HDL-cholesterol and the Treatment of Coronary Heart Disease: Contrasting Effects of Atorvastatin and Simvastatin

Summary

Although the levels of low-density lipoprotein (LDL) cholesterol remain the main therapeutic goal when treating dyslipidaemias, there is a need to consider high-density lipoprotein (HDL) concentrations. This conclusion is based on the findings of epidemiological surveys and appropriately designed trials using statins or fibrates. The importance of HDL, as a ‘protective’ lipoprotein fraction, has been recognised by major treatment guidelines.

This review considers the differences in HDL-raising capacity of two of the most commonly prescribed statins – atorvastatin and simvastatin. When compared with simvastatin, atorvastatin is associated with progressively decreasing rises in the levels of HDL as the dose increases (negative dose response), an effect not reported with other statins. In contrast, simvastatin shows a positive dose response (increasing concentrations of HDL with increasing dose). This effect is paralleled by changes in apolipoprotein A-I levels. Apolipoprotein A-I is the main apolipoprotein associated with HDL.

This dissimilarity in HDL response is an example of several differences that have

been reported when comparing various statins. If ‘all statins are not created equal’, we should focus prescribing on those statins

that have end point evidence originating from appropriately designed trials.

Key words::

• High-density lipoprotein (HDL)
• Apolipoprotein A-I
• Low-density lipoprotein (LDL) cholesterol
• Coronary heart disease
• Atorvastatin
• Simvastatin