Introduction . While the clinical benefit to prevent cardiovascular events by using statins in hypercholesterolemic patients with diabetes has been demonstrated in several randomized trials, based on these new findings, study investigators suggest further prospective studies are needed to confirm the differences in the effects on diabetes among statins. Statistical significance of least-squares differences among treatment groups was determined with an ANCOVA model that included controls for treatment, study center, and baseline value. Compared with placebo, RSV10 increased HDL particle concentration (15%) and HDL cholesterol (10%) significantly (P < 0.001) (Fig. LDL cholesterol was calculated as (LDL + HDL cholesterol) from the bottom ultracentrifugation fraction minus HDL cholesterol from the precipitation assay. For determination of HDL cholesterol, plasma was treated with Mn2+ and heparin to precipitate chylomicrons, VLDL, and LDL cholesterol. After the 6-week treatment period, patients treated with RSV10 or placebo received 20 mg/day RSV (RSV20), and patients previously treated with ATV10 received 20 mg/day ATV (ATV20) for another 6 weeks. Sign In to Email Alerts with your Email Address. Least-squares mean percentage change from baseline in lipids and lipoproteins by treatment group. In this population, the magnitude of LDL particle concentration reduction with statins was smaller than that of LDL cholesterol reduction, suggesting that LDL cholesterol may underestimate residual CHD risk in patients with the metabolic syndrome. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. A recent report described the apparent dysfunction of HDL in patients with the metabolic syndrome (14); thus, any mechanistichypothesis would not necessarily apply to other patient groups. Lipids and lipoproteins were measured at a central laboratory certified for lipid analysis by the Standardization Program of the Centers for Disease Control and Prevention and the National Heart, Lung, and BloodInstitute (Medical Research Laboratories International, Zaventum, Belgium, and Highland Heights, KY). This proposal is supported by our observation in patients with the metabolic syndrome that LDL particle concentration remains elevated in many patients who achieve LDL cholesterol goals. Patients were randomly assigned at 56 clinical centers in Europe and the U.S. into a double-blind, double-dummy,parallel-group study (9). Demographic and clinical characteristics of the study population. Atorvastatin 80 mg/day has a clear advantage over rosuvastatin 40 mg/day in terms of renal protection and renal damage. The study was conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Lipoprotein particle concentrations were measured by automated nuclear magnetic resonance spectroscopy (LipoScience, Raleigh, NC) (10). Whether this cholesterol depletion is due to higher cholesterol ester transfer protein–mediated reverse cholesterol transport activity or to reduced cholesterol uptake from the periphery is uncertain. All rights reserved. Number and percentage of patients achieving LDL particle and LDL cholesterol goals. HDL cholesterol, HDL particle concentration, and apoA-I increases with RSV20 were numerically greater than those with ATV20 regardless of baseline triglyceride levels. This difference was apparent at 6 weeks (34 vs. 45% for RSV10 and 30 vs. 38% for ATV10) and became more pronounced after 12 weeks (38 vs. 50% for RSV20 and 33 vs. 44% for ATV20). The costs of publication of this article were defrayed in part by the payment of page charges. No other potential conflicts of interest relevant to this article were reported. J.D.O. A higher proportion of patients assigned to RSV achieved LDL cholesterol <2.59 mmol/l (<100 mg/dl); however, even with RSV20, only 27% of these patients with the metabolic syndrome reached comparably low LDL particle concentration levels of <1,000 nmol/l. Triglycerides weremeasured using the automatic analyzer, and apolipoproteins were measured by immunonephelometry. These findings suggest the possibility that treating patients with the metabolic syndrome to targets based on LDL particle concentration rather than on LDL cholesterol may provide a more reliable approach to reducing residual CHD risk, but this remains to be established. With either statin, percent reductions in LDL particle concentration were smaller than reductions in LDL cholesterol. RESEARCH DESIGN AND METHODS Patients with dyslipidemia and the metabolic syndrome (n = 318) were randomly assigned in a double-blind study comparing 10 mg rosuvastatin (RSV), 10 mg atorvastatin, or placebo daily for 6 weeks. Study procedures were approved by ethics committees, and all patients provided informed, written consent. Increases in HDL cholesterol, HDL particle concentration, and apoA-I were greater with RSV than with ATV (P < 0.001 for all vs. ATV10; P < 0.01 for HDL cholesterol and HDL particle concentration, and P < 0.05 for apoA-I vs. ATV20).