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HDL Levels and Cardiovascular Risk in Patients with Very Low LDL Levels

HDL level was inversely correlated with cardiovascular events, regardless of LDL level.

Although high HDL cholesterol levels are generally associated with a reduced incidence of cardiovascular events, whether this association persists among statin-treated patients who achieve very low LDL levels is uncertain. To address this question, researchers performed a post hoc analysis of data from a previously published industry-sponsored study (see Journal Watch General Medicine Apr 1 2005).

Patients with coronary heart disease received either 10 mg or 80 mg of atorvastatin per day, which resulted in mean LDL levels of 101 mg/dL and 77 mg/dL, respectively. Regardless of the LDL level achieved by these statin recipients, higher HDL levels predicted lower rates of cardiovascular events at 5 years. In the subgroup of patients with the lowest LDL levels (<70 mg/dL), the 5-year risk for a major cardiovascular event was about 40% lower among those in the highest HDL quintile (55 mg/dL) than among those in the lowest HDL quintile (<37 mg/dL).

Comment: In this study, HDL cholesterol remained inversely correlated with cardiovascular events, even among atorvastatin-treated patients who achieved LDL cholesterol levels below 70 mg/dL. Whether patients with both low LDL and low HDL would benefit from additional drug therapies to raise HDL cholesterol is unclear.

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 26, 2007

Citation(s):

Barter P et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007 Sep 27; 357:1301.

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