Lipoprotein(a) and coronary atheroma progression rates during long-term high-intensity statin therapy: Insights from SATURN

Rishi Puri, Christie M. Ballantyne, Ron C. Hoogeveen, Mingyuan Shao, Philip Barter, Peter Libby, M. John Chapman, Raimund Erbel, Benoit J. Arsenault, Joel S. Raichlen, Steven E. Nissen, Stephen J. Nicholls

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20 Citations (Scopus)

Abstract

Background & aims Lipoprotein(a) [Lp(a)] is a low-density lipoprotein (LDL)-like particle that associates with major adverse cardiovascular events (MACE). We examined relationships between Lp(a) measurements and changes in coronary atheroma volume following long-term maximally-intensive statin therapy in coronary artery disease patients. Methods Study of coronary atheroma by intravascular ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. Baseline and follow-up Lp(a) levels were measured in 915 of the 1039 SATURN participants, and were correlated with changes in percent atheroma volume (ΔPAV). Results Mean age was 57.7 ± 8.6 years, 74% were men, 96% were Caucasian, with statin use prior to study enrolment occurring in 59.3% of participants. Baseline [median (IQR)] LDL-cholesterol (LDL-C) and measured Lp(a) levels (mg/dL) were 114 (99, 137) and 17.4 (7.6, 52.9) respectively; follow-up measures were 60 (47, 77), and 16.5 (6.7, 57.7) (change from baseline: p <0.001, p = 0.31 respectively). At baseline, there were 676 patients with Lp(a) levels 50 mg/dL. Conclusions In coronary artery disease patients prescribed long-term maximally intensive statin therapy with low on-treatment LDL-C levels, measured Lp(a) levels (predominantly below the 50 mg/dL threshold) do not associate with coronary atheroma progression. Alternative biomarkers may thus associate with residual cardiovascular risk in such patients.
Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalAtherosclerosis
Volume263
DOIs
Publication statusPublished - 1 Aug 2017

Keywords

  • Atherosclerosis
  • IVUS
  • Lipoprotein(a)
  • Residual risk
  • Statins

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