NEW YORK (Reuters Health) In statin-treated patients with coronary artery disease (CAD), high levels of the enzyme phospholipid transferprotein (PLTP) significantly increase the risk of cardiovascular events, independent of classic risk factors, researchers have observed.

Writing in the April issue of the Journal of Lipid Research, they say it’s possible that the beneficial effects of statins are blunted in patients with high PLTP activity, which means that high PLTP activity could be one confounder for less-beneficial effect of statin treatment.

PLTP is involved in cholesterol transport and has been shown to have proatherogenic properties in murine models, although the enzymes’ role in human atherosclerosis remains controversial, Dr. Axel Schlitt from Martin Luther-University Halle-Wittenberg, Germany and colleagues explain.

To investigate, they measured plasma PLTP levels in 1,085 patients with angiographically proven CAD and analyzed its relation to clinical outcome. At baseline, 395 patients were receiving statins.

During a median follow up of 5.1 years, 156 patients experienced the combined endpoint of myocardial infarction or cardiovascular death, including 47 who were taking statins at baseline.

In the total cohort, there was no association between baseline PLTP activity and clinical outcome. In those who were taking statins from the start, however, high PLTP activity was significantly associated with fatal and nonfatal cardiovascular events (p = 0.019).

The results held up in multivariate Cox regression analyses (p = 0.041) taking into account potential confounders including classic risk factors and HDL cholesterol, the team reports.

Our data are hypothesis generating, Dr. Schlitt and colleagues conclude. They call for “further prospective trialsto elucidate the exact connection between statin treatment and PLTP activity.

Reference:
J Lipid Res 2009;50:723-729.

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