HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events

Abstract

In this post hoc analysis, HDL cholesterol levels were predictive of major cardiovascular events in patients treated with statins. This relationship was also observed among patients with LDL cholesterol levels below 70 mg per deciliter. (ClinicalTrials.gov number, NCT00327691 [ClinicalTrials.gov].).

Cholesterol Goals: Moving from Numbers to Treatment

“…Conversely, 2 recent analyses demonstrate that even when the NCEP optional LDL target of <70 mg/dl is attained, residual CHD risk persists if accompanied by low HDL or elevated triglycerides. 11,22 Therefore, while LDL lowering is necessary, it is likely to be insufficient for maximizing CHD risk reduction. As such, the current evidence base more strongly supports a treatment-based approach whereby proven therapies are the goals.…”

Targeting Low HDL-Cholesterol to Decrease Residual Cardiovascular Risk in the Managed Care Setting

“…In particular, the TNT data revealed that, even for patients in the lowest stratum of LDL-C (≤ 70 mg per dL) after 3 months of statin treatment, there was an increased 5-year risk for major cardiovascular events if HDL-C levels also were low. 45 The risk for a major cardiovascular event differed significantly among quintiles of HDL-C levels (P = 0.03) in which those patients in the highest HDL-C quintile (Q5 ≥ 55 mg per dL) had a lower risk for major cardiovascular events than did patients in the lowest HDL-C quintile (Q1 < 37 mg per dL; hazard ratio [HR] vs. Q5 = 0.61). 45 Although LDL is recognized as the most important atherogenic lipoprotein, elevations in TG levels can be considered a marker for atherogenic remnant lipoproteins.…”

“…45 The risk for a major cardiovascular event differed significantly among quintiles of HDL-C levels (P = 0.03) in which those patients in the highest HDL-C quintile (Q5 ≥ 55 mg per dL) had a lower risk for major cardiovascular events than did patients in the lowest HDL-C quintile (Q1 < 37 mg per dL; hazard ratio [HR] vs. Q5 = 0.61). 45 Although LDL is recognized as the most important atherogenic lipoprotein, elevations in TG levels can be considered a marker for atherogenic remnant lipoproteins. VLDL-C and other TG-rich lipoproteins are able to enter the artery wall and initiate atherosclerotic processes and aid in foam cell formation just as LDL can.…”

Treating diabetic dyslipidemia: What have we learnt from recent clinical trials?

“…Intensive lipid lowering with high‐dose statin therapy further improves clinical outcomes compared with less intensive statin therapy, but there is still a significant residual risk, particularly in those with low HDL cholesterol and hypertriglyceridemia. Even if LDL cholesterol levels are <1.8 mmol/L, vascular risk remains up to 40% higher in subjects with low HDL cholesterol (<0.9 mmol/L) or elevated TG (TG > 2.3 mmol/L) 2 . Therefore, it has been suggested that development of new approaches to cardiovascular risk reduction should also target non‐LDL parameters including HDL cholesterol and TG.…”