LCAS (Lipoprotein and Coronary Atherosclerosis Study) Sub-study

18 Aug, 10

LCAS (Lipoprotein and Coronary Atherosclerosis Study) Sub-study

Introduction

Influence of low HDL on progression of coronary artery disease and response to fluvastatin therapy.

Purpose

To determine the effects of fluvastatin therapy on the angiographic progression of coronary artery disease in patients with low vs higher HDL as part of LCAS.

339 patients with biochemical and angiographic data. 68 had baseline HDL <35 mg/dL with a mean of 31.7-2.2 mg/dL vs patients with baseline HDL ≥35 mg/dL at a mean of 47.4-11.2 mg/dL. Patients had to have evidence of CAD. LDLs were 115-190 mg/dL.

Follow-up

Quantitative coronary angiography at 2.5 years.

Treatment Regimen

As per LCAS

Results

Patients with low LDL were more likely to be male and have increased triglyceride. Placebo patients with low HDL had more progression of coronary artery disease on quantitative angiography than placebo patients with higher HDL.
In patients with low HDL, fluvastatin significantly reduced angiography progression measured as minimum lumen diameter : 0.065-0.036 mm in fluvastatin group vs 0.274-0.045 mm in the placebo group, p=0.0004).
In patients with higher HDL the minimum lumen diameter was 0.036-0.021 mm vs 0.083-0.019 mm, p =0.09 Fluvastatin's effect was therefore greater in patients with low HDL vs those with high HDL.
Fluvastatin's major effect on lipids in both high and low HDL groups was to lower LDL and apoB-100.
In patients with low HDL, event - free survival was improved with fluvastatin (p=0.002). Clinical events (PTCA, CABG, definite or probable MI, unstable angina requiring hospitalization, death) occurred in 8 out of 25 placebo patients and 2 of 43 fluvastatin patients.

Conclusion

Fluvastatin's major benefit is to decrease LDL but patients with baseline low HDL have the greatest angiographic and clinical benefit.

Circulation 1999;99:736-43