"HDL cholesterol levels have prognostic importance even in patients in
whom aggressive statin treatment has achieved low LDL cholesterol
levels."

Does HDL Matter When Statins Are Working?
In a post hoc analysis of TNT trial data, HDL levels predicted
cardiovascular events in patients with very low LDL levels.

Little information is available about risk for cardiovascular events in
patients who are treated aggressively with statins. In particular, does
HDL retain its strong prognostic value in patients with very low LDL
levels? To find out, investigators from the Treating to New Targets
(TNT) trial, in which 2661 participants achieved LDL cholesterol levels
below 70 mg/dl (Journal Watch Cardiology Dec 30 2005), analyzed post hoc
the relationship between HDL cholesterol levels and major cardiovascular
events.
A total of 9770 study patients (age range, 35 to 75) with clinically
evident coronary artery disease were stratified by quintile of HDL
cholesterol level at 3 months of statin treatment. In multivariable
analysis, HDL quintile at month 3 was a strong and significant predictor
of cardiovascular events. Patients in the highest quintile (55 mg/dL)
had a 25% lower risk for cardiovascular events than those in the lowest
quintile (<38 mg/dL). This relationship was independent of statin dose
or LDL level. The ratio of LDL cholesterol to HDL cholesterol at 3
months was also strongly and significantly predictive of cardiovascular
events. Subjects with the lowest LDL:HDL ratios (<1.33) experienced
fewer than half as many events as those with the highest ratios (2.41).

Comment: HDL cholesterol levels have prognostic importance even in
patients in whom aggressive statin treatment has achieved low LDL
cholesterol levels. Clinicians should remain alert to all known
cardiovascular risk factors when using statins to treat patients with
coronary artery disease.

‹ Harlan M. Krumholz, MD, SM
Published in Journal Watch Cardiology September 26, 2007

CITATION(S):
Barter P et al. for the Treating to New Targets Investigators. HDL
cholesterol, very low levels of LDL cholesterol, and cardiovascular
events. N Engl J Med 2007 Sep 27; 357:1301.
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