Bisher AKIL, MD

Treatment Induced Changes in HDL , LDL and Heart Disease

In Heart on March 22, 2009 at 11:06 pm

High-density lipoprotein (HDL) cholesterol level is associated independently and inversely with coronary heart disease risk. However, evidence that treatment-mediated increases in HDL cholesterol levels lower risk for heart disease is lacking. In analysis of 108 randomized trials (Briel M et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: Systematic review and meta-regression analysis. BMJ 2009 Feb 16; 338:b92.), involving nearly 300,000 patients, investigators assessed whether changes in HDL and Low -density lipoprotein (LDL) as a result of medical treatment was associated with changes in the risk for heart disease.
All but five trials involved lipid-modifying drugs. After adjustment for changes in LDL cholesterol levels related to treatment and drug class, no associations were noted between treatment-mediated changes in HDL cholesterol levels and all-cause death. However, changes in LDL cholesterol levels were associated with significant outcomes: For a 10 mg/dL reduction in LDL cholesterol level, relative risks were lowered for all-cause death by 4.4%, for coronary heart disease-related death by 7.2%.
Comments: the good news is that is the LDL is lowered using medications, there is clear and significant benefit; on the other hand, changes in HDL did not seem to make a difference, in this analysis. This analysis may not reveal hidden benefits for increasing HDL, but it makes it clear that the goal of treatment should be lowering LDL _ BA

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