Abstract
The Framingham Heart Study found that high-density lipoprotein cholesterol (HDL-C)
was the most potent lipid predictor of coronary artery disease risk in men and women
>49 years of age. The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS),
in which subjects were randomized to treatment with lovastatin or placebo, also reported
a striking benefit of treatment, particularly in patients with HDL-C ≤35 mg/dL at
baseline. Treatment with lovastatin was associated with a remarkable 45% reduction
in events for this group. The Veterans Affairs HDL Intervention Trial (VA-HIT) randomized
subjects to gemfibrozil or placebo. A high proportion of enrolled subjects with low
HDL-C also had characteristics of the dysmetabolic syndrome. HDL-C likewise increased
by 6% on treatment, total cholesterol was reduced by 4% and triglycerides by 31%.
There was no change in low-density lipoprotein cholesterol (LDL-C) levels. These changes
in lipid were associated with a cumulative 22% reduction in the trial primary endpoint
of all-cause mortality and nonfatal myocardial infarction (MI). Additionally, significant
reductions in secondary endpoints including death from coronary artery disease, nonfatal
MI, stroke, transient ischemic attack, and carotid endarterectomy were associated
with the increase in HDL-C. In VA-HIT, for every 1% increase in HDL-C, there was a
3% reduction in death or MI, a therapeutic benefit that eclipses the benefit associated
with LDL-C reduction.
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© 2000 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
