Effects of Rosuvastatin and Atorvastatin on Low-Density and High-Density Lipoprotein Particle Concentrations in Patients With Metabolic Syndrome: A Randomized, Double-Blind, Controlled Study

doi:10.2337/dc08-1681

Abstract

Objective — To examine the effects of statin therapy on lipoprotein particle concentrations in patients with the metabolic syndrome. Changes in lipoprotein particle concentration may predict risk of coronary heart disease more accurately than lipoprotein cholesterol levels.

Research design and methods — Patients with dyslipidemia and the metabolic syndrome (n = 318) were randomized in a double-blind study comparing rosuvastatin (RSV) 10 mg, atorvastatin (ATV) 10 mg, or placebo daily for 6 weeks. From weeks 6 to 12, patients in the RSV and placebo groups received RSV 20 mg, whereas the ATV group increased their dose to 20 mg daily. Lipoprotein particle concentrations were measured by nuclear magnetic resonance spectroscopy, LDL cholesterol (LDL-C) by beta-quantification, and other lipoproteins by standard methods at baseline, 6 weeks, and 12 weeks. Lipoprotein levels were compared by analysis of covariance.

Results — Statins reduced LDL particle concentration (LDL-P) less than LDL-C (−30% to −38% vs. −38% to −51%). Reductions were greater with RSV than with ATV (P < 0.05 for LDL-P, P < 0.001 for LDL-C). Most patients attained LDL-C <2.59 mmol/l (100 mg/dl) at 12 weeks (80% on RSV, 59% on ATV; P = 0.003), but only 27% of patients on RSV and 19% on ATV attained the goal of LDL-P <1000 nmol/l (P = 0.07).

Conclusions — In patients with the metabolic syndrome, statin-induced changes in LDL-C do not accurately reflect changes in LDL-P. Consequently, despite attainment of LDL-C goals, these patients may retain considerable residual coronary heart disease risk.