CHICAGO — A low HDL-cholesterol level confers increased coronary risk even in persons with an enviably low LDL-cholesterol level of less than 60 mg/dL, Dr. Emil M. deGoma reported at the annual scientific sessions of the American Heart Association.
This observation that HDL cholesterol retains its clinical relevance even in the setting of very low LDL cholesterol suggests that HDL-boosting therapies may play an important role in primary and secondary cardiovascular prevention across the full range of LDL values. Certainly the door is now open for the conduct of clinical trials testing this possibility, added Dr. deGoma of Stanford (Calif.) University.
He presented a retrospective observational study involving 6,357 consecutive patients with an LDL level below 60 mg/dL seen at the Palo Alto VA Medical Center or Stanford-affiliated community clinics. Their mean age was 65. Nearly half were diabetic and three-quarters were hypertensive. Overall, 42% had been diagnosed with ischemic heart disease, and 15% had heart failure.
Patients were grouped in quartiles by HDL level and followed for 1 year. The study end point was the combined 1-year incidence of acute MI or hospitalization for ischemic heart disease, which proved to be inversely related to baseline HDL (see box). Particularly impressive was the hefty 1-year event rate of 8.5% in patients in the lowest HDL quartile.
After adjusting for age and other demographic variables, comorbidities, laboratory values, and—most importantly—statin use, the risk of the combined end point continued to increase in stepwise fashion with decreasing HDL.
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