Research article summary (published 24 Oct 2009):

Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels.

Full Abstract

BACKGROUND: The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events. METHODS: Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (average follow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides, and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of beta-blockers) were then added to the model. Interactions between blood lipid levels were also explored. RESULTS: The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C. CONCLUSIONS: Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events.

Author information

Author/s: Grover, Steven A (SA); Kaouache, Mohammed (M); Joseph, Lawrence (L); Barter, Philip (P); Davignon, Jean (J);

Affiliation: McGill Cardiovascular Health Improvement Program and Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada. steven.grover(-atsign-)mcgill.ca

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2009-Oct; vol 169 (issue 19) : pp 1775-80

Dates: Created 2009/10/27; Completed 2009/11/05;

PMID: 19858435, status: MEDLINE (last retrieval date: 11/5/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged Aged, 80 and over Anticholesteremic Agents - therapeutic use Antilipemic Agents - therapeutic use Biological Markers - blood Blood Pressure Body Mass Index Cardiovascular Diseases - blood; prevention & control Cholesterol, HDL - blood; drug effects Cholesterol, LDL - blood Comorbidity

Female Humans Kaplan-Meiers Estimate Male Middle Aged Multivariate Analysis Odds Ratio Predictive Value of Tests Proportional Hazards Models Treatment Outcome Triglycerides - blood

Associated Chemicals: Anticholesteremic Agents (0) ; Antilipemic Agents (0) ; Biological Markers (0) ; Cholesterol, HDL (0) ; Cholesterol, LDL (0) ; Triglycerides (0)

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