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Raising HDL levels may be as important as lowering LDL

Researchers find that changing the focus of lipid-lowering therapy may improve outcomes, but some experts say it is too soon to alter recommendations.

By Victoria Stagg Elliott, AMNews staff. April 28, 2003.

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Targeting drug therapy to raise levels of HDL cholesterol alone may be sufficient to reduce the risk of heart disease and improve cardiovascular health, according to several studies presented at the American College of Cardiology meeting held earlier this month in Chicago.

One study, which was presented by researchers at the Heart Institute, Sheba Medical Center in Tel Hashomer, Israel, found that raising HDL cholesterol was associated with improved long-term survival among more than 1,500 patients with coronary disease.

Another from the Uniformed Services University of Health Sciences in Bethesda, Md., randomized nearly 150 patients with stable coronary disease to receive either medications to raise HDL or a placebo. Those on meds increased their HDL as well as decreasing their total cholesterol significantly and had far fewer heart-related mortality or morbidity events.

"There's ample epidemiologic evidence that HDL cholesterol is very predictive of cardiovascular events," said Maj. Richard A. Krasuski, MD, the study's lead author and director of cardiovascular research at Uniformed Services University. "This study suggests that it could be possible that aiming to raise the HDL may be as good or maybe even better than trying to lower the LDL."

Although these studies focused on people who have already had cardiac events, the strategy does have the potential to impact prevention for those who do not yet have heart disease. "If you have a primary prevention group that has a number of cardiovascular risk factors and a low level of HDL cholesterol, I think looking at ways to raise HDL is certainly a viable option, but it's certainly one that needs further study," said Dr. Krasuski.

[...]

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