HDL No Risk Marker When LDL Was Very Low : Achieving low LDL levels via statin use may reduce the clinical relevance of HDL levels.

In an accompanying editorial comment, Dr. Derek Hausenloy of The Hatter Cardiovascular Institute, University College London Hospital, and his colleagues noted that although the researchers had shown that HDL cholesterol concentrations do not predict residual cardiovascular risk in patients with very low LDL cholesterol concentrations, the reasons for this observation remain unclear (Lancet 2010;376:305-6).

“Perhaps, in patients with a low cardiovascular risk … who are treated to very low concentrations of LDL cholesterol, the relation between HDL cholesterol and cardiovascular risk is lessened; however, [the researchers] were not able to find a relation between apolipoprotein A1 and reduced cardiovascular risk,” they wrote.

They added that in the setting of very low LDL cholesterol, other lipid measures such as apolipoprotein B to A1 ratio may provide a better prediction of cardiovascular risk.

Regardless, the findings should not “detract from the fact that raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol,” wrote Dr. Hausenloy and his colleagues, none of whom had any disclosures to make in relation to the study.

It still needs to be determined in large randomized trials whether increasing HDL cholesterol in patients with very low LDL cholesterol is of benefit, they noted.

They added that such trials will be particularly important given that two new inhibitors of cholesterol ester transfer proteins—anacetrapib and dalcetrapib—are now in clinical testing.

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Source Elsevier Global Medical News