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Small HDL rises cut risk of cardiovascular risk events

By Mark Pownall

Increasing HDL-cholesterol by just 0.13mmol/l reduces the risk of a cardiovascular event by 21% - emphasising its importance as a therapeutic target say US researchers.

The impact of HDL levels was studied in 454 patients in the Framingham Offspring Study who were started on any lipid lowering treatment.

They were followed up for an average of eight years and the independent effect of HDL levels were estimated after adjusting for changes in LDL, triglycerides and pre-treatment lipid levels.

The change in HDL-C level was a strong independent risk factor for cardiovascular events- with a 21% drop in the risk of an event for every 0.13mmol/l increase in HDL-C.

That effect did not appear to change across different patient sub-groups and did not appear to be associated with any specific class of lipid lowering drugs.

But it did appear that the impact of raising HDL was greatest in those who started the trial with the lowest LDL levels.

The authors says: ‘This suggests raising HDL might be particularly beneficial in patients with mixed dyslipidaemia, rather than those with isolated elevations in LDL-C levels.'

Some pharmaceutical companies have been studying drugs targeted at raising HDL-C but none have yet been successfully licensed.

Archives of Internal Medicine 2009; 169(19): 1775-1780.

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