Influence of low HDL on progression of coronary artery disease and response to fluvastatin therapy

Christie M. Ballantyne, J. Alan Herd, Laura L. Ferlic, J. Kay Dunn, John A. Farmer, Peter H. Jones, Jeffrey R. Schein, Antonio M. Gotto

Research output: Contribution to journalArticle

172 Scopus citations

Abstract

Backgrounds - Patients with coronary artery disease (CAD) commonly have low HDL cholesterol (HDL-C) and mildly elevated LDL cholesterol (LDL-C), leading to uncertainty as to whether the appropriate goal of therapy should be lowering LDL-C or raising HDL-C. Methods and Results - Patients in the Lipoprotein and Coronary Atherosclerosis Study (LCAS) had mildly to moderately elevated LDL-C; many also had low HDL-C, providing an opportunity to compare angiographic progression and the benefits of the HMG-CoA reductase inhibitor fluvastatin in patients with low versus patients with higher HDL- C. Of the 339 patients with biochemical and angiographic data, 68 had baseline HDL-C <0.91 mmol/L (35 mg/dL), mean 0.82 ± 0.06 mmol/L, (31.7 ± 2.2 mg/dL), versus 1.23 ± 0.29 mmol/L (47.4 ± 11.2 mg/dL) in patients with baseline HDL-C ≥ 0.91 mmol/L. Among patients on placebo, those with low HDL- C had significantly more angiographic progression than those with higher HDL- C. Fluvastatin significantly reduced progression among low-HDL-C patients: 0.065 ± 0.036 mm versus 0.274 ± 0.045 mm in placebo patients (P = 0.0004); respective minimum lumen diameter decreases among higher-HDL-C patients were 0.036 ± 0.021 mm and 0.083 ± 0.019 mm (P = 0.09). The treatment effect of fluvastatin on minimum lumen diameter change was significantly greater among low-HDL-C patients than among higher-HDL-C patients (P = 0.01); among low- HDL-C patients, fluvastatin patients had improved event-free survival compared with placebo patients. Conclusions - Although the predominant lipid- modifying effect of fluvastatin is to decrease LDL-C, patients with low HDL- C received the greatest angiographic and clinical benefit.

Original languageEnglish (US)
Pages (from-to)736-743
Number of pages8
JournalCirculation
Volume99
Issue number6
DOIs
StatePublished - Feb 16 1999

Keywords

  • Angiography
  • Cholesterol
  • Coronary disease
  • Drugs
  • Lipoproteins

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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