Insights from recent meta-analysis: role of high-density lipoprotein cholesterol in reducing cardiovascular events and rates of atherosclerotic disease progression.
BACKGROUND
Although low-density lipoprotein cholesterol (LDL-C) traditionally has been the focus of treatment guidelines and clinical trials of lipid therapy, patients continue to have cardiovascular disease (CVD) events despite effective lowering of their LDL-C levels, suggesting the influence of other risk factors. High-density lipoprotein cholesterol (HDL-C) levels have been shown to be inversely associated with CVD risk in epidemiological studies.


METHODS
Meta-analyses and clinical trials that reported on the potential relation between HDL-C and CVD were reviewed.


RESULTS
Low HDL-C level is associated with increased CVD risk. Statins reduce CVD events in patients with low HDL-C, and fibrates benefit patients with low HDL-C and high triglyceride levels. The benefit of statins on event reduction may be related to their effects on HDL-C. However, not all therapies that increase HDL-C reduce CVD events. Imaging trials have provided evidence of the combined influence of HDL-C and LDL-C on surrogate end points.


CONCLUSIONS
Drugs in the same class may have different effects on HDL-C, and these different lipid effects may translate into different effects on atherosclerosis and CVD events. A new class of agents, cholesteryl ester transfer protein inhibitors, is being examined in ongoing trials to determine whether dalcetrapib may have different effects than torcetrapib, which increased levels of HDL-C but was associated with increased adverse events. In addition, ongoing trials are examining whether targeting both HDL-C and LDL-C, by combining a second agent such as niacin with a statin, leads to greater benefit on CVD and clinical events.
Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 6565 Fannin, M.S. A-601, Houston, TX 77030, USA.
Smita
S
Negi
Christie M
CM
Ballantyne
D050197:Atherosclerosis / Q000175:diagnosis* / Q000188:drug therapy; D001384:Azetidines / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood / Q000502:physiology*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004359:Drug Therapy, Combination; D000069438:Ezetimibe; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D009525:Niacin / Q000627:therapeutic use; D012307:Risk Factors
D001384:Azetidines; D008076:Cholesterol, HDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D009525:Niacin; D000069438:Ezetimibe