Key result
Statins cut LDL-c ~37% in FCH, but pro-atherogenic lipoprotein alterations frequently persist with hypertriglyceridemia.
Why the study?
Does standard statin therapy improve qualitative lipoprotein function in familial combined hyperlipidemia patients with high versus normal triglyceride levels?
Cohort (n=41)
Does standard statin therapy improve qualitative lipoprotein function in familial combined hyperlipidemia patients with high versus normal triglyceride levels?
FCH patients with hypertriglyceridemia retain significant proatherogenic lipoprotein dysfunction despite standard statin therapy, suggesting a need for additional lipid-lowering approaches targeting triglycerides.
Statin therapy may leave pro-atherogenic lipoprotein alterations unaddressed in hypertriglyceridemic FCH; leaves open whether triglyceride-targeted approaches are required.
Lipoprotein characteristics were analyzed in familial combined hyperlipidemia (FCH) patients before and after statin treatment. Twenty-six FCH patients were classified according to the presence (HTG group, n = 13) or absence (normotriglyceridemic (NTG) group, n = 13) of hypertriglyceridemia. Fifteen healthy subjects comprised the control group. Lipid profile, inflammation markers, and qualitative characteristics of lipoproteins were assessed. Both groups of FCH subjects showed high levels of plasma C-reactive protein (CRP), lipoprotein-associated phospholipase A2 (Lp-PLA2) activity and apolipoprotein J. Statins reverted the increased levels of Lp-PLA2 and CRP. Lipoprotein composition alterations detected in FCH subjects were much more frequent in the HTG group, leading to dysfunctional low-density lipoproteins (LDL) and high-density lipoproteins (HDL). In the HTG group, LDL was smaller, more susceptible to oxidation, and contained more electronegative LDL (LDL(-)) compared to the NTG and control groups. Regarding HDL, the HTG group had less Lp-PLA2 activity than the NTG and control groups. HDL from both FCH groups was less anti-inflammatory than HDL from the control group. Statins increased LDL size, decreased LDL(-), and lowered Lp-PLA2 in HDL from HTG. In summary, pro-atherogenic alterations were more frequent and severe in the HTG group. Statins improved some alterations, but many remained unchanged in HTG.
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Puig et al. (2020) conducted a cohort in Familial combined hyperlipidemia (FCH) (n=41). Statin therapy vs. Baseline (before treatment) and healthy controls was evaluated on Qualitative characteristics of lipoproteins (Lp-PLA2, CRP, LDL size, HDL anti-inflammatory function). Statin therapy decreased total cholesterol and LDL-c by 30% and 37% respectively, but pro-atherogenic lipoprotein alterations were more frequent and persistent in FCH patients with hypertriglyceridemia.
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