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Published on: November 10, 2017
Atorvastatin increases HDL cholesterol in hypercholesterolemic patients. Evidence of a relationship with baseline HDL
A Branchi1, A M Fiorenza, A Torri
1Department of Internal Medicine, University of Milan, Maggiore Hospital IRCCS, Milan, Italy. adriana.branchi@unimi.it
Insights
Atorvastatin increases high-density lipoprotein cholesterol (HDL-C) more in patients with low baseline levels. This effect is linked to the drug
Area of Science:
- Cardiology
- Pharmacology
- Biochemistry
Background:
- Previous reports suggest atorvastatin yields greater high-density lipoprotein cholesterol (HDL-C) increases in patients with lower baseline HDL-C.
- This observation may stem from biological factors or statistical regression to the mean.
Purpose of the Study:
- To investigate the differential effect of atorvastatin on HDL-C levels based on baseline HDL-C.
- To explore the potential role of regression to the mean versus biological mechanisms.
Main Methods:
- A study involving 121 hypercholesterolemic patients treated with atorvastatin 10 mg/day for two months.
- Analysis of HDL-C changes relative to baseline levels, median values, and correlation with triglyceride changes.
Main Results:
- A 4% increase in HDL-C was observed in 55% of patients, predominantly those with lower baseline HDL-C.
- HDL-C significantly increased in patients below the median baseline, with no change in those above the median.
- Regression to the mean was noted (r=0.84), but did not fully account for the observed differential HDL-C increases.
Conclusions:
- Atorvastatin 10 mg/day demonstrates a greater HDL-C increasing effect in patients with lower baseline HDL-C.
- This effect appears associated with the drug's capacity to lower triglycerides.
Background And Aim:
It has been reported that atorvastatin increases high-density lipoprotein cholesterol (HDL-C) more in patients with low than in those with high baseline HDL-C levels. This may have a biological explanation, but also suggests a statistical artifact known as the regression to the mean.
Methods And Results:
Atorvastatin 10 mg/day led to a 4% increase in HDL-C after two months in 67/121 patients with hypercholesterolemia (55%), who had lower baseline HDL-C levels than the patients in whom HDL-C did not increase. In the patients with baseline HDL-C below the median, HDL-C significantly increased whereas no change was observed in patients with baseline HDL-C above the median. The correlation coefficient between pre- and post-treatment HDL-C was 0.84, thus suggesting a regression to the mean. However, the regression artifact did not entirely explain the increase in HDL-C in patients with low baseline HDL-C or the lack of an increase in those with high baseline HDL-C. The adjusted mean increase was 5.4% in patients with low pretreatment HDL-C, and 2.4% in the patients with high pretreatment HDL-C. Multiple regression analysis with the changes in HDL-C as the dependent variable showed that baseline HDL-C and the changes in serum triglycerides independently contributed to the change in HDL-C levels.
Conclusions:
Atorvastatin 10 mg/day increases HDL-C more in patients with low pretreatment HDL-C levels, an effect that seems to be related to the hypotriglyceridemic activity of the drug.
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