Statins
Atorvastatin lowers Lp(a) more than simvastatin, but neither affects apo(a) fragments, a double-blind trial of 391 patients (Atherosclerosis 2002)
Original title: Atorvastatin lowers lipoprotein(a) but not apolipoprotein(a) fragment levels in hypercholesterolemic subjects at high cardiovascular risk
This double-blind trial randomised 391 hypercholesterolaemic patients at high cardiovascular risk to atorvastatin 10 mg/day (n=199) or simvastatin 20 mg/day (n=192) for 6 weeks, measuring Lp(a) and apo(a) fragment levels before and after treatment. Baseline Lp(a) and apo(a) fragment levels were similar between groups. Both statins significantly reduced Lp(a) (atorvastatin: 6% reduction, P<0.001; simvastatin: 0.02% reduction, P=0.046), with the reduction independently associated with baseline Lp(a) concentration but not LDL cholesterol reduction; neither statin significantly changed apo(a) fragment levels. The findings show both atorvastatin and simvastatin significantly lower Lp(a), with a greater effect from atorvastatin, while apo(a) fragmentation remains unaffected by either statin.
Original abstract
The effect of statins on Lp(a) levels is controversial; furthermore, the potential action of statins on apo(a) fragmentation is indeterminate. We therefore determined the circulating levels of Lp(a) and of apo(a) fragments in hypercholesterolemic patients before and after treatment (6 weeks) with Atorvastatin 10 mg/day (A10) or Simvastatin 20 mg/day (S20). In a double blind study, hypercholesterolemic patients (n=391) at high cardiovascular risk (LDL-C>=4.13 mmol/l; TG<2.24 mmol/l; 34% with documented CHD; 45% hypertensive; and 29% current smokers) were assigned to treatment with A10 (n=199) or S20 (n=192). Plasma Lp(a) and apo(a) fragment levels (n=206) were measured prior to and after treatment. At baseline, A10 and S20 groups did not differ in plasma levels of lipids, Lp(a) (A10: 0.45+/-0.48 mg/ml, S20: 0.46+/-0.5), and apo(a) fragments (A10: 3.88+/-5.22 microg/ml; S20: 3.25+/-3), and equally in apo(a) isoform size (A10: 26+/-5 kr, S20: 25.5+/-5.3). After treatment, both statins significantly reduced Lp(a) levels (A10: 0.42+/-0.47 mg/ml, 6% variation, P<0.001; S20: 0.45+/-0.53 mg/ml, 0.02% variation, P=0.046). A10 and S20 did not significantly differ in their efficacy to lower Lp(a) levels. In a multivariate logistic regression analysis, the reduction of Lp(a) levels was independently associated with Lp(a) baseline concentration, but not to other variables, including LDL-C reduction. Plasma levels of apo(a) fragments were not modified by either statin. In conclusion, both A10 and S20 significantly lowered Lp(a), although this effect was of greater magnitude in atorvastatin-treated patients.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.