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Statins Do Not Eliminate Risk of Low HDL-Cholesterol Levels

Low levels of HDL cholesterol, even among statin-treated patients, are associated with a significantly increased risk of cardiovascular disease, particularly the risk of MI, a new study has shown.

To reduce the residual risk of disease among these well-treated patients, researchers say clinicians should also focus on HDL-cholesterol levels, despite the failure of recent HDL-cholesterol-raising drugs and the lack of hard outcomes data.

Senior investigator Dr Richard Karas (Tufts Medical Center, Boston, MA) stated that, “In common clinical practice, my sense is that among healthcare providers, once they aggressively lower LDL-cholesterol levels, the thinking is that they have done all they can do to remove their patient’s cardiovascular disease risk…. The thinking is that because the LDL-cholesterol levels are so well treated, we won’t have to worry about HDL cholesterol.”

Presenting the results of a new meta-analysis at the American Heart Association (AHA) 2009 Scientific Sessions, Karas stressed that the findings are not meant to minimize the use of statin medications for lowering LDL cholesterol, a cornerstone for reducing cardiovascular disease morbidity and mortality. Instead, he said, the results show that statins do not mitigate the risks associated with low HDL-cholesterol levels.

Low levels of HDL cholesterol are known to be associated with increased cardiovascular disease risk, and many high-profile studies in the past have focused on raising HDL cholesterol. One cholesteryl ester transfer protein inhibitor, however, Pfizer’s torcetrapib, bombed when it was shown the drug increased the risk of death and cardiovascular events. Other agents, including Merck’s anacetrapib, are still in development and don’t appear to have the same early off-target toxicity as torcetrapib, a drug that increased blood pressure.

Karas said that although statins reduce the risk of cardiovascular disease, event rates in statin-treated patients remain unacceptably high. It is unclear, he said, whether the cardiovascular disease risk associated with low levels of HDL cholesterol is altered by statin therapy.

Presented at the American Heart Association (AHA) 2009 Scientific Sessions