Pravastatin reduces levels of both small and large LDL particles

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WESTPORT, CT (Reuters Health) – Contrary to some other
findings, results from a new study indicate that pravastatin does reduce all subclasses of low density lipoproteins–including small, intermediate and large LDL particles–researchers report in the current issue of Atherosclerosis.

"Other studies have found that statins were ineffective in reducing the most atherogenic LDL subclasses–the small particles," Dr. Robert S. Rosenson from Northwestern University Medical School in Chicago told Reuters Health.

Dr. Rosenson and colleagues used NMR spectroscopy to study frozen plasma samples for 292 participants in the Pravastatin Limitation of Atherosclerosis in the Coronaries trial. "We looked at the response to pravastatin as a function of baseline LDL size and we looked at patients with predominantly small LDL, intermediate LDL and large LDL particles," Dr Rosenson said.

Pravastatin was effective in reducing LDL levels to the same extent in all three groups, he said. The subclasses of LDL size that were reduced depended on the predominant subclass, Dr. Rosenson added.

For example, pravastatin was most effective in reducing small particles for patients with small LDL, while for patients with large LDL, pravastatin reduced the large and intermediate LDL particles to a greater extent than the small particles. "Statins should be considered a sledgehammer, because they reduce whichever LDL subclass is predominant," Dr. Rosenson said.

For patients with predominantly small LDL particles, reducing the concentration of small LDL particles will increase the average LDL particle size, Dr. Rosenson said. "So patients with small LDL do not get the least benefit from a statin, but get the greatest benefit," he stressed.

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