Archief Roodbont

Population-based studies show that HDL levels <40 href="http://cardiology.jwatch.org/cgi/content/full/2008/1110/1">JW Cardiol Nov 10 2008). A total of 17,802 patients with elevated high-sensitivity C-reactive protein levels and baseline LDL levels <130>

At 2 years, the composite event rate was 44% lower (P<0.0001)>P=0.0047). However, in the rosuvastatin group, the median on-treatment LDL level was 54 mg/dL (1.4 mmol/L), and neither baseline nor on-treatment HDL level was associated with cardiovascular risk. Likewise, low apolipoprotein A1 levels were associated with a significant increase in the composite event rate in the placebo group but not in the rosuvastatin group.

Comment: These findings suggest that HDL levels do not predict cardiovascular events in patients who attain very low LDL levels with potent statin therapy for primary prevention. As editorialists note, these results should not distract from the fact that raising HDL cholesterol with lifestyle changes and drugs such as niacin might provide additional cardiovascular benefit in the majority of patients on statin therapy who do not attain very low LDL cholesterol levels. However, we don't yet know whether such strategies or novel HDL-raising agents will improve outcomes in these patients.

— Beat J. Meyer, MD

Published in Journal Watch Cardiology August 4, 2010