The predictive value of HDL cholesterol all but disappeared with treatment-induced low levels of LDL, according to a new analysis of data from a large trial of lipid-lowering therapy.
Among patients treated with rosuvastatin (Crestor), the usual inverse association between HDL levels and vascular risk lost its statistical significance. Neither baseline (P=0.82) nor on-treatment (P=0.97) HDL levels predicted the risk of clinical events, Paul M. Ridker, MD, of Harvard, and colleagues reported online in The Lancet.
In contrast, HDL levels in placebo-treated patients had a significant association with subsequent events both at baseline (P=0.0039) and during randomized treatment (P=0.0047).
"Our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment," Ridker and his co-authors wrote in conclusion. "As shown here among those allocated to placebo, HDL cholesterol was a powerful inverse risk predictor.
"However, these primary prevent data and recent secondary prevention data from [other] trials provide little evidence to support the hypotheses that HDL cholesterol levels predict risk of vascular events in the setting of high-dose statin therapy."
In multiple randomized clinical trials, statin therapy has consistently led to large, statistically significant reductions in cardiovascular events. The benefits have been observed in both primary- and secondary-prevention trials, the authors wrote.
However, in every trial, residual risk has remained among patients assigned to statin therapy. One possible explanation for the residual risk is low levels of HDL.
Continue Reading
No comments:
Post a Comment