Friday, March 20, 2009
cholesterol statines
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Summary and Comment
Treatment-Mediated Change in HDL Cholesterol Levels and CHD Risks
Lowering LDL levels yielded benefit; raising HDL levels did not.
High-density lipoprotein (HDL) cholesterol level is associated independently and inversely with coronary heart disease risk. Nevertheless, evidence that treatment-mediated increases in HDL cholesterol levels lower CHD risk is lacking. In this analysis of 108 randomized trials, involving nearly 300,000 patients, investigators assessed whether treatment-mediated changes in HDL cholesterol levels are associated with all-cause death, CHD-related death, and adverse CHD events (CHD-related death and nonfatal myocardial infarction).
All but five trials involved lipid-modifying drugs. After adjustment for changes in low-density lipoprotein (LDL) cholesterol levels related to treatment and drug class, no associations were noted between treatment-mediated changes in HDL cholesterol levels and all-cause death, CHD-related death, or adverse CHD events. However, after adjustments for changes in HDL cholesterol levels and drug class, treatment-mediated changes in LDL cholesterol levels were associated with significant outcomes: For a 10 mg/dL reduction in LDL cholesterol level, relative risks were lowered for all-cause death by 4.4%, for CHD-related death by 7.2%, and for adverse CHD events by 7.1%.
Comment: In this analysis, no association was found between treatment-mediated increases in HDL cholesterol level and CHD-related morbidity and mortality. However, the overall mean treatment-mediated HDL increase was small (4%) compared with the LDL reduction (16%). As a result, the authors acknowledge that detecting a benefit associated with HDL-raising therapy might have been hindered. Nevertheless, the results affirm that lowering LDL cholesterol levels should be the goal of lipid-modifying treatments.
— Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine March 19, 2009
Citation(s):
Briel M et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: Systematic review and meta-regression analysis. BMJ 2009 Feb 16; 338:b92. (http://dx.doi.org/10.1136/bmj.b92)
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Medline abstract (Free)
Summary and Comment
Treatment-Mediated Change in HDL Cholesterol Levels and CHD Risks
Lowering LDL levels yielded benefit; raising HDL levels did not.
High-density lipoprotein (HDL) cholesterol level is associated independently and inversely with coronary heart disease risk. Nevertheless, evidence that treatment-mediated increases in HDL cholesterol levels lower CHD risk is lacking. In this analysis of 108 randomized trials, involving nearly 300,000 patients, investigators assessed whether treatment-mediated changes in HDL cholesterol levels are associated with all-cause death, CHD-related death, and adverse CHD events (CHD-related death and nonfatal myocardial infarction).
All but five trials involved lipid-modifying drugs. After adjustment for changes in low-density lipoprotein (LDL) cholesterol levels related to treatment and drug class, no associations were noted between treatment-mediated changes in HDL cholesterol levels and all-cause death, CHD-related death, or adverse CHD events. However, after adjustments for changes in HDL cholesterol levels and drug class, treatment-mediated changes in LDL cholesterol levels were associated with significant outcomes: For a 10 mg/dL reduction in LDL cholesterol level, relative risks were lowered for all-cause death by 4.4%, for CHD-related death by 7.2%, and for adverse CHD events by 7.1%.
Comment: In this analysis, no association was found between treatment-mediated increases in HDL cholesterol level and CHD-related morbidity and mortality. However, the overall mean treatment-mediated HDL increase was small (4%) compared with the LDL reduction (16%). As a result, the authors acknowledge that detecting a benefit associated with HDL-raising therapy might have been hindered. Nevertheless, the results affirm that lowering LDL cholesterol levels should be the goal of lipid-modifying treatments.
— Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine March 19, 2009
Citation(s):
Briel M et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: Systematic review and meta-regression analysis. BMJ 2009 Feb 16; 338:b92. (http://dx.doi.org/10.1136/bmj.b92)
Original article (Subscription may be required)
Medline abstract (Free)
# posted by roodbont @ 9:19 AM 
