The current study investigated the relationship between changes in lipoprotein levels and atheroma volume in patients with coronary artery disease (CAD) who were treated with statins.This post-hoc analysis was performed by combining the results for patients enrolled in 4 prospective clinical trials that used intravascular ultrasound to determine changes in atheroma volume during treatment.The principal objective was to determine the relative contribution of statin-induced reductions in atherogenic lipoproteins and increases in HDL-C on the rate of atheroma progression.

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Monitoring atheroma progression using serial intravascular ultrasound has been used to characterize the natural history of atherosclerosis and the effect of antiatherosclerotic therapies.

Serial intravascular ultrasound studies have demonstrated that reduction in LDL-C levels using statins slows the rate of atherosclerotic disease progression However, it has never been established that these small statin-induced increases in HDL-C translate into a meaningful clinical benefit.

Accordingly, statins are used primarily to decrease LDL-C levels and other therapies are used to increase HDL-C levels.

Nissen, MDAuthor Affiliations: Departments of Cardiovascular Medicine (Drs Nicholls, Tuzcu, Sipahi, Grasso, Schoenhagen, Desai, Hazen, Kapadia, and Nissen, Messrs Hu and Crowe, and Ms Wolski), Cell Biology (Drs Nicholls and Hazen), and Diagnostic Radiology (Dr Schoenhagen), and Center for Cardiovascular Diagnostics and Prevention (Drs Nicholls and Hazen), Cleveland Clinic, Cleveland, Ohio.

Ultrasound analysis was performed in the same core laboratory for all of the studies.

Main Outcome Measure Relationship between changes in lipoprotein levels and coronary artery atheroma volume.

Results During statin therapy, mean (SD) LDL-C levels were reduced from 124.0 (38.3) mg/d L (3.2 [0.99] mmol/L) to 87.5 (28.8) mg/d L (2.3 [0.75] mmol/L) (a 23.5% decrease; A large body of evidence supports a central role for lowering levels of low-density lipoprotein cholesterol (LDL-C) in the prevention of atherosclerotic cardiovascular disease.

Design, Setting, and Patients Post-hoc analysis combining raw data from 4 prospective randomized trials (performed in the United States, North America, Europe, and Australia between 19), in which 1455 patients with angiographic coronary disease underwent serial intravascular ultrasonography while receiving statin treatment for 18 months or for 24 months.

Objective To investigate the relationship between changes in LDL-C and HDL-C levels and atheroma burden.

Grasso, MD; Paul Schoenhagen, MD; Tingfei Hu, MS; Kathy Wolski, MPH; Tim Crowe, BS; Milind Y. However, no data exist describing the relationship between statin-induced changes in high-density lipoprotein cholesterol (HDL-C) and disease progression.

Context Statins reduce low-density lipoprotein cholesterol (LDL-C) levels and slow progression of coronary atherosclerosis.