BACKGROUND: Lowering
low-density lipoprotein cholesterol (
LDL-C) with
statins reduces
atherosclerosis.
LDL and
high-density lipoprotein (HDL) are commonly measured by their
cholesterol content, but non-
HDL cholesterol,
LDL particle number (
LDL-P), or total
apolipoprotein B (
apoB) may better predict cardiovascular risk. Few studies have examined relations among
lipoprotein levels and composition before and after interventions to lower
LDL-C and non-HDL-C. OBJECTIVE: To measure changes in carotid artery intimal media thickness (CIMT) and
lipid concentration and composition during 36 months of
statin therapy. METHODS: Analyses were conducted on 418 diabetic individuals, with complete data and no prior cardiovascular events, who were randomized to aggressive (AG) versus standard (STD) treatment for
LDL-C, non-HDL-C, and systolic blood pressure (SBP) as part of the Stop
Atherosclerosis in Native Diabetics Study (
SANDS). RESULTS: The AG group achieved average
LDL-C and non-HDL-C of 71mg/dL and 100mg/dL and a decrease in CIMT. No significant interactions were observed between treatment effect and initial levels of
LDL-C, non-HDL-C, HDL-C,
triglycerides,
apoB, or
LDL-P. Decreases in
LDL-C (p<.005) and non-HDL-C (p<.001) were independently correlated with CIMT regression in the AG group. Changes in
apoB and
LDL-P showed borderline correlations with CIMT regression (p=.07 and p=.09). CONCLUSIONS: In diabetic adults with no prior cardiovascular events, treatment to current targets for
lipids and SBP reduces
atherosclerosis progression and when more aggressive targets are met,
atherosclerosis regresses. The aggressive targets for
LDL-C and non-HDL-C appeared to be the main determinants of CIMT regression and were more predictive of this outcome than changes in
LDL-P or
apoB.