Low HDL-C is common despite statin therapy

Low high-density lipoprotein cholesterol (HDL cholesterol) is prevalent, affecting over 50% of high-risk statin-treated patients, irrespective of attainment of low-density lipoprotein (LDL) cholesterol goals, according to a recent US observational study.   The findings were reviewed by HDL Forum Editor Professor Philip Barter, Heart Research Institute, Sydney, Australia.

 Nichols GA, Ambegaonkar BM, Sazonov V et al. Frequency of obtaining National Cholesterol Education Program Adult Treatment Panel III goals for all major serum lipoproteins after initiation of lipid altering therapy. Am J Cardiol 2009;104:1689-94.

 This study reported observational data from 5,158 patients aged at least 35 years who started lipid-modifying treatment between July 2004 and June 2006 and had full lipid panels (LDL cholesterol, HDL cholesterol and triglycerides) <12 months before (baseline) and 9-15 months after starting treatment. Over 50% of these patients were considered to be at high risk of cardiovascular events, based on National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) recommendations (with established coronary heart disease (CHD) with or without diabetes, diabetes without CHD or 10 year CHD-risk >20%). LDL cholesterol treatment goals were as specified by the NCEP ATP III (1). Normal HDL cholesterol was defined as ³40 mg/dL in men and ³50 mg/dl in women and normal triglycerides were defined as <150 mg/dL.

At baseline, 77% of all patients had elevated LDL cholesterol (mean 143 ±40 mg/dL), 49% had low HDL cholesterol (mean 47 ± 14 mg/dL) and 34% had elevated triglycerides (mean 197 ± 160 mg/dL) (Table 1). Among high-risk patients, more than 50% had low HDL cholesterol levels (mean levels 40-45 mg/dL).

 

Statin therapy was the predominant lipid-modifying therapy initiated (in 96% of patients). However, despite improvement in achievement of LDL cholesterol goals (only 22% were not at goal), low HDL cholesterol persisted in more than 50% of high-risk patients (55% with CHD, 61% with diabetes and without CHD and 57% in those with 10-year coronary risk >20%) (Fig 1). These data were consistent with recent data from the National Health and Nutrition Examination Survey (2).

 

The authors did acknowledge that the data represent the ‘best-case’ scenario, given the focus on adherent patients with baseline and follow-up lipid panels (about one-third of all patients who initiated statin therapy during this period). Despite this limitation, the authors concluded that low HDL cholesterol is prevalent in high-risk statin-treated patients and poorly managed. The current study indicates that approximately 50% of high-risk patients starting statin therapy could be candidates for additional lipid-modifying therapy targeting HDL cholesterol (as well as other lipid targets).

 References

1. Grundy SM, Cleeman JI, Merz NB et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Arterioscler Thromb Vasc Biol 2004;24:e149-e161

2. Ghandehari H, Kamal-Bahl S, Wong ND. Prevalence and extent of dyslipidemia and recommended lipid levels in US adult with and without cardiovascular co-morbidities: The National Health and Nutrition Examination Survey 2003-2004. Am Heart J 2008;156:112-9.

 


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