HDL biology
Pravastatin lowers serum CETP 21% while probucol raises it 23%, with baseline CETP predicting Achilles tendon xanthoma regression (Atherosclerosis 1999)
Original title: Opposite effects on serum cholesteryl ester transfer protein levels between long-term treatments with pravastatin and probucol in patients with primary hypercholesterolemia and xanthoma
In 23 patients with primary hypercholesterolemia and xanthoma or xanthelasma, including 11 with heterozygous familial hypercholesterolemia, pravastatin (20 mg/day, 11 patients) and probucol (1000 mg/day, 12 patients) were compared over 24 months. Serum CETP decreased from 2.5 +/- 0.2 to 2.0 +/- 0.2 microg/ml with pravastatin (-21%, P = 0.002), while it increased from 2.3 +/- 0.1 to 2.8 +/- 0.2 microg/ml with probucol (+23%, P = 0.02). Achilles tendon xanthoma regressed in 4 of 5 pravastatin-treated patients (80%) versus 2 of 5 probucol-treated patients (40%). Patients with xanthoma or xanthelasma regression had higher baseline serum CETP than those without (2.7 +/- 0.2 microg/ml [n = 9] vs. 2.1 +/- 0.2 microg/ml [n = 7], P = 0.05), though serial CETP change was unrelated to the degree of regression.
Original abstract
Long-term effects of pravastatin and probucol on serum cholesteryl ester transfer protein (CETP) and xanthoma/xanthelasma size were compared. Twenty-three patients with primary hypercholesterolemia and xanthoma/xanthelasma, including 11 patients with heterozygous familial hypercholesterolemia, were treated with pravastatin (20 mg/day) or probucol (1000 mg/day) for 24 months. Serum CETP levels were measured by sandwich ELISA. In 11 patients (six men and five women, 55 +/- 2 [SE] yr) treated with pravastatin, serum cholesterol levels decreased from 262 +/- 13 to 229 +/- 13 mg/dl during the 24-month treatment period (P = 0.05). Serum HDL cholesterol levels were not changed. Serum CETP levels decreased from 2.5 +/- 0.2 to 2.0 +/- 0.2 microg/ml (-21%, P = 0.002). By contrast, in 12 patients (four men and eight women, 57 +/- 4 year) treated with probucol, serum cholesterol levels did not significantly decrease from 236 +/- 11 to 207 +/- 13 mg/dl. Serum HDL cholesterol levels decreased from 44 +/- 2 to 30 +/- 2 mg/dl (P = 0.009). Serum CETP levels increased from 2.3 +/- 0.1 to 2.8 +/- 0.2 microg/ml (+23%, P = 0.02). Xanthelasma regression was found in two of four patients (50%) each treated with pravastatin and probucol, respectively. In contrast, Achilles' tendon xanthoma regressed in four of five patients (80%) treated with pravastatin, but only in two of five patients (40%) treated with probucol. Patients with xanthoma/xanthelasma regression after 2 years treatment had higher baseline levels of serum CETP than those without regression (2.7 +/- 0.2 microg/ml [n = 9] versus 2.1 +/- 0.2 microg/ml [n = 7], P = 0.05). Serial changes in serum CETP levels during treatment with pravastatin and probucol were discordant, but not related to the degree of xanthoma regression. However, higher level of serum HDL3 cholesterol was an independent factor in the smaller size of Achilles' tendon xanthoma at baseline. In addition, higher levels of serum HDL3 triglyceride on lipid-lowering therapy (6 months) appear to be a common predictor of regression of Achilles' tendon xanthoma in the treatment with either pravastatin or probucol.
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 19 August 2026. Methods.