Abstract
Three clinical trials have recently focused on the benefits of lipid-regulating therapy in populations with normocholesterolaemia and low high-density lipoprotein (HDL)-cholesterol. Two secondary prevention studies (Veterans Affairs HDL-Cholesterol Intervention Trial [VA-HIT] and Bezafibrate Infarction Prevention [BIP] trial) testified to the efficacy of fibrates in decreasing cardiovascular events, particularly in patients with coexisting risk factors, including hypertriglyceridaemia. The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) demonstrated that a statin could decrease acute coronary events in patients with isolated low HDL-cholesterol in a primary prevention setting. The absolute risk reduction in coronary events in the VA-HIT study compares favourably with those reported from the statin-based Cholesterol and Recurrent Events (CARE) and Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) trials. The absolute risk reduction in AFCAPS-TexCAPS is similar to that in West of Scotland Coronary Pravastatin Study (WOSCOPS). Recommendations are given concerning lifestyle and pharmacological management of low HDL-cholesterol. Optimal management also requires review of current treatment targets for HDL-cholesterol and triglycerides levels.
Highlights
Low plasma high-density lipoprotein (HDL)-cholesterol concentration is encountered in clinical practice as part of mixed hyperlipidaemia, hypertriglyceridaemia, or as an isolated abnormality
The favourable effect of lowering elevated plasma low-density lipoprotein (LDL)-cholesterol has been well emphasized [3,4,5], the therapeutic benefits of raising low HDL-cholesterol has only recently been demonstrated in clinical trials
The present review describes the evidence and implications of these recent trials, and places them into the wider context of the management of patients with low HDL-cholesterol
Summary
Retard (400 mg/day) on myocardial infarction and sudden death in middle-aged persons, most of whom were men and 10% of whom had diabetes. Clinical implications The VA-HIT results suggest that when LDLcholesterol levels are optimal, or near optimal, increasing HDL-cholesterol with reduction in triglyceride-rich lipoproteins may be a cost-effective approach to decreasing the incidence of coronary events in secondary prevention. Whether there is incremental benefit in both primary and secondary prevention settings of employing a fibrate together with a statin in treating patients with low HDL-cholesterol remains to be rigorously demonstrated. This issue is being addressed in diabetic patients in the Oxford-based Lipids in Diabetes Study (LDS) [9]. Drug and gene therapies that selectively elevate HDL are under development [29], and may eventually find a place in clinical practice
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