CHICAGO — A low HDL cholesterol level confers increased coronary risk even in patients with a low LDL cholesterol level of less than 60 mg/dL, Dr. Emil M. deGoma reported at the annual scientific sessions of the American Heart Association.
This observation suggests that HDL-boosting therapies may play an important role in primary and secondary cardiovascular prevention across the full range of LDL values, said Dr. deGoma of Stanford (Calif.) University.
He presented a retrospective observational study involving 6,357 consecutive patients with an LDL level below 60 mg/dL seen at the Palo Alto VA Medical Center or Stanford-affiliated community clinics. Their mean age was 65 years. Nearly half of them were diabetic and three-quarters were hypertensive. Overall, 42% had been diagnosed with ischemic heart disease, and 15% had heart failure.
Patients were grouped in quartiles by HDL level and followed for 1 year. The study end point was the combined 1-year incidence of acute MI or hospitalization for ischemic heart disease, which proved to be inversely related to baseline HDL. (See box.) Of particular note was the 1-year event rate of 8.5% in patients in the lowest HDL quartile, he said. After adjustment for patient age and other demographic variables, comorbid conditions, laboratory values, and, most important, statin use, the risk of the combined end point continued to increase in stepwise fashion with decreasing HDL. The adjusted odds ratio of MI or hospitalization for ischemic heart disease in patients in the top quartile for HDL was half that of those in the lowest quartile.
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