This article is available online at http://www.jlr.org a CHD event during pravastatin therapy: insights from the PROSPER trial. J. Lipid Res . 2010. 51: 202-209.
Supplementary key words lipoproteins • lathosterol • desmosterol • phytosterolsElevated plasma LDL-cholesterol and triglyceride concentrations and low HDL-cholesterol concentrations are well-established risk factors for coronary heart disease (CHD) ( 1, 2 ). Several primary and secondary prevention trials have documented that statin therapy is effi cacious in lowering these lipid risk factors and subsequent CHD events and mortality ( 3-10 ). Nonetheless, CHD events still occur in some treated patients. For instance, in the Scandinavian Simvastatin Survival Study, which evaluated the effect of simvastatin on mortality and morbidity in 4444 CHD patients, simvastatin (20-40 mg/day) lowered LDLcholesterol concentrations by 35% and raised HDLcholesterol concentrations by 8% relative to placebo ( 8 ). These changes were associated with a 42% reduction in the risk of coronary deaths over a 5.4 year median follow-up period. However, there were 431 coronary events and 111 CHD-related deaths in the simvastatin-treated group.Likewise, the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) Trial examined the effects of pravastatin therapy (40 mg/day) in an elderly cohort of Abstract Cholesterol homeostasis, defi ned as the balance between absorption and synthesis, infl uences circulating cholesterol concentrations and subsequent coronary heart disease (CHD) risk. Statin therapy targets the rate-limiting enzyme in cholesterol biosynthesis and is effi cacious in lowering CHD events and mortality. Nonetheless, CHD events still occur in some treated patients. To address differences in outcome during pravastatin therapy (40 mg/day), plasma markers of cholesterol synthesis (desmosterol, lathosterol) and fractional cholesterol absorption (campesterol, sitosterol) were measured, baseline and on treatment, in the Prospective Study of Pravastatin in the Elderly at Risk trial participants with (cases, n = 223) and without (controls, n = 257) a CHD event. Pravastatin therapy decreased plasma LDL-cholesterol and triglycerides and increased HDLcholesterol concentrations to a similar extent in cases and controls. Decreased concentrations of the cholesterol synthesis markers desmosterol ( ؊ 12% and ؊ 11%) and lathosterol ( ؊ 50% and ؊ 56%) and increased concentrations of the cholesterol absorption markers campesterol (48% and 51%) and sitosterol (25% and 26%) were observed on treatment, but the magnitude of change was similar between cases and controls. These data suggest that decreases in cholesterol synthesis in response to pravastatin treatment were accompanied by modest compensatory increases in fractional cholesterol absorption. The magnitude of these alterations were similar between cases and controls and do not explain differences in outcomes with pravastatin treatment.-N. R. Matthan, N.