Effect of therapeutic interventions on oxidized phospholipids on apolipoprotein B100 and lipoprotein(a)

Calvin Yeang, Ming Yow Hung, Young Sup Byun, Paul Clopton, Xiaohong Yang, Joseph L. Witztum, Sotirios Tsimikas

Research output: Contribution to journalArticlepeer-review

70 Citations (Scopus)


Background Oxidized phospholipids (OxPL) on apolipoprotein B-100 (OxPL-apoB) reflect the biological activity of lipoprotein(a) (Lp[a]) and predict cardiovascular disease events. However, studies with statins and low-fat diets show increases in OxPL-apoB and Lp(a). Objective This study evaluated changes in OxPL-apoB and Lp(a) with extended-release niacin (N), ezetimibe/simvastatin (E/S) and combination E/S/N. A systematic literature review of previously published trials, measuring both OxPL-apoB and Lp(a) after therapeutic interventions, was also performed. Methods OxPL-apoB and Lp(a) were measured in 591 patients at baseline and 24 weeks after therapy with N, E/S, or E/S/N in a previously completed randomized trial of hypercholesterolemic patients. The literature review included 12 trials and 3896 patients evaluating statins, low-fat diets, antisense to apolipoprotein(a) and lipid apheresis. Results Niacin decreased OxPL-apoB levels (median [interquartile range]; 3.5 [2.2-9.2] nM to 3.1 [1.8-7.2] nM, P <.01) and Lp(a) (10.9 [4.6-38.4] to 9.3 [3.1-32.9] mg/dL, P <.01). In contrast, E/S and E/S/N significantly increased OxPL-apoB (3.5 [2.1-7.8] to 4.9 [3.0-11.1] nM, P <.01) and (3.3 [1.9-9.3] to 4.3 [2.6-11.2] nM, P <.01), respectively and Lp(a) (11.5 [6.1-36.4] to 14.9 [6.6-54.6] mg/dL, P <.01) and (11.3 [5.4-43.8] to 11.6 [5.9-52.8] mg/dL, P <.01), respectively. The systematic review of statins and diet demonstrated 23.8% and 21.3% mean increases in OxPL-apoB and 10.6% and 19.4% increases in Lp(a), respectively. However 44.1% and 52.0% decreases in OxPL-apoB and Lp(a), respectively, were present with Lp(a)-lowering therapies. Conclusions This study demonstrates differential changes in OxPL-apoB and Lp(a) with various lipid-lowering approaches. These changes in OxPL-apoB and Lp(a) may provide insights into the results and interpretation of recent cardiovascular disease outcomes trials.

Original languageEnglish
Pages (from-to)594-603
Number of pages10
JournalJournal of Clinical Lipidology
Issue number3
Publication statusPublished - May 1 2016


  • Diet
  • Ezetimibe
  • Lipoprotein(a)
  • Niacin
  • Oxidized phospholipids
  • Simvastatin
  • Statin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine


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