Effect of statins on lipoprotein (a) in dyslipidemic patients


  • Joel Bijou Irudayam Department of Pharmacology, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India
  • R. Sivaraj Department of Pharmacology, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India
  • P. Nirmala Department of Pharmacology, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India


Lipoprotein (a), Dyslipidemia, Simvastatin, Atorvastatin, Rosuvastatin


Background: Elevated plasma lipoprotein (a) (Lp(a)) levels, which act synergistically with low-density lipoprotein cholesterol (LDL-C), are an independent risk factor for cardiovascular diseases (CVD). The effect of statin drugs on Lp(a) levels has not been well-demonstrated in clinical studies. This prospective, randomized, comparative clinical study with parallel treatment groups was conducted to assess the effect of simvastatin, atorvastatin and rosuvastatin, on serum Lp(a) levels and serum lipid profile, in treatment-naive dyslipidemic patients without CVD.

Methods: A 12 weeks study, with 85 patients, aged 40-70 years, diagnosed with borderline high LDL-C, were assigned to three groups with their informed consents. Group A (n=28) was treated on simvastatin 20 mg/day; Group B (n=29) on atorvastatin 10 mg/day; and Group C (n=28) on rosuvastatin 5 mg/day. Patients’ lipid profile and Lp(a) levels were assessed at 0, 4th and 12th week of treatment period. Statistical analysis was done using Duncan’s test (p<0.05) and one-way ANOVA (p<0.001).

Results: At the end of 12 weeks, serum Lp(a) reduction was substantial at 18.73% in atorvastatin group; at insignificant levels (3.15%) in simvastatin group, whereas an elevated level of 8.58% in Lp(a) was recorded in rosuvastatin group. All three treatment groups showed a significant positive impact on the lipid profile. No adverse drug reactions were reported.

Conclusion: The impact of statin monotherapy on lipid profile doesn’t correlate with its effect on Lp(a). Atorvastatin has shown a significant reduction in Lp(a) unlike the other statins, and should be preferred in patients with increased risk of CVD.


Gupta R, Guptha S, Sharma KK, Gupta A, Deedwania P. Regional variations in cardiovascular risk factors in India: India heart watch. World J Cardiol. 2012;4(4):112-20.

Braunwald E. Shattuck lecture – Cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med. 1997;337(19):1360-9.

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.

International Atherosclerosis Society (IAS) Harmonized Clinical. Guidelines on Prevention of Atherosclerotic Vascular Disease. Printed in March, 2003. Available at http://www.athero.cz/cze/odborna-doporuceni/ias_guidelines_ex_sum.pdf. Accessed 11 Sep 2014.

Sacks FM, Pfeffer MA, Moye’ L, Brown LE, Hamm P, Cole TG, et al. Rationale and design of a secondary prevention trial of lowering normal plasma cholesterol levels after acute myocardial infarction: the Cholesterol and Recurrent Events trial. (CARE) Am J Cardiol. 1991;68(15):1436-46.

Dubé JB, Boffa MB, Hegele RA, Koschinsky ML. Lipoprotein(a): more interesting than ever after 50 years. Curr Opin Lipidol. 2012;23(2):133-40.

Luc G, Bard JM, Arveiler D, Ferrieres J, Evans A, Amouyel P, et al. Lipoprotein (a) as a predictor of coronary heart disease: the PRIME Study. Atherosclerosis. 2002;163(2):377-84.

Ariyo AA, Thach C, Tracy R, Cardiovascular Health Study Investigators. Lp(a) lipoprotein, vascular disease, and mortality in the elderly. N Engl J Med. 2003;349(22):2108 15.

Hernández C, Francisco G, Chacón P, Simó R. Lipoprotein(a) as a risk factor for cardiovascular mortality in type 2 diabetic patients: a 10-year follow-up study. Diabetes Care. 2005;28(4):931-3.

Danesh J, Collins R, Peto R. Lipoprotein(a) and coronary heart disease. Meta-analysis of prospective studies. Circulation. 2000;102(10):1082-5.

Maher VM, Brown BG, Marcovina SM, Hillger LA, Zhao XQ, Albers JJ. Effects of lowering elevated LDL cholesterol on the cardiovascular risk of lipoprotein(a). JAMA. 1995;274(22):1771-4.

Marburger C, Hambrecht R, Niebauer J, Schoeppenthau M, Scheffler E, Hauer K, et al. Association between lipoprotein(a) and progression of coronary artery disease in middle-aged men. Am J Cardiol. 1994;73(11):742-6.

Insull W Jr, Basile JN, Vo AN, Jiang P, Thakkar R, Padley RJ. Efficacy and safety of combination therapy with niacin extended-release and simvastatin versus atorvastatin in patients with dyslipidemia: the SUPREME Study. J Clin Lipidol. 2009;3(2):109-18.

McKenney JM, Jones PH, Bays HE, Knopp RH, Kashyap ML, Ruoff GE, et al. Comparative effects on lipid levels of combination therapy with a statin and extended-release niacin or ezetimibe versus a statin alone (the COMPELL study). Atherosclerosis. 2007;192(2):432-7.

Fieseler HG, Armstrong VW, Wieland E, Thiery J, Schütz E, Walli AK, et al. Serum Lp(a) concentrations are unaffected by treatment with the HMG-CoA reductase inhibitor Pravastatin: results of a 2-year investigation. Clin Chim Acta. 1991;204(1-3):291-300.

Wanner C, Böhler J, Eckardt HG, Wieland H, Schollmeyer P. Effects of simvastatin on lipoprotein (a) and lipoprotein composition in patients with nephrotic syndrome. Clin Nephrol. 1994;41(3):138-43.

Umeda F, Watanabe J, Inoue K, Hisatomi A, Mimura K, Yamauchi T, et al. Effect of pravastatin on serum lipids, apolipoproteins and lipoprotein (a) in patients with non-insulin dependent diabetes mellitus. Endocrinol Jpn. 1992;39(1):45-50.

Hunninghake DB, Stein EA, Mellies MJ. Effects of one year of treatment with pravastatin, an HMG-CoA reductase inhibitor, on lipoprotein a. J Clin Pharmacol. 1993;33(6):574 80.

Jones P, Kafonek S, Laurora I, Hunninghake D. Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatin in patients with hypercholesterolemia (the CURVES study). Am J Cardiol. 1998;81(5):582-7.

Crouse JR 3rd, Frohlich J, Ose L, Mercuri M, Tobert JA. Effects of high doses of simvastatin and atorvastatin on high-density lipoprotein cholesterol and apolipoprotein A-I. Am J Cardiol. 1999;83(10):1476-7, A7.

Jones PH, Davidson MH, Stein EA, Bays HE, McKenney JM, Miller E, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol. 2003;92(2):152-60.

Fujita S, Sano T, Katayama Y. Measurement of serum Lp(a) by COBAS MIRA using a latex immunoturbidimetric assay kit. J Clin Lab Anal. 1994;8(6):385-90.

Kolshinsky LM, Marcovina SM. Lipoprotein (a). In: Ballantyne CM, editor. Clinical Lipidology; A Companion to Braunwald’s Heart Disease. Philadelphia: Elsevier; 2010:130-43.

Gonbert S, Malinsky S, Sposito AC, Laouenan H, Doucet C, Chapman MJ, et al. Atorvastatin lowers lipoprotein(a) but not apolipoprotein(a) fragment levels in hypercholesterolemic subjects at high cardiovascular risk. Atherosclerosis. 2002;164(2):305-11.

Hernández C, Francisco G, Ciudin A, Chacón P, Montoro B, Llaverias G, et al. Effect of atorvastatin on lipoprotein (a) and interleukin-10: a randomized placebo-controlled trial. Diabetes Metab. 2011;37(2):124-30.




How to Cite

Irudayam, J. B., Sivaraj, R., & Nirmala, P. (2017). Effect of statins on lipoprotein (a) in dyslipidemic patients. International Journal of Basic & Clinical Pharmacology, 3(6), 1024–1029. Retrieved from https://www.ijbcp.com/index.php/ijbcp/article/view/1181



Original Research Articles