The HMG CoA reductase inhibitors have quickly
become the most widely prescribed family of agents
for treating patients with elevated low-density lipopro-
tein (LDL) cholesterol. The medical community’s rapid
acceptance of these agents stems from the impression
that they are the most efficacious and well tolerated of
the cholesterol-lowering agents.
The recommended starting dose of lovastatin is 20
mg, whereas that of pravastatin is 10 or 20 mg.
mg preparation of lovastatin was originally introduced
primarily for use with patients concomitantly receiv-
ing cyclosporine. Recently, low-dose therapy with
HMG CoA reductase inhibitors, particularly in combi-
nation with other agents, has been explored as a
means to maximize efficacy while minimizing risk
Limited data suggest that treatment with 10 mg of
lovastatin yields substantial reductions in serum choles-
Although a number of studies have compared
the efficacy and side effects of pravastatin and lova-
most have compared nonequivalent dosages.
Because the incidence of side effects with HMG CoA
reductase inhibitors may increase with dose within the
recommended dosage range,
a lower dosage, if
effective, may be preferable. In addition, low doses
should translate into reduced drug costs. We compared
the efficacy of 10 mg of pravastatin with that of 10 mg
of lovastatin in a randomized, crossover design trial.
Patients eligible for drug treatment according to the
National Cholesterol Education Program (NCEP-1) guidelines
were eligible for this study. Secondary causes for hyperlipi-
demia such as hypothyroidism or nephrotic syndrome were
excluded. Eligible patients had demonstrated on repeat deter-
mination LDL cholesterol ≥160 mg/dL while not receiving
drug therapy. Patients with borderline values (>130 mg/dL,
<160 mg/dL) were eligible if they had documented coronary
artery disease or ≥2 additional risk factors. Because we recog-
nized the controversy over the cost-effectiveness of treating
patients with modest elevations of cholesterol or without
prior cardiac events, patient recruitment was designed to
ensure that more than half of the patients would have LDL
Comparative efficacy and tolerability of low-dose
pravastatin versus lovastatin in patients with
William E. Strauss, MD, Diane Lapsley, RN, and J. Michael Gaziano, MD West Roxbury and Boston, Mass
The HMG CoA reductase inhibitors have quickly become the most widely prescribed family of agents
for the treatment of patients with elevated low-density lipoprotein (LDL) cholesterol. The incidence of side effects with these
agents increases as the dose increases within the recommended dosage range. A lower dosage presumably would have a
lower incidence of adverse effects. In addition, lower doses should translate into reduced drug costs.
Methods and Results
We compared the efficacy of 10 mg of pravastatin and 10 mg of lovastatin in a random-
ized, crossover design trial among 30 patients with hypercholesterolemia. At baseline, their total cholesterol and LDL choles-
terol levels were 249.0 ± 27.3 and 185.1 ± 25.5 mg/dL. After 4 weeks of treatment with lovastatin, the total cholesterol
and LDL cholesterol levels fell to 202.8 ± 29.6 and 141.0 ± 25.3 mg/dL, decreases of 19% and 24%, respectively. Four
weeks of pravastatin treatment resulted in levels of 212.6 ± 30.8 and 150.5 ± 25.5 mg/dL, or 15% and 19%, respectively.
There were highly significant changes in total cholesterol and LDL cholesterol levels with each agent and
no differences in effect between the 2 agents. In 13 (43%) of the 30 patients, LDL levels were reduced to ≤130 mg/dL with
one of the agents. Both agents were generally well tolerated, with no clinically important change in liver function tests or cre-
atinine kinase levels. (Am Heart J 1999;137:458-62.)
From the Department of Medicine and the Massachusetts Veterans Epidemiology
Research and Information Center, Department of Veterans Affairs Medical Center;
and the Department of Medicine, Brigham and Women’s Hospital, and Harvard
Submitted January 12, 1998; accepted June 3, 1998.
Reprint requests: William E. Strauss, MD, Department of Veterans Affairs Medical
Center, 1400 VFW Parkway, West Roxbury, MA 02132.
0002-8703/99/$8.00 + 0 4/1/92262