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Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels.
Arch Intern Med. 2009 Oct 26; 169(19):1775-80.AI

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.

Authors+Show Affiliations

McGill Cardiovascular Health Improvement Program and Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada. steven.grover@mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19858435

Citation

Grover, Steven A., et al. "Evaluating the Incremental Benefits of Raising High-density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels." Archives of Internal Medicine, vol. 169, no. 19, 2009, pp. 1775-80.
Grover SA, Kaouache M, Joseph L, et al. Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels. Arch Intern Med. 2009;169(19):1775-80.
Grover, S. A., Kaouache, M., Joseph, L., Barter, P., & Davignon, J. (2009). Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels. Archives of Internal Medicine, 169(19), 1775-80. https://doi.org/10.1001/archinternmed.2009.328
Grover SA, et al. Evaluating the Incremental Benefits of Raising High-density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels. Arch Intern Med. 2009 Oct 26;169(19):1775-80. PubMed PMID: 19858435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels. AU - Grover,Steven A, AU - Kaouache,Mohammed, AU - Joseph,Lawrence, AU - Barter,Philip, AU - Davignon,Jean, PY - 2009/10/28/entrez PY - 2009/10/28/pubmed PY - 2009/11/6/medline SP - 1775 EP - 80 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 169 IS - 19 N2 - 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. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/19858435/Evaluating_the_incremental_benefits_of_raising_high_density_lipoprotein_cholesterol_levels_during_lipid_therapy_after_adjustment_for_the_reductions_in_other_blood_lipid_levels_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2009.328 DB - PRIME DP - Unbound Medicine ER -