Statins have proven beneficial for reducing both primary and secondary events in patients with
coronary heart disease. Tight control of serum
lipid parameters in these patients is recommended by the most recent clinical guidelines. Although numerous
lipid-lowering treatments are available, only a small percentage of eligible patients receive
therapy and fewer achieve their
lipid-lowering goals. Thus it is clear that new treatment strategies to manage patients with
lipid abnormalities are warranted.
Pitavastatin (Lival; Kowa
Pharmaceuticals America, Montgomery, AL, USA) has been recently approved for the treatment of
hypercholesterolemia and combined
dyslipidemia.
Pitavastatin 1-4 mg/day has shown similar
low-density lipoprotein-reducing activity to other commercially available
statins, including
simvastatin and
atorvastatin. Adverse events occurred at similar rates to other
statins in clinical trials with favorable effects seen in patients with
dyslipidemia and
metabolic syndrome. Pharmacokinetic
drug-drug interactions are minimized due to the lack of significant metabolism of
pitavastatin by the
cytochrome P450 enzyme system, although some drugs affect its uptake into hepatocytes and should be avoided. In addition to its higher acquisition cost,
pitavastatin has not been shown to improve clinical outcomes in high-risk patient populations and thus may not be the agent of choice in many patients at this time in lieu of cheaper, clinically proven alternatives.