Changes in HDL cholesterol and cardiovascular outcomes after lipid modification therapy Heart, 04/09/2012

Ray K et al. – Following adjustment for conventional non–lipid risk factors of cardiovascular disease, this study provides no evidence to support a significant benefit from increasing HDL–C independent of the effect of lowering non–HDL–C.

• A total of 1148 participants, 446 from the EPIC–Norfolk and 702 from the Rotterdam study, were assessed for lipids before and after starting LMT.
• Subsequent risk of cardiovascular events, ascertained through linkage with mortality records and hospital databases, was investigated using Cox proportional hazards regression.
• Random effects meta–analysis was used to combine results across studies.

• Based on combined data from the EPIC–Norfolk and Rotterdam studies there was some evidence that change in HDL–C resulting from LMT was associated with reduced cardiovascular risk (HR per pooled SD (=0.34 mmol/l) increase=0.74, 95% CI 0.56 to 0.99, adjusted for age, sex and baseline HDL–C).
• However, this association was attenuated and was not (statistically) significant with further adjustments for non–HDL–C and for cigarette smoking history, prevalent diabetes, systolic blood pressure, body mass index, use of antihypertensive medication, previous myocardial infarction, prevalent angina and previous stroke (0.92, 0.701.20).