HDL NOT SO IMPORTANT IF LDL IS VERY LOW..

from medscape

July 23, 2010 (Boston, Massachusetts) — A post hoc analysis of the JUPITER trial has shown that when patients have very low concentrations of LDL cholesterol attained through the use of potent statin therapy, "good" HDL cholesterol may no longer be predictive of cardiovascular risk [1].

This is the first time this has been observed in a primary-prevention population, although there are similar data from contemporary secondary-prevention statin trials, say Dr Paul MRidker (Brigham and Women's Hospital, Boston, MA) and colleagues in their paper published in the Lancet.

They emphasize, however, that HDL was predictive of cardiovascular risk in patients taking placebo in JUPITER, so "our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment."

Raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol.

In an accompanying comment [2], Drs Derek J Hausenloy (University College, London, UK), Lionel Opie (University of Cape Town, South Africa), and Derek Yellon (University College, London) say that it is "unclear" why HDL concentrations did not predict cardiovascular risk at very low concentrations of LDL cholesterol in those treated withrosuvastatin in JUPITER. But given that more potent drugs for raising HDL cholesterol are on the horizon, the issue will require more research and needs to be examined in large randomized trials, they say.

The findings from this study "should not detract from the fact that raising HDL cholesterol remains a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol; the problem, in most cases, is how to achieve this strategy," they stress

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