News from ACC 2009: HDL cholesterol: an important component of residual heart disease risk in statin-treated patients

31 March 2009 - Analysis based on a systematic review of statin trials (476,917 person-years of follow-up) demonstrated that a low level of high density lipoprotein (HDL) cholesterol is an important contributor to residual coronary risk in statin-treated patients. Results were reported at the American College of Cardiology Annual Scientific Sessions, Orlando, March 29-31 2009.

 

Jafri H, Alsheikh-Ali AA, Karas RH. High density lipoprotein cholesterol levels contribute significantly to residual coronary heart disease risk in statin-treated patients. Abstract 1048-70.

 

Investigators from the Tufts Medical Center, Boston, USA identified 16 placebo-controlled trials of statin therapy (total of 7,175 myocardial infarction [MI] events). In patients treated with statin therapy, there was a significant inverse association between on-treatment HDL cholesterol and risk for MI (p=0.001). A similar inverse association between HDL cholesterol and MI risk was also demonstrated in patients in the control arms (p<0.001).

 

Overall, every 10 mg/dL decrease in HDL cholesterol was associated with 6.9 (95% CI 3.1 to 10.5) more MIs per 1000 patient-years in statin-treated patients, and 8.9 (95% CI 4.5 to 13.4) more MIs per 1000 patient-years in control patients (p=0.31, statin vs. control treatment arms).

 

The significant inverse association between HDL cholesterol and risk for MI persisted in both treatment arms even after adjusting for on-treatment levels of low density lipoprotein (LDL) cholesterol and age.

 

The authors concluded that low HDL cholesterol is an important contributor to residual coronary risk in statin-treated patients, even among those who achieve target LDL cholesterol levels.