Cardiovascular disease is the leading cause of death worldwide. Reducing concentrations of LDL cholesterol with statin therapy has resulted in reductions of 23% in cardiovascular risk for every 1•03 mmol/L (40 mg/dL) decrease in LDL cholesterol. However, despite a reduction in LDL cholesterol with high-dose statins to 1•6 mmol/L in patients with stable coronary heart disease, and to 2•0 mmol/L in those with acute coronary syndrome, the risk of cardiovascular disease remains substantial at 8-7% after 4•9 years of follow-up, and 22-4% after 24 months’ follow-up, respectively. Low concentrations of HDL cholesterol might contribute to this residual cardiovascular risk.”
Population-based studies show that low concentrations of HDL cholesterol «1•03 mmol/L) are a risk factor for cardiovascular disease. thus increasing HDL cholesterol by 0•03 mmol/L can reduce cardiovascular risk by 2-3% per year.
Paul Ridker and colleagues, for the JUPITER Trial Study Group, challenge whether HDL cholesterol concentrations are predictive of cardiovascular risk at low concentrations of LDL cholesterol.
Raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol; the problem, in most cases, is how to achieve this strategy.
Lifestyle changes, such as more aerobic exercise, weight loss, smoking cessation, moderate alcohol intake, and dietary changes might result in modest increases in HDL choiesterol.
Drugs that specifically raise HDL cholesterol concentrations are less available, with niacin being the most effective current agent. Others include the fibrates, the thiazolidinediones, and the qlitazars.
Hausenloy et al 2010 Dissociating HDL cholesterol from cardiovascular risk Lancet vol 376, pp 305-6
Ridker PM et al 2010 HDL cholesterol and residual risk of first cardiovascular events after events after treatment with statin : an analysis from the JUPITER trial vol 376 333-39
- Martin Eastwood