Can change in high-density lipoprotein cholesterol levels reduce cardiovascular risk?

The cardiovascular risk reduction observed in many trials of lipid-lowering agents is greater than expected on the basis of observed low-density lipoprotein cholesterol (LDL-C) level reductions. Our objective was to explore the degree to which high-density lipoprotein cholesterol (HDL-C) level chang...

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Bibliographic Details
Published in:The American heart journal 2004-06, Vol.147 (6), p.966-976
Main Authors: Dean, Bonnie B, Borenstein, Jeff E, Henning, James M, Knight, Kevin, Merz, C.Noel Bairey
Format: Article
Language:English
Subjects:
Adult
Anticholesteremic Agents - therapeutic use
Apolipoprotein A-I - biosynthesis
Apolipoprotein A-I - pharmacology
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cholesterol
Cholesterol, HDL - drug effects
Cholesterol, HDL - metabolism
Cholesterol, LDL - metabolism
Coronary Artery Disease - etiology
Coronary Artery Disease - metabolism
Coronary Artery Disease - mortality
Coronary Artery Disease - prevention & control
Female
Heart attacks
Humans
Hypercholesterolemia - complications
Hypercholesterolemia - prevention & control
Male
Medical sciences
Mortality
Risk Assessment
Statins
Studies
Survival Rate
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Summary:The cardiovascular risk reduction observed in many trials of lipid-lowering agents is greater than expected on the basis of observed low-density lipoprotein cholesterol (LDL-C) level reductions. Our objective was to explore the degree to which high-density lipoprotein cholesterol (HDL-C) level changes explain cardiovascular risk reduction. A systematic review identified trials of lipid-lowering agents reporting changes in HDL-C and LDL-C levels and the incidence of coronary heart disease (CHD). The observed relative risk reduction (RRR) in CHD morbidity and mortality rates was calculated. The expected RRR, given the treatment effect on total cholesterol level, was calculated for each trial with logistic regression coefficients from observational studies. The difference between observed and expected RRR was plotted against the change in HDL-C level, and a least-squares regression line was calculated. Fifty-one trials were identified. Nineteen statin trials addressed the association of HDL-C with CHD. Limited numbers of trials of other therapies precluded additional analyses. Among statin trials, therapy reduced total cholesterol levels as much as 32% and LDL-C levels as much as 45%. HDL-C level increases were
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2003.10.051