The impact of statins on high-density lipoprotein (HDL) levels is unrelated to their effect on low-density lipoprotein (LDL) concentrations, a meta-analysis of over 30,000 patients suggests.
LDL cholesterol decreases are implicated in the cardiovascular risk reductions that accompany statin treatment but mounting evidence suggests the ability of statins to increase HDL cholesterol may also be of benefit.
To investigate how the two measures are related, Philip Barter (The Heart Research Institute, Sydney, Australia) and colleagues conducted a meta-analysis of 32,258 patients from 37 randomized trials involving rosuvastatin, atorvastatin, and simvastatin.
The ability of rosuvastatin and simvastatin to raise HDL cholesterol levels was superior to that of atorvastatin, the researchers report. HDL-cholesterol increases were positively related to rosuvastatin and simvastatin dosages, but were inversely related to atorvastatin dose.
With rosuvastatin, HDL cholesterol increased by 5.5% to 7.9% over the dose range of 5 to 40 mg/day, while increases with simvastatin ranged from 4.2% at 10 mg to 5.3% at 80 mg.
But with atorvastatin, HDL cholesterol increases were 4.5% at the 10 mg dose, falling to 2.3% with 80 mg/day.
There was no relationship between LDL-cholesterol reductions and increases in HDL cholesterol with the statins, either collectively or individually.
However, the percent increase in apolipoprotein A-I was “virtually identical” to that of HDL cholesterol at all doses of the three statins, the researchers write in the Journal of Lipid Research.
Baseline HDL-cholesterol and triglyceride concentrations and the presence of diabetes were strong independent predictors of statin-induced elevations of HDL cholesterol.
The relationship between HDL rises with statins and coronary atheroma changes was also assessed in 1455 patients from four intravascular imaging trials.
The researchers report: “Multivariate analysis showed that both the achieved level of LDL cholesterol and the increase in HDL cholesterol during statin treatment were significant independent predictors of coronary atheroma progression.”