Several possible limitations should be noted. © 2009 by the American Diabetes Association. Corresponding author: Robert S. Rosenson. CONCLUSIONS In patients with the metabolic syndrome, statin-induced changes in LDL cholesterol do not accurately reflect changes in LDL particle concentration. RSV increased HDL cholesterol, and both statins increased HDL particle concentration compared with placebo. 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Lipitor (atorvastatin) is an HMG-CoA reductase inhibitor (a “statin” drug) used to lower blood cholesterol levels. has served on the speakers' bureau of AstraZeneca, owns stock in LipoScience, and has received consulting fees and honoraria from LipoScience. In nearly all prospective studies, LDL particle concentration or apoB has been a stronger predictor of cardiovascular outcomes than LDL cholesterol. We sought to determine the efficacy of statin therapy in achieving LDL cholesterol targets set by the National Cholesterol Education Program Adult Treatment Panel III (ATP III) and the corresponding numbers of patients who achieved LDL particle concentration targets below the 50th percentile (<1,300 nmol/l) and below the 20th percentile (<1,000 nmol/l) based on values established by the Multi-Ethnic Study of Atherosclerosis (MESA) (10). Neither statin showed a statistically significant effect on apoA-I compared with placebo; however, increases in apoA-I were significantly greater with RSV than with ATV at 6 (P = 0.001) and 12 weeks (P = 0.02) (Fig. Roland Tacke and Michael Theisen, from Scientific Connections (Newtown, PA), who provided assistance with medical writing that was funded by AstraZeneca. is an employee and stockholder of AstraZeneca. Atorvastatin (10 or 20 mg) had a greater effect on blood sugar than the same doses of pravastatin or simvastatin in one study, while another showed that the higher-intensity statins such as atorvastatin, rosuvastatin and simvastatin increased the risk of newly diagnosed diabetes compared to treatment with fluvastatin or lovastatin over a 14-year period. However, the objective nature of the measurements and the small magnitude of changes observed with placebo in the first 6-week period suggest that changes by 12 weeks can be attributed to statin therapy. A recent analysis of the Framingham Offspring Study showed that LDL particle concentration was approximately twice as strongly related to CVD incidence as was LDL cholesterol (6). The population included 318 patients at baseline, of whom 136 were randomly assigned to RSV10, 119 to ATV10, and 63 to placebo. Lipoprotein particle concentrations were measured by nuclear magnetic resonance spectroscopy, LDL cholesterol was measured by β-quantification, and other lipoproteins were measured by standard methods at baseline, 6 weeks, and 12 weeks.