Individuals with coronary artery disease often have low HDL cholesterol and elevated LDL cholesterol. It is currently unclear whether the priority should be to attempt to lower the LDL cholesterol (LDL-C) component or increase the HDL cholesterol (HDL-C) levels in order to reduce the progression of the disease.
A recent post hoc analysis utilizing data and subjects from the Lipoprotein and Coronary Atherosclerosis Study (LCAS) attempted to determine benefits of the HMG-CoA reductase inhibitor, fluvastatin, in individuals with a low HDL-C ([is less than] 35 mg/dL) compared to those with a normal HDLC ([is greater than] 35 mg/dL). Subjects were men and postmenopausal women with angiographic evidence of coronary artery disease, and all had a mildly to moderately high LDL-C. The 339 subjects were randomly chosen to receive treatment with fluvastatin or a placebo. Sixty-eight of the subjects had baseline low HDL-C and were used for comparison. The results were based on the primary endpoint of per-lesion change in minimum lumen diameter, which was assessed via a quantitative coronary angiography at baseline and at 2.5 years following the initiation of treatment. The researchers also looked at the number of clinical events that occurred during the duration of the study, which included definite or probable myocardial infarction, unstable angina pectoris requiring hospitalization, and death by any cause.
Fluvastatin significantly reduced the progression of atherosclerosis among patients with low HDL-C. The positive effect of increasing lumen diameter was significantly greater among those with low HDL-C treated with fluvastatin than among those with higher HDL-C treated with fluvastatin. The subjects with low HDL-C treated with fluvastatin also had significantly improved event-free survival rates than those subjects with low HDL-C administered a placebo.
The results of this study show that fluvastatin use can have a positive effect, not only by lowering LDL-C, but also by decreasing the progression of atherosclerosis in patients with low HDL-C.
Christie M. Ballantyne, Alan Herd, Laura L. Ferlic, et al., Influence of Low HDL on Progression of Coronary Artery Disease and Response to Fluvastatin Therapy, Circulation, 99:736-743 (February 16, 1999) [Correspondence: Christie M. Balllantyne, MD, Baylor College of Medicine, 6565 Fannin, Ms A-601, Houston, TX 77030. E-mail: cmb@bcm.tmc.edu]
COPYRIGHT 1999 Technical Insights, a divison of John Wiley & Sons.
COPYRIGHT 2000 Gale Group
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