Boosting HDL Levels May Not Benefit Patients on Statins
Statin drugs such as Crestor (rosuvastatin) work primarily by lowering low-density lipoprotein (LDL) cholesterol levels to reduce the risk of cardiovascular disease. Physicians often also suggest increasing high-density lipoprotein (HDL) levels for further protection, but a new study suggests that once LDL is lowered through statin use, raising HDL may not provide additional benefits.
Researcher Paul Ridker MD, director of the Center for Cardiovascular Disease Prevention at Brigham & Women’s Hospital and professor of medicine at Harvard Medical School said, “HDL cholesterol is a well-established ‘protective risk factor’ for heart disease. [But] once we get the levels of LDL down to very low levels, it becomes unclear whether HDL is an important determinant of [cardiovascular] risk.”
His statement is based on data collected during a follow-up analysis of the JUPITER trial, which stands for Justification for the Use of Statins in Primary Prevention. The study, which included 17,800 healthy participants, previously found that Crestor reduced heart attacks and strokes by 44% in men and women with average to low LDL at the start of the study and no history of cardiovascular disease.
Ridker and colleagues divided JUPITER participants into four groups based on HDL levels. Because women tend to have higher concentrations of HDL than men, the researchers used sex-specific quartiles.
Patients with high HDL levels taking a placebo had about half the risk of cardiovascular events, supporting the evidence that high HDL levels are, in fact, protective against heart disease. However, those on Crestor – who have lowered LDL levels - showed no link between HDL levels and their risk of heart attack or stroke.
According to the manufacturer (AstraZeneca), Crestor reduces LDL up to 52% and raises HDL by up to 14%. Overall, people taking Crestor have been found to have a 54% reduction in heart attack, 48% decrease in stroke, and 43% decrease in venous thromboembolism (blood clot in the leg). Other statin drugs available include Lipitor and Zocor.
"Our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment," Ridker and his co-authors wrote in conclusion. "As shown here among those allocated to placebo, HDL cholesterol was a powerful inverse risk predictor.
Ridker PM, et al "HDL cholesterol and residual risk of first cardiovascular events after treatment with potent statin therapy: an analysis from the JUPITER trial" Lancet 2010; DOI: 10.1016/S0140-6736(10)60713-1.