Journal Article

Is high-density lipoprotein the protector of the cardiovascular system?

P Barter

in European Heart Journal Supplements

Published on behalf of European Society of Cardiology

Volume 6, issue suppl_A, pages A19-A22
Published in print March 2004 | ISSN: 1520-765X
Published online March 2004 | e-ISSN: 1554-2815 | DOI: http://dx.doi.org/10.1016/j.ehjsup.2004.01.005
Is high-density lipoprotein the protector of the cardiovascular system?

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Low high-density lipoprotein (HDL-C) cholesterol is a powerful predictor of risk for coronary heart disease (CHD), and raising HDL-C reduces CHD risk, with available data indicating a 1% decrease in risk with each 1% increase in HDL-C. Both epidemiological and intervention studies have shown that HDL is predictive of risk independent of low-density lipoprotein cholesterol. In treatment trials, both fibrates and statins have been shown to reduce risk in patients with low HDL-C. Statins reduce risk across all HDL-C levels from low to high, whereas fibrates appear to have benefits limited to low HDL-C in the context of the metabolic syndrome. The primary management component of increasing HDL-C is lifestyle intervention focusing on diet, exercise and smoking cessation. Drug options for raising HDL-C include niacin (+10–30%), fibrates (+5–25%) and statins (+3–12%). Niacin is poorly tolerated. Fenofibrate may pose advantages over gemfibrozil among fibrates. Findings in the large-scale Statin Therapies for Elevated Lipid Levels compared Across dose ranges to Rosuvastatin (STELLAR) trial indicate that rosuvastatin has the best HDL-C raising effect among statins. Selection of therapy requires consideration of the individual patient’s overall risk profile.

Keywords: Coronary heart disease; High-density lipoprotein cholesterol; Low-density lipoprotein; Statins; Fibrate; Niacin

Journal Article.  1829 words.  Illustrated.

Subjects: Cardiovascular Medicine

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