Effect of atorvastatin on high density lipoprotein cholesterol and its relationship with coronary events: a subgroup analysis of the GREek Atorvastatin and Coronary heart-disease Evaluation (GREACE) Study

被引:68
作者
Athyros, VG
Mikhailidis, DP
Papageorgiou, AA
Symeonidis, AN
Mercouris, BR
Pehlivanidis, AN
Bouloukos, VI
Elisaf, M
机构
[1] Univ Ioannina, Sch Med, Dept Internal Med, GR-45110 Ioannina, Greece
[2] Greek Soc Gen Practitioners, Thessaloniki, Greece
[3] UCL Royal Free & Univ Coll, Sch Med, Dept Clin Biochem, London, England
[4] Aristotle Univ Thessaloniki, Hippocration Hosp, Propedeut Dept Internal Med 2, Thessaloniki 54642, Greece
[5] Aristotle Univ Thessaloniki, Hippocration Hosp, Atherosclerosis Unit, Thessaloniki 54642, Greece
关键词
atorvastatin; coronary heart disease; high density lipoprotein cholesterol (HDL-C); low density lipoprotein cholesterol (LDC-C); statins;
D O I
10.1185/030079904125003421
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To investigate the relationship between changes in high density lipoprotein cholesterol (HDL-C) levels after statin treatment and the risk for coronary heart disease (CHD)-related events in the secondary CHD prevention GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study. These findings suggested that dose titration with atorvastatin (10-80 mg/day, mean 24 mg/day) achieves the National Cholesterol Educational Program treatment goals and significantly reduces morbidity and mortality, in comparison to usual care. Methods: Analysis of variance was used to assess the effect of atorvastatin on HDL-C over time (up to 48 months) in 1600 CHD patients. The time-dependent multivariate Cox predictive model, involving backward stepwise logistic regression, was used to evaluate the relation between coronary events and HDL-C changes. Results:The mean increase in HDL-C levels during the study was 7%. All doses of atorvastatin significantly increased HDL-C levels. Increases were greater in men (7.8 vs 6.1%; p = 0.02), in combined hyperlipidaemia (7.9 vs 6.4% for hypercholesterol-aemia; p = 0.04), and in the lower baseline HDL-C quartile (9.2 vs 5.3%, 1st vs 4th quartile; p = 0.001). After adjustment for 24 predictors of coronary events, multivariate analysis revealed a Hazards Ratio of 0.85 (95% confidence interval 0.76-0.94; p = 0.002) for every 4 mg/dL (0.1 mmol/L) increase in HDL-C. Conclusions: There was a significant beneficial effect on HDL-C levels across the dose range of atorvastatin. Clinical outcomes in the structured care arm of GREACE were determined in part by the extent of atorvastatin-induced HDL-C increase. This effect was independent from benefit induced by low density lipoprotein cholesterol (LDL-C) reduction, suggesting that the CHD risk reduction associated with a rise in a low HDL-C at baseline remains significant under aggressive (-46%) LDLC lowering conditions. However, the relationship between HDL-C and vascular risk may be weaker when LDL-C levels are aggressively lowered.
引用
收藏
页码:627 / 637
页数:11
相关论文
共 54 条
[1]   A low high density lipoprotein (HDL) level is associated with carotid artery intima-media thickness in asymptomatic members of low HDL families [J].
Alagona, C ;
Soro, A ;
Ylitalo, K ;
Salonen, R ;
Salonen, JT ;
Taskinen, MR .
ATHEROSCLEROSIS, 2002, 165 (02) :309-316
[2]  
[Anonymous], 1994, CIRCULATION
[3]   High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. The PROCAM experience and pathophysiological implications for reverse cholesterol transport [J].
Assmann, G ;
Schulte, H ;
vonEckardstein, A ;
Huang, YD .
ATHEROSCLEROSIS, 1996, 124 :S11-S20
[4]   Effects of atorvastatin on the HDL subpopulation profile of coronary heart disease patients [J].
Asztalos, BF ;
Horvath, KV ;
McNamara, JR ;
Roheim, PS ;
Rubinstein, JJ ;
Schaefer, EJ .
JOURNAL OF LIPID RESEARCH, 2002, 43 (10) :1701-1707
[5]   Comparing the effects of five different statins on the HDL subpopulation profiles of coronary heart disease patients [J].
Asztalos, BF ;
Horvath, KV ;
McNamara, JR ;
Roheim, PS ;
Rubinstein, JJ ;
Schaefer, EJ .
ATHEROSCLEROSIS, 2002, 164 (02) :361-369
[6]   Treatment with atorvastatin to the National Cholesterol Educational Program goal versus 'usual' care in secondary coronary heart disease prevention - The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) Study [J].
Athyros, VG ;
Papageorgiou, AA ;
Mercouris, BR ;
Athyrou, VV ;
Symeonidis, AN ;
Basayannis, EO ;
Demitriadis, DS ;
Kontopoulos, AG .
CURRENT MEDICAL RESEARCH AND OPINION, 2002, 18 (04) :220-228
[7]   Early benefit from structured care with atorvastatin in patients with coronary heart disease and diabetes mellitus - A subgroup analysis of the GREek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study [J].
Athyros, VG ;
Papageorgiou, AA ;
Symeonidis, AN ;
Didangelos, TP ;
Pehlivanidis, AN ;
Bouloukos, VI ;
Mikhailidis, DP .
ANGIOLOGY, 2003, 54 (06) :679-690
[8]   Statins and renal function in patients with diabetes mellitus [J].
Athyros, VG ;
Papageorgiou, AA ;
Elisaf, M ;
Mikhailidis, DP .
CURRENT MEDICAL RESEARCH AND OPINION, 2003, 19 (07) :615-617
[9]  
ATHYROS VG, IN PRESS J CLIN PATH
[10]  
ATHYROS VG, IN PRESS AM J KIDNEY