| Title | Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels. | | Author(s) | Grover SA, Kaouache M, Joseph L, Barter P, Davignon J | | Institution | McGill Cardiovascular Health Improvement Program and Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada. steven.grover@mcgill.ca | | Source | Arch Intern Med 2009 Oct 26; 169(19):1775-80. | | MeSH | Aged
Aged, 80 and over
Anticholesteremic Agents
Antilipemic Agents
Biological Markers
Blood Pressure
Body Mass Index
Cardiovascular Diseases
Cholesterol, HDL
Cholesterol, LDL
Comorbidity
Female
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Proportional Hazards Models
Treatment Outcome
Triglycerides
| | Abstract | BACKGROUND: The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events.
METHODS: Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (average follow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides, and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of beta-blockers) were then added to the model. Interactions between blood lipid levels were also explored.
RESULTS: The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C.
CONCLUSIONS: Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events. | | Language | eng | | Pub Type(s) | Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
| | PubMed ID | 19858435 |
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