The Journal of the American Medical Association has published the results of a population study into the association between levels of high density lipoprotein (HDL) and development ischaemic heart disease (IHD).
Low levels of HDL are known to be associated with IHD but it is unclear if the relationship is causal. Recent attempts to produce drugs that increase levels HDL and therefore reduce cardiovascular morbidity and mortality have proven unsuccessful.
This study was conducted at population level in Denmark and collected data for HDL level, IHD and presence of a gene mutation that results in low levels of HDL. On average people with the gene mutation had HDL levels of 1.05 mmol/L (41mg/dL) while the general population had levels of 1.49 mmol/L (58mg/dL). The average difference was 0.4mmol/L (17mg/dL).
While a difference in HDL of 0.4mmol/L was associated with an increased risk of IHD there was no difference in risk in those patients who had low levels of HDL due to genetic mutations. This finding has thrown into doubt any benefits of artificially raising levels of HDL to protect against heart disease.
Action: Clinicians should continue to focus upon proven methods for reducing cardiovascular risk. These include smoking cessation, increased activity, adoption of a healthy diet and appropriate use of antiplatelets, antihypertensive agents and statins.
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