(Circulation. 1999;99:736-743.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Influence of Low HDL on Progression of Coronary Artery Disease and Response to Fluvastatin Therapy
From Baylor College of Medicine (C.M.B., J.A.H., L.L.F., J.K.D., J.A.F., P.H.J.), Houston, Tex; Novartis Pharmaceuticals Corporation (J.R.S.), East Hanover, NJ; and Cornell University Medical College (A.M.G.), New York, NY.
Correspondence to Christie M. Ballantyne, MD, Baylor College of Medicine, 6565 Fannin, MS A-601, Houston, TX 77030. E-mail cmb{at}bcm.tmc.edu
Background—Patients with coronary artery disease (CAD) commonly have low HDL cholesterol (HDL-C) and mildly elevated LDL cholesterol (LDL-C), leading to uncertainty as to whether the appropriate goal of therapy should be lowering LDL-C or raising HDL-C.
Methods and Results—Patients in the Lipoprotein and
Coronary Atherosclerosis Study (LCAS) had
mildly to moderately elevated LDL-C; many also had low HDL-C, providing
an opportunity to compare angiographic progression and the benefits of
the HMG-CoA reductase inhibitor fluvastatin in
patients with low versus patients with higher HDL-C. Of the 339
patients with biochemical and angiographic data, 68 had baseline HDL-C
<0.91 mmol/L (35 mg/dL), mean 0.82±0.06 mmol/L (31.7±2.2
mg/dL), versus 1.23±0.29 mmol/L (47.4±11.2 mg/dL) in patients
with baseline HDL-C 
0.91 mmol/L. Among patients on placebo,
those with low HDL-C had significantly more angiographic progression
than those with higher HDL-C. Fluvastatin significantly
reduced progression among low–HDL-C patients: 0.065±0.036 mm
versus 0.274±0.045 mm in placebo patients
(P=0.0004); respective minimum lumen diameter decreases
among higher–HDL-C patients were 0.036±0.021 mm and
0.083±0.019 mm (P=0.09). The treatment effect of
fluvastatin on minimum lumen diameter change was
significantly greater among low–HDL-C patients than among
higher–HDL-C patients (P=0.01); among low–HDL-C
patients, fluvastatin patients had improved event-free
survival compared with placebo patients.
Conclusions—Although the predominant lipid-modifying effect of fluvastatin is to decrease LDL-C, patients with low HDL-C received the greatest angiographic and clinical benefit.
Key Words: angiography • cholesterol • coronary disease • drugs • lipoproteins
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