Heart Research Institute, Sydney, Australia.
J Lipid Res. 2010 Jun;51(6):1546-53. doi: 10.1194/jlr.P002816. Epub 2009 Dec 2.
The relationship between statin-induced increases in HDL cholesterol (HDL-C) concentration and statin-induced decreases in LDL cholesterol (LDL-C) is unknown. The effects of different statins on HDL-C levels, relationships between changes in HDL-C and changes in LDL-C, and predictors of statin-induced increases in HDL-C have been investigated in an individual patient meta-analysis of 32,258 dyslipidemic patients included in 37 randomized studies using rosuvastatin, atorvastatin, and simvastatin. The HDL-C raising ability of rosuvastatin, and simvastatin was comparable, with both being superior to atorvastatin. Increases in HDL-C were positively related to statin dose with rosuvastatin and simvastatin but inversely related to dose with atorvastatin. There was no apparent relationship between reduction in LDL-C and increase in HDL-C, whether analyzed overall for all statins (correlation coefficient = 0.005) or for each statin individually. Percentage increase in apolipoprotein A-I was virtually identical to that of HDL-C at all doses of the three statins. Baseline concentrations of HDL-C and triglyceride (TG) and presence of diabetes were strong, independent predictors of statin-induced elevations of HDL-C. Statins vary in their HDL-C raising ability. The HDL-C increase achieved by all three statins was independent of LDL-C decrease. However, baseline HDL-C and TGs and the presence of diabetes were predictors of statin-induced increases in HDL-C.
他汀类药物引起的高密度脂蛋白胆固醇（HDL-C）浓度升高与他汀类药物引起的低密度脂蛋白胆固醇（LDL-C）降低之间的关系尚不清楚。本个体患者荟萃分析纳入了 37 项随机研究中的 32258 例血脂异常患者，旨在评估不同他汀类药物对 HDL-C 水平的影响、HDL-C 变化与 LDL-C 变化之间的关系，以及他汀类药物引起 HDL-C 升高的预测因素。结果显示，瑞舒伐他汀和辛伐他汀升高 HDL-C 的能力与阿托伐他汀相当，且均优于阿托伐他汀。瑞舒伐他汀和辛伐他汀的 HDL-C 升高与他汀类药物剂量呈正相关，但阿托伐他汀的 HDL-C 升高与剂量呈负相关。总体上分析所有他汀类药物（相关系数=0.005）或单独分析每种他汀类药物，HDL-C 降低与 HDL-C 升高之间均无明显关系。三种他汀类药物在所有剂量下，载脂蛋白 A-I 的百分比增加与 HDL-C 几乎相同。HDL-C 和三酰甘油（TG）的基线浓度以及糖尿病的存在是他汀类药物引起 HDL-C 升高的强有力独立预测因素。他汀类药物在升高 HDL-C 的能力方面存在差异。三种他汀类药物均可独立于 LDL-C 降低来升高 HDL-C。然而，基线 HDL-C 和三酰甘油以及糖尿病的存在是他汀类药物引起 HDL-C 升高的预测因素。
