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The evolving role of high-density lipoprotein in reducing cardiovascular risk
1Section of Atheroscelorsis, Department of Medicine, Baylor College of Medicine, Houston, TX 77030.
Insights
Low high-density lipoprotein cholesterol (HDL-C) is a key issue in coronary artery disease. Guidelines may need to redefine low HDL-C levels and emphasize raising HDL-C for better risk reduction.
Area of Science:
- Cardiology
- Lipid Metabolism
- Preventive Medicine
Background:
- Low high-density lipoprotein cholesterol (HDL-C) is a prevalent lipid abnormality in patients with coronary artery disease (CAD).
- Current National Cholesterol Education Program (NCEP) guidelines prioritize low-density lipoprotein cholesterol (LDL-C) lowering, potentially overlooking the significance of low HDL-C in risk assessment.
- This creates uncertainty regarding optimal lipid management strategies for high-risk individuals with low HDL-C.
Purpose of the Study:
- To evaluate the role of HDL-C in cardiovascular risk assessment.
- To propose potential adjustments to the definition of low HDL-C.
- To advocate for increased emphasis on HDL-C-raising strategies in CAD management.
Main Methods:
- Review of recent clinical trial evidence.
- Analysis of epidemiologic data related to HDL-C levels and cardiovascular risk.
- Comparison of current NCEP guidelines with emerging data on HDL-C's prognostic value.
Main Results:
- Epidemiologic data and clinical trials indicate HDL-C plays a crucial role in cardiovascular risk assessment.
- The current NCEP definition of low HDL-C (<35 mg/dL) may be insufficient.
- Proposed adjusted definitions for low HDL-C: <40 mg/dL for men and <45 mg/dL for women.
Conclusions:
- Low HDL-C is a significant risk factor in coronary artery disease that warrants aggressive management.
- Risk reduction strategies should include a greater focus on increasing HDL-C levels, in addition to LDL-C lowering.
- Revising the definition of low HDL-C is necessary to improve patient risk stratification and guide therapy.
Abstract:
In many patients with coronary artery disease, a low level of high-density lipoprotein cholesterol (HDL-C), rather than substantially elevated low-density lipoprotein cholesterol (LDL-C), is often the predominant lipid abnormality. Although the National Cholesterol Education Program treatment guidelines include HDL-C concentration as a major risk factor for primary prevention, the guidelines' emphasis on LDL-C as the primary target of therapy may cause uncertainty as to whether risk reduction strategies should focus on lowering LDL-C or raising HDL-C in high-risk patients with low HDL-C. Recent clinical trial evidence and epidemiologic data suggest that HDL-C should play a more important role in risk assessment, and that the definition of low HDL-C may need adjustment from the current National Cholesterol Education Program definition of <35 mg/dL to perhaps <40 mg/dL in men and <45 mg/dL in women. Patients with low HDL-C should receive aggressive risk factor modification, and more emphasis on increasing HDL-C may be warranted in addition to lowering LDL-C. (c) 2001 by CHF, Inc.