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Statin Therapy and Atherosclerosis Regression

Reductions in LDL and increases in HDL were both important in reversing atherosclerosis.

Most studies of statin therapy for reducing the risk for coronary atherosclerosis have focused on reducing LDL cholesterol and not on increasing HDL cholesterol, despite the known risk-reducing benefits of high HDL levels.

Cleveland Clinic investigators pooled data from four large trials to study the relation between LDL levels, HDL levels, and atheroma volume as measured by intravascular ultrasound. A total of 1455 patients (mean age, 58; 73% men) with coronary artery disease received high-dose statin therapy and were followed for 18 or 24 months with serial intravascular ultrasound. Mean LDL levels dropped from 124.0 to 87.5 mg/dL, mean HDL levels increased from 42.5 to 45.1 mg/dL, and the ratio of LDL to HDL decreased from 3.0 to 2.1. Median total atheroma volume in a standardized segment of diseased coronary artery decreased by roughly 2%. In a multivariate analysis adjusting for all known risk factors for CAD, patients with LDL levels lower than the mean reduction and with HDL increases higher than the mean percentage increase had the greatest regression in atheroma volume (5%).

Comment: This study was not designed to assess how reduced LDL levels or increased HDL levels affect clinical outcomes, but it provides evidence that that manipulating both components may be necessary to reduce CAD risk maximally. This finding is particularly important in light of current efforts to develop novel pharmacologic approaches to raising HDL levels.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine February 6, 2007

Citation(s):

Nicholls SJ et al. Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA 2007 Feb 7; 297:499-508.

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