Atorvastatin Reduces Remnant Lipoproteins and Small, Dense Low‐Density Lipoproteins Regardless of the Baseline Lipid Pattern

Abstract

Elevated plasma levels of remnant lipoproteins and small, dense low-density lipoprotein (LDL) particles increase the risk of atherosclerosis. This prospective, placebo-controlled, crossover trial evaluated the effect of atorvastatin on various lipid parameters including remnant lipoproteins and small, dense-LDL cholesterol levels. Forty-five subjects were enrolled in the study. These subjects fell into three distinct lipid patterns: atherogenic dyslipidemia, isolated hypercholesterolemia, and mixed dyslipidemia. Regardless of the baseline lipid profile, atorvastatin (10 mg q x d) reduced levels of remnant lipoproteins by 25%, LDL-cholesterol by 27%, and the three LDL subfractions by 23%-28% (p<0.0001 for all). Combining all patients, atorvastatin did not significantly alter the overall LDL subfraction pattern; however, in the isolated hypercholesterolemia group, the proportion of LDL present as the small, dense fraction increased by 23% (p=0.01) with treatment, whereas it did not change significantly in the other two groups. Overall, atorvastatin reduced triglycerides by 18% and apolipoprotein-B100 by 23% and increased high-density lipoproteins by 6.2% (p<0.001 all). Since atorvastatin is known to reduce the risk for coronary heart disease events and these data suggest that it does not appear to alter the LDL subfraction pattern, it is unclear whether or not the latter is an important risk predictor independent of LDL-cholesterol concentrations. Increased attention should be paid to absolute concentrations of LDL subfraction cholesterol, which may be a more sensitive indicator of coronary heart disease risk than total LDL or an LDL pattern.

Effects of patient‐tailored atorvastatin therapy on ameliorating the levels of atherogenic lipids and inflammation beyond lowering low‐density lipoprotein cholesterol in patients with type 2 diabetes

“…With respect to the sd-LDL cholesterol levels in the present study, the individualized starting doses of atorvastatin had a strong effect on the mean LDL particle size, and markedly reduced the sd-LDL cholesterol levels with all of the doses. These findings are in agreement with previous small studies, which have shown that atorvastatin is effective in reducing the levels of sd-LDL cholesterol particles and improving the abnormal LDL particle distribution in patients with or without diabetes 27,28 . Notably, the changes in the sd-LDL cholesterol levels were proportionately greater based on the baseline LDL cholesterol levels, which supports the idea that a higher starting dose based on a treatment algorithm was advantageous for patients with type 2 diabetes [9][10][11]26 .…”

The Clinical Relevance of Low-Density-Lipoproteins Size Modulation by Statins

“…Treatment with atorvastatin resulted more frequently in a beneficial effect (nineteen studies) [26,30,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] than not (eleven studies) [36,46,[71][72][73][74][75][76][77][78][79] and this has been confirmed at different doses and in a wide-range of different categories of patients: with hypercholesterolaemia [60,63,64,70], with hypertriglyceridemia [65], with combined [30,55,56,58,59,67,69] or familial combined hyperlipidemia [26], with familial hypercholesterolemia [54,61], with type 1 [68] and 2 diabetes [57,58,…”

Statins in nephrotic syndrome: A new weapon against tissue injury

“…Generally, with a 1% decrease in cholesterol levels, a 1% reduction in coronary risk is achieved. [42][43][44][45] The particular properties of statins were discovered in a metanalysis of 51 studies evaluating the efficacy of hypocholesterolemic therapy, statins appearing to be more effective than other hypocholesterolemic drugs. 46 However, as these drugs have no effect on Lp(a)-derived cholesterol, subjects with markedly higher overall Lp(a) levels should be carefully evaluated for the effects of statins.…”