R, Scamardi M.A, Pizzoleo A. Gaudio R. Long-term hemostatic effects of cholesterol–lowering therapy with atorvastatin. Pathophysiol Haemost Thromb 2003 ;33:84–7.

- Jeevan k.S, Mungli P, Sudashna T. Effect of atorvastatin on paraoxonase activity in patients with hyperlipidemia. Asian j Bioch 2008;3(2): 139-42 .

- Martin G, Duez H, Blanquart C, Berezowski V, Poulain P, Fruchart JC. Statin-induced inhibition of the Rho-signaling pathway activates PPARalpha and induces HDL apoA-I. J Clin Invest 2001;107: 1423-32.

- Bays H, Stein EA. Pharmacotherapy for dyslipidaemia–current therapies and future agents. Expert Opin Pharmacother 2003; 4:1901-38.

- Michael B, Clearfield J.A, Jean-Pierre B Hugo R. Sam S. Comparison of the efficacy and safety of rosuvastatin 10 mg and atorvastatin 20 mg in high-risk patients with hypercholesterolemia. Eur J Biochem 2006 ;29: 7-35.

- Kamran A, didar Z . Efficacy of alternative dosing of atorvastatin. Journal of Chinese clinical medicine 2007; 2 : 11-7.

How to Cite
Husain, S., Hamad, W., & Salih, A. (2018). Efficacy of simvastatin compared with atorvastatin in patients with hyperlipidaemia in Kurdistan. Zanco Journal of Medical Sciences (Zanco J Med Sci), 16(2), 90-97. https://doi.org/10.15218/zjms.2012.0016
Original Articles