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Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database

Philip J Barter1, Gunnar Brandrup-Wognsen, Mike K Palmer

  • 1Heart Research Institute, Sydney, Australia. barterp@hri.org.au

Journal of Lipid Research
|December 8, 2009
PubMed

Insights

Statin therapy can increase HDL cholesterol, but this effect is independent of LDL cholesterol reduction. Rosuvastatin and simvastatin raise HDL more effectively than atorvastatin, with baseline HDL, triglycerides, and diabetes predicting HDL increases.

Area of Science:

  • Cardiology
  • Pharmacology
  • Metabolic Diseases

Background:

  • The relationship between statin-induced increases in high-density lipoprotein cholesterol (HDL-C) and decreases in low-density lipoprotein cholesterol (LDL-C) remains unclear.
  • Different statins exhibit varying effects on HDL-C levels, necessitating a comprehensive analysis.

Purpose of the Study:

  • To investigate the effects of rosuvastatin, atorvastatin, and simvastatin on HDL-C levels.
  • To examine the relationship between changes in HDL-C and LDL-C concentrations.
  • To identify predictors of statin-induced HDL-C elevations.

Main Methods:

  • An individual patient meta-analysis of 37 randomized controlled trials involving 32,258 dyslipidemic patients.
  • Analysis of data from patients treated with rosuvastatin, atorvastatin, and simvastatin.

Main Results:

  • Rosuvastatin and simvastatin demonstrated comparable HDL-C raising abilities, superior to atorvastatin.
  • HDL-C increases were dose-dependent for rosuvastatin and simvastatin, but inversely dose-related for atorvastatin.
  • No significant correlation was observed between LDL-C reduction and HDL-C increase across all statins or individually.
  • Apolipoprotein A-I (ApoA-I) percentage increase mirrored HDL-C increase.
  • Baseline HDL-C, triglyceride (TG) levels, and diabetes were significant predictors of HDL-C elevation.

Conclusions:

  • Statins possess varying capabilities in elevating HDL-C.
  • The observed increase in HDL-C with rosuvastatin, atorvastatin, and simvastatin was independent of their LDL-C lowering effects.
  • Baseline lipid profile (HDL-C, TG) and the presence of diabetes are key factors influencing statin-induced HDL-C increases.

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