Patients with acute coronary syndromes assigned
atorvastatin had a positive response to the therapy, study results
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
Fraley A. J
Am Coll Cardiol.