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Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid--a position paper developed by the European Consensus Panel on HDL-C.
Curr Med Res Opin. 2004 Aug; 20(8):1253-68.CM

Abstract

Reduction of low-density lipoprotein cholesterol (LDL-C) is presently the primary focus of lipid-lowering therapy for prevention and treatment of coronary heart disease (CHD). However, the high level of residual risk among statin-treated patients in recent coronary prevention studies indicates the need for modification of other major components of the atherogenic lipid profile. There is overwhelming evidence that a low plasma level of high-density lipoprotein cholesterol (HDL-C) is an important independent risk factor for CHD. Moreover, a substantial proportion of patients with or at risk of developing premature CHD typically exhibit distinct lipid abnormalities, including low HDL-C levels. Thus, therapeutic intervention aimed at raising HDL-C, within the context of reducing global cardiovascular risk, would benefit such patients, a viewpoint increasingly adopted by international treatment guidelines. Therapeutic options for patients with low HDL-C include treatment with statins, fibrates and nicotinic acid, either as monotherapy or in combination. Of these options, nicotinic acid is not only the most potent agent for raising HDL-C but is also effective in reducing key atherogenic lipid components including triglyceride-rich lipoproteins (mainly very low-density lipoproteins [VLDL] and VLDL remnants), LDL-C, and lipoprotein(a). The principal features of the atherogenic lipid profile in type 2 diabetes and the metabolic syndrome make them logical targets for nicotinic acid therapy, either alone or in combination with a statin. The lack of comprehensive European data on the prevalence of low HDL-C levels highlights a critical need for education on the importance of raising HDL-C in CHD prevention and treatment. The development of a reliable and accurate assay for HDL-C, as well as clarification of criteria for low and optimal levels of HDL-C in both men and women, constitute critical factors in the reliable identification and treatment of patients at elevated risk of CHD due to low HDL-C. Based on the available evidence, the European Consensus Panel recommends that the minimum target for HDL-C should be 40 mg/dL (1.03 mmol/L) in patients with CHD or with a high level of risk for CHD, including patients at high global risk with type 2 diabetes or the metabolic syndrome.

Authors+Show Affiliations

Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Pitié, Paris, France. chapman@chups.jussieu.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Consensus Development Conference
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

15324528

Citation

Chapman, M John, et al. "Raising High-density Lipoprotein Cholesterol With Reduction of Cardiovascular Risk: the Role of Nicotinic Acid--a Position Paper Developed By the European Consensus Panel On HDL-C." Current Medical Research and Opinion, vol. 20, no. 8, 2004, pp. 1253-68.
Chapman MJ, Assmann G, Fruchart JC, et al. Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid--a position paper developed by the European Consensus Panel on HDL-C. Curr Med Res Opin. 2004;20(8):1253-68.
Chapman, M. J., Assmann, G., Fruchart, J. C., Shepherd, J., & Sirtori, C. (2004). Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid--a position paper developed by the European Consensus Panel on HDL-C. Current Medical Research and Opinion, 20(8), 1253-68.
Chapman MJ, et al. Raising High-density Lipoprotein Cholesterol With Reduction of Cardiovascular Risk: the Role of Nicotinic Acid--a Position Paper Developed By the European Consensus Panel On HDL-C. Curr Med Res Opin. 2004;20(8):1253-68. PubMed PMID: 15324528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid--a position paper developed by the European Consensus Panel on HDL-C. AU - Chapman,M John, AU - Assmann,Gerd, AU - Fruchart,Jean-Charles, AU - Shepherd,James, AU - Sirtori,Cesare, AU - ,, PY - 2004/8/25/pubmed PY - 2004/12/16/medline PY - 2004/8/25/entrez SP - 1253 EP - 68 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 20 IS - 8 N2 - Reduction of low-density lipoprotein cholesterol (LDL-C) is presently the primary focus of lipid-lowering therapy for prevention and treatment of coronary heart disease (CHD). However, the high level of residual risk among statin-treated patients in recent coronary prevention studies indicates the need for modification of other major components of the atherogenic lipid profile. There is overwhelming evidence that a low plasma level of high-density lipoprotein cholesterol (HDL-C) is an important independent risk factor for CHD. Moreover, a substantial proportion of patients with or at risk of developing premature CHD typically exhibit distinct lipid abnormalities, including low HDL-C levels. Thus, therapeutic intervention aimed at raising HDL-C, within the context of reducing global cardiovascular risk, would benefit such patients, a viewpoint increasingly adopted by international treatment guidelines. Therapeutic options for patients with low HDL-C include treatment with statins, fibrates and nicotinic acid, either as monotherapy or in combination. Of these options, nicotinic acid is not only the most potent agent for raising HDL-C but is also effective in reducing key atherogenic lipid components including triglyceride-rich lipoproteins (mainly very low-density lipoproteins [VLDL] and VLDL remnants), LDL-C, and lipoprotein(a). The principal features of the atherogenic lipid profile in type 2 diabetes and the metabolic syndrome make them logical targets for nicotinic acid therapy, either alone or in combination with a statin. The lack of comprehensive European data on the prevalence of low HDL-C levels highlights a critical need for education on the importance of raising HDL-C in CHD prevention and treatment. The development of a reliable and accurate assay for HDL-C, as well as clarification of criteria for low and optimal levels of HDL-C in both men and women, constitute critical factors in the reliable identification and treatment of patients at elevated risk of CHD due to low HDL-C. Based on the available evidence, the European Consensus Panel recommends that the minimum target for HDL-C should be 40 mg/dL (1.03 mmol/L) in patients with CHD or with a high level of risk for CHD, including patients at high global risk with type 2 diabetes or the metabolic syndrome. SN - 0300-7995 UR - https://www.unboundmedicine.com/medline/citation/15324528/Raising_high_density_lipoprotein_cholesterol_with_reduction_of_cardiovascular_risk:_the_role_of_nicotinic_acid__a_position_paper_developed_by_the_European_Consensus_Panel_on_HDL_C_ L2 - https://www.tandfonline.com/doi/full/10.1185/030079904125004402 DB - PRIME DP - Unbound Medicine ER -