This analysis aimed to assess if the correlation between HDL-C (high density lipoprotein cholesterol) and cardiovascular risk remains, even at low levels of LDL-C (low density lipoprotein cholesterol). The primary outcome used was a composite of death from coronary heart disease, non-fatal myocardial infarction, resuscitation after cardiac arrest and fatal or non-fatal stroke.
Patients were stratified into five groups based on HDL-C levels. A significant difference was detected between those patients in the upper and lower groups. This difference was maintained but was only marginally significant when the analysis stratified for LDL-C.
The authors conclude that, "HDL cholesterol levels were predictive of major cardiovascular events in patients treated with statins" and that this relationship can be observed even in patients with low levels of LDL-C.
The statins are much more effective at lowering LDL-C than at increasing HDL-C. Reducing levels of LDL-C is more important than increasing level of HDL-C however this can be considered when choosing statin therapy. The Summaries of Product Characteristics list the effect of statins on HDL-C as follows:
- Simvastatin increases HDL-C by 13 to 16%
- Atorvastatin increases HDL-C by -3 to 12%
- Rosuvastatin increases HDL-C by 8 to 14%
Action: LDL-C and HDL-C are both important risk factors for preventing cardiovascular morbidity and mortality. Using simvastatin 40mg as first line treatment for lipid management will effectively reduce LDL-C and raise HDL-C to a greater extent than other statins.
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