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.
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.
Authors: Adam D Gepner; Megan E Piper; Heather M Johnson; Michael C Fiore; Timothy B Baker; James H Stein Journal: Am Heart J Date: 2011-01 Impact factor: 4.749
Authors: Seth S Martin; Atif N Qasim; Megan Wolfe; Caitlin St Clair; Stanley Schwartz; Nayyar Iqbal; Mark Schutta; Roshanak Bagheri; Nehal N Mehta; Daniel J Rader; Muredach P Reilly Journal: Am J Cardiol Date: 2011-02-01 Impact factor: 2.778
Authors: S Matthijs Boekholdt; Benoit J Arsenault; G Kees Hovingh; Samia Mora; Terje R Pedersen; John C Larosa; K M A Welch; Pierre Amarenco; David A Demicco; Andrew M Tonkin; David R Sullivan; Adrienne Kirby; Helen M Colhoun; Graham A Hitman; D John Betteridge; Paul N Durrington; Michael B Clearfield; John R Downs; Antonio M Gotto; Paul M Ridker; John J P Kastelein Journal: Circulation Date: 2013-08-21 Impact factor: 29.690
Authors: Kausik Ray; Nick W J Wainwright; Loes Visser; Jacqueline Witteman; Monique Breteler; Baishali Ambegaonkar; Albert Hofman; Bruno Stricker; Nick Wareham; Kay Tee Khaw; Manjinder Sandhu Journal: Heart Date: 2012-03-24 Impact factor: 5.994