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MIRACL: Atorvastatin associated with increased oxidized phospholipids, apolipoprotein B-100 in patients with ACS

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Patients with acute coronary syndromes assigned atorvastatin had a positive response to the therapy, study results suggested.

Researchers for the MIRACL trial enrolled 2,342 patients with ACS or non-Q wave MI into the study. They randomly assigned patients to either atorvastatin 80 mg daily (n=1,151) or placebo (n=1,191) for a duration of 16 weeks. The researchers measured levels of oxidized phospholipids, apolipoprotein B-100, lipoprotein (a) and various oxidized LDL biomarkers.

According to the study results, atorvastatin was associated with large changes in all biomarkers in female patients, patients <65 years, patients with LDL <120 mg/dL, nonsmokers and patients without diabetes (P<.0001 for all). Oxidized phospholipids and apolipoprotein B-100 levels increased in the atorvastatin group vs. placebo (9.5% vs. –3.9%, P<.0001), as did lipoprotein (a) levels (8.8% vs. –0.7%, P<.0001) over the 16-week treatment period. The increases were reported across all 20 subgroups evaluated in the study. There were no significant correlations reported between all oxidized LDL biomarkers and CRP, serum amyloid A, tissue plasminogen activator, interleukin-6, intracellular adhesions molecule, vascular cell adhesion molecule, P-selectin and E-selectin at both randomization and at 16 weeks.

“The consistent increase in oxidized phospholipids and apolipoprotein B-100, and to a lesser extent lipoprotein (a), in response to atorvastatin across all subgroups tested suggests that it may serve as a benchmark for future studies evaluating such biomarkers,” the researchers concluded. “Future studies are warranted to assess whether changes in these biomarkers reflect therapeutic efficacy and predict clinical events.”

Fraley A. J Am Coll Cardiol. 2009;53:2186-2196