The robust and specific association between elevated lipoprotein(a) [Lp(a)] levels
and increased cardiovascular disease (CVD)/coronary heart disease (CHD) risk, together
with recent genetic findings, indicates that elevated Lp(a), like elevated low-density
lipoprotein (LDL)-cholesterol, is causally related to premature CVD/CHD, and the association
is continuous without a threshold or dependence on LDL- or non-high-density lipoprotein-cholesterol
levels [
[1]
]. A meta-analysis [
[2]
] of 31 prospective studies, involving a total of 9870 CHD cases, suggested that the
combined relative risk of CHD for individuals in the top versus bottom thirds of baseline
Lp(a) concentrations was 1.5 (95% confidence interval [CI], 1.3 to 1.8). Treatment
should primarily be niacin 1–3 g/day, as a meta-analysis of randomized controlled intervention trials demonstrates
reduced CVD by niacin treatment [
[1]
]. In a meta-analysis [
[3]
] including 11 randomized controlled trials with 2682 patients in the active group
and 3934 in the control group, niacin 1–3 g/day reduced major coronary events by 25% (95% CI, 13% to 35%), stroke by 26% (95%
CI, 8% to 41%), and any cardiovascular event by 27% (95% CI, 15% to 37%). On the other
hand, several randomized controlled trials [
4
,
5
,
6
,
7
] suggest that atorvastatin, high-intensity hydroxymethylglutaryl-CoA reductase inhibitor,
may decrease Lp(a) levels. To our best knowledge, however, no meta-analysis of statins
for reduction of Lp(a) concentrations has been conducted up to date. To determine
whether or not atorvastatin decreases Lp(a) levels, we performed a meta-analysis of
randomized controlled trials.Keywords
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References
- Lipoprotein(a) as a cardiovascular risk factor: current status.Eur Heart J. 2010; 31: 2844-2853
- Lipoprotein(a) levels and risk of future coronary heart disease: large-scale prospective data.Arch Intern Med. 2008; 168: 598-608
- Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis.Atherosclerosis. 2010; 210: 353-361
- Long term statin treatment reduces lipoprotein(a) concentrations in heterozygous familial hypercholesterolaemia.Heart. 2003; 89: 893-896
- Atorvastatin lowers lipoprotein(a) but not apolipoprotein(a) fragment levels in hypercholesterolemic subjects at high cardiovascular risk.Atherosclerosis. 2002; 164: 305-311
- Effect of atorvastatin on lipoprotein (a) and interleukin-10: a randomized placebo-controlled trial.Diabetes Metab. 2011; 37: 124-130
- Effects of atorvastatin on Lp(a) and lipoprotein profiles in hemodialysis patients.Ann Pharmacother. 2008; 42: 9-15
Higgins JP, Deeks JJ, editors. Chapter 7: Selecting studies and collecting data. In: Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
- Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1101
- Atorvastatin and micronized fenofibrate alone and in combination in type 2 diabetes with combined hyperlipidemia.Diabetes Care. 2002; 25: 1198-1202
- The influence of pravastatin and atorvastatin on markers of oxidative stress in hypercholesterolemic humans.J Am Coll Cardiol. 2008; 51: 1653-1662
- High-dose atorvastatin reduces total plasma levels of oxidized phospholipids and immune complexes present on apolipoprotein B-100 in patients with acute coronary syndromes in the MIRACL trial.Circulation. 2004; 110: 1406-1412
- The effect of atorvastatin on serum lipoproteins in acromegaly.Clin Endocrinol (Oxf). 2005; 62: 650-655
- Effects of atorvastatin on fasting and postprandial lipoprotein subclasses in coronary heart disease patients versus control subjects.Am J Cardiol. 2002; 90: 689-696
- Efficacy and safety of combination therapy with niacin extended-release and simvastatin versus atorvastatin in patients with dyslipidemia: The SUPREME Study.J Clin Lipidol. 2009; 3: 109-118
- Comparison of the efficacy of atorvastatin and micronized fenofibrate in the treatment of mixed hyperlipidemia.J Cardiovasc Risk. 1999; 6: 113-116
- Studies on the role of specific cell surface receptors in the removal of lipoprotein (a) in man.J Clin Invest. 1983; 71: 1431-1441
- The low density lipoprotein receptor is not required for normal catabolism of Lp(a) in humans.J Clin Invest. 1995; 95: 1403-1408
- HMG CoA reductase inhibitors lower LDL cholesterol without reducing Lp(a) levels.Circulation. 1989; 80: 1313-1319
- Differential influence of LDL cholesterol and triglycerides on lipoprotein(a) concentrations in diabetic patients.Diabetes Care. 2001; 24: 350-355
- Lp(a): an acute-phase reactant?.Chem Phys Lipids. 1994; 67–68: 411-417
- 5′ control regions of the apolipoprotein(a) gene and members of the related plasminogen gene family.Proc Natl Acad Sci U S A. 1993; 90: 1369-1373
- Native, oxidized lipoprotein(a) and lipoprotein(a) immune complex in patients with active and inactive rheumatoid arthritis: plasma concentrations and relationship to inflammation.Clin Chim Acta. 2008; 390: 67-71
Article info
Publication history
Published online: October 13, 2011
Accepted:
September 17,
2011
Received:
August 22,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
