Cardiovascular Drugs and Therapy

, Volume 20, Issue 3, pp 205–217 | Cite as

The Clinical Relevance of Low-Density-Lipoproteins Size Modulation by Statins

  • Manfredi RizzoEmail author
  • Kaspar Berneis
Review Article


The predominance of small, dense low density lipoproteins (LDL) has been accepted as an emerging cardiovascular risk factor by the National Cholesterol Education Program Adult Treatment Panel III; in fact, LDL size seems to be an important predictor of cardiovascular events and progression of coronary heart disease. Several studies have also shown that the therapeutical modulation of LDL size is of great benefit in reducing the risk of cardiovascular events. Hypolipidemic treatment is able to alter LDL subclass distribution and statins are currently the most widely used lipid-lowering agents. Statins are potent inhibitors of hydroxy-methyl-glutaryl-coenzyme A reductase, the rate-limiting enzyme in hepatic cholesterol synthesis and are the main drugs of choice for the treatment of elevated plasma LDL cholesterol concentrations. Statins potentially lower all LDL subclasses (e.g., large, medium and small particles); thus, their net effect on LDL subclasses or size is often only moderate. However, a strong variation has been noticed among the different agents: analyses of all published studies suggest a very limited role of pravastatin and simvastatin in modifying LDL size and their subclasses, while fluvastatin and atorvastatin seem to be much more effective agents. Finally, rosuvastatin, the latest statin molecule introduced in the market, seems to be promising in altering LDL subclasses towards less atherogenic particles.

Key words

statins small, dense LDL coronary heart disease atherosclerosis prevention therapy 


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© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  1. 1.Dipartimento di Medicina Clinica e delle Patologie EmergentiUniversita’ di PalermoPalermoItaly
  2. 2.Department of Internal Medicine, Division of Endocrinology and DiabetologyUniversity Hospital ZurichZurichSwitzerland

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