Switching to Pitavastatin in Statin-Treated Low HDL-C Patients Further Improves the Lipid Profile and Attenuates Minute Myocardial Damage

BACKGROUND: The aim of this study is to determine the prevalence of minute myocardial damage (MMD) in already statin-treated dyslipidemic patients with a low high-density lipoprotein-cholesterol (HDL-C) level, and to evaluate whether pitavastatin could affect the lipid profiles and biomarkers reflecting myocardial stress and injury. METHODS: Twenty patients (15 men; age 66 ± 8) being treated with any statin but who had HDL-C < 40 mg/dL, were switched to pitavastatin (2 mg/day) treatment. The patient lipid profiles and the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT), and high-sensitive C-reactive protein (hs-CRP) were evaluated for six months. RESULTS: At three months after the statin replacement, the HDL-C significantly increased from 37 ± 3 mg/dL to 40 ± 5 mg/dL (P < 0.05), and the low-density lipoprotein-cholesterol (LDL-C) and LDL-C/HDL-C ratio significantly reduced (100 ± 28 mg/dL to 86 ± 22 mg/dL, P < 0.05; 2.68 ± 0.67 to 2.17 ± 0.64, P < 0.05, respectively), and these changes were sustained for six months. In the whole study population, no significant changes were observed in the NT-proBNP, hsTnT, or hsCRP for six months. However, in 11 cases who showed a positive (> 0.003 ng/mL) hsTnT at baseline, a significant reduction in the hsTnT was observed (0.016 ± 0.020 ng/mL to 0.014 ± 0.020 ng/mL, P < 0.05), and its percent reduction significantly correlated with the percent increase in HDL-C (r = -0.68, P < 0.05). CONCLUSIONS: MMD (positive hsTnT) was observed in more than half of patients with low HDL-C despite the administration of any statin, and the replacement of their previous statin with pitavastatin further improved their lipid profiles and led to better myocardial protection, possibly mediated via the elevation of the HDL-C level.