Atorvastatin and the plasma activities of lipoprotein lipase, hepatic lipase and lecithin:cholesterol acyltransferase in patients with mixed hyperlipidemia

Background: Atorvastatin provokes a strong reduction in plasma total cholesterol (TC) and LDL-cholesterol (LDL-C), an effect attributed to the increase in the receptor-mediated catabolism of LDL and well-demonstrated for statins. In addition, atorvastatin induces a reduction in plasma triglycerides (TG), an effect that must be ascribed to another mechanism. Methods: Ten patients with mixed hyperlipidemia (TC and TG greater than 250 and 200 mg/dl, respectively) were treated with atorvastatin, 10 mg/day for 1 month and 20 mg/day for another month. The plasma activities of lecithin:cholesterol acyltransferase (LCAT), of lipoprotein lipase (LPL), and of hepatic lipase (HL) were measured before and at the end of treatment. The changes were analyzed in relation to changes in plasma lipids and in components of lipoproteins. Results: A marked increase (65%) in the plasma LCAT was observed, together with a slight (18.1%) decrease in the plasma HL activity. Plasma activity of LPL remained unchanged. Conclusions: In this uncontrolled study, atorvastatin provoked a marked increase in the turnover of cholesteryl esters in accordance with the well-known stimulating effect of statins on the receptor-mediated catabolism of LDL. The marked decrease in TG is explained not by an increased activity of LPL but probably by a reduced synthesis of VLDL by the liver. The results must be confirmed in a placebo- controlled study. (C) 2000 Elsevier Science B.V.