HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events 
Author Message
 HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events

NEJM Volume 357:1301-1310  September 27, 2007  Number 13

HDL Cholesterol, Very Low Levels of LDL Cholesterol, and
Cardiovascular Events

Philip Barter, M.D., Ph.D., Antonio M. Gotto, M.D., D.Phil., John C.
LaRosa, M.D., Jaman Maroni, M.D., Michael Szarek, M.S., Scott M.
Grundy, M.D., Ph.D., John J.P. Kastelein, M.D., Ph.D., Vera Bittner,
M.D., M.S.P.H., Jean-Charles Fruchart, Pharm.D., Ph.D., for the
Treating to New Targets Investigators

ABSTRACT

Background High-density lipoprotein (HDL) cholesterol levels are a
strong inverse predictor of cardiovascular events. However, it is not
clear whether this association is maintained at very low levels of low-
density lipoprotein (LDL) cholesterol.

Methods A post hoc analysis of the recently completed Treating to New
Targets (TNT) study assessed the predictive value of HDL cholesterol
levels in 9770 patients. The primary outcome measure was the time to a
first major cardiovascular event, defined as death from coronary heart
disease, nonfatal non-procedure-related myocardial infarction,
resuscitation after cardiac arrest, or fatal or nonfatal stroke. The
predictive relationship between HDL cholesterol levels at the third
month of treatment with statins and the time to the first major
cardiovascular event was assessed in univariate and multivariate
analyses and was also assessed for specific LDL cholesterol strata,
including subjects with LDL cholesterol levels below 70 mg per
deciliter (1.8 mmol per liter).

Results The HDL cholesterol level in patients receiving statins was
predictive of major cardiovascular events across the TNT study cohort,
both when HDL cholesterol was considered as a continuous variable and
when subjects were stratified according to quintiles of HDL
cholesterol level. When the analysis was stratified according to LDL
cholesterol level in patients receiving statins, the relationship
between HDL cholesterol level and major cardiovascular events was of
borderline significance (P=0.05). Even among study subjects with LDL
cholesterol levels below 70 mg per deciliter, those in the highest
quintile of HDL cholesterol level were at less risk for major
cardiovascular events than those in the lowest quintile (P=0.03).

Conclusions In this post hoc analysis, HDL cholesterol levels were
predictive of major cardiovascular events in patients treated with
statins. This relationship was also observed among patients with LDL
cholesterol levels below 70 mg per deciliter. (ClinicalTrials.gov
number, NCT00327691 [ClinicalTrials.gov] .)

Source Information

Quote:
>From the Heart Research Institute, Sydney (P.B.); the Joan and Sanford

I. Weill Medical College of Cornell University, New York (A.M.G.); the
State University of New York Downstate Medical Center, Brooklyn
(J.C.L.); Pfizer, New York (J.M., M.S.); the Center for Human
Nutrition, University of Texas Southwestern Medical Center, Dallas
(S.M.G.); the Academic Medical Center, University of Amsterdam,
Amsterdam (J.J.P.K.); the Division of Cardiovascular Disease,
University of Alabama, Birmingham (V.B.); and the Institut Pasteur,
Lille, France (J.-C.F.).

Address reprint requests to Dr. Barter at the Heart Research
Institute, 145 Missenden Rd., Camperdown, NSW 2050, Australia, or at

http://www.***.com/



Mon, 15 Mar 2010 08:10:27 GMT
 HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events
Soooo.... in English.... does this mean anything other than, the
higher the HDL, the lower the risk of an event, regardless of LDL
level?
Anyhow, from all I've gathered here and elsewhere, that's what I've
been thinkin'.  And it seems this abstract confirms it.
Yes/no?

Port



Quote:
>NEJM Volume 357:1301-1310  September 27, 2007  Number 13

>HDL Cholesterol, Very Low Levels of LDL Cholesterol, and
>Cardiovascular Events

>Philip Barter, M.D., Ph.D., Antonio M. Gotto, M.D., D.Phil., John C.
>LaRosa, M.D., Jaman Maroni, M.D., Michael Szarek, M.S., Scott M.
>Grundy, M.D., Ph.D., John J.P. Kastelein, M.D., Ph.D., Vera Bittner,
>M.D., M.S.P.H., Jean-Charles Fruchart, Pharm.D., Ph.D., for the
>Treating to New Targets Investigators

>ABSTRACT

>Background High-density lipoprotein (HDL) cholesterol levels are a
>strong inverse predictor of cardiovascular events. However, it is not
>clear whether this association is maintained at very low levels of low-
>density lipoprotein (LDL) cholesterol.

>Methods A post hoc analysis of the recently completed Treating to New
>Targets (TNT) study assessed the predictive value of HDL cholesterol
>levels in 9770 patients. The primary outcome measure was the time to a
>first major cardiovascular event, defined as death from coronary heart
>disease, nonfatal non-procedure-related myocardial infarction,
>resuscitation after cardiac arrest, or fatal or nonfatal stroke. The
>predictive relationship between HDL cholesterol levels at the third
>month of treatment with statins and the time to the first major
>cardiovascular event was assessed in univariate and multivariate
>analyses and was also assessed for specific LDL cholesterol strata,
>including subjects with LDL cholesterol levels below 70 mg per
>deciliter (1.8 mmol per liter).

>Results The HDL cholesterol level in patients receiving statins was
>predictive of major cardiovascular events across the TNT study cohort,
>both when HDL cholesterol was considered as a continuous variable and
>when subjects were stratified according to quintiles of HDL
>cholesterol level. When the analysis was stratified according to LDL
>cholesterol level in patients receiving statins, the relationship
>between HDL cholesterol level and major cardiovascular events was of
>borderline significance (P=0.05). Even among study subjects with LDL
>cholesterol levels below 70 mg per deciliter, those in the highest
>quintile of HDL cholesterol level were at less risk for major
>cardiovascular events than those in the lowest quintile (P=0.03).

>Conclusions In this post hoc analysis, HDL cholesterol levels were
>predictive of major cardiovascular events in patients treated with
>statins. This relationship was also observed among patients with LDL
>cholesterol levels below 70 mg per deciliter. (ClinicalTrials.gov
>number, NCT00327691 [ClinicalTrials.gov] .)

>Source Information

>>From the Heart Research Institute, Sydney (P.B.); the Joan and Sanford
>I. Weill Medical College of Cornell University, New York (A.M.G.); the
>State University of New York Downstate Medical Center, Brooklyn
>(J.C.L.); Pfizer, New York (J.M., M.S.); the Center for Human
>Nutrition, University of Texas Southwestern Medical Center, Dallas
>(S.M.G.); the Academic Medical Center, University of Amsterdam,
>Amsterdam (J.J.P.K.); the Division of Cardiovascular Disease,
>University of Alabama, Birmingham (V.B.); and the Institut Pasteur,
>Lille, France (J.-C.F.).

>Address reprint requests to Dr. Barter at the Heart Research
>Institute, 145 Missenden Rd., Camperdown, NSW 2050, Australia, or at

>http://cardiology.jwatch.org/cgi/content/full/2007/926/1



Mon, 15 Mar 2010 09:19:09 GMT
 HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events

Quote:

> Soooo.... in English.... does this mean anything other than, the
> higher the HDL, the lower the risk of an event, regardless of LDL
> level?

Phrasing it that way would be confusing because some would take it to
mean that LDL should be ignored.

Instead, one could write that it would be optimal to have both high
HDL (more than 50) **and** low LDL (less than 70).

Quote:
> Anyhow, from all I've gathered here and elsewhere, that's what I've
> been thinkin'.  And it seems this abstract confirms it.
> Yes/no?

It simply underscores the fact that a low HDL (less than 50) should
not be ignored.

It is vascular inflammation fueled by adipocytokines from VAT that
lowers HDL.

Truly, it is only when we are hungry (stomachs singing and laughing
loudly) that our bodies get rid of the VAT.

Be hungry... be healthy... be hungrier... be blessed:

http://HeartMDPhD.com/PressRelease

Prayerfully in the infinite power and might of the Holy Spirit,

Andrew <><
--
Andrew B. Chung, MD/PhD
Lawful steward of http://EmoryCardiology.com
Bondservant to the KING of kings and LORD of lords.



Mon, 15 Mar 2010 10:32:29 GMT
 HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events

Quote:
>It is vascular inflammation fueled by adipocytokines from VAT that
>lowers HDL.

Interesting concept. Thanks.
--
Jim Chinnis   Warrenton, {*filter*}ia, USA


Mon, 15 Mar 2010 11:28:15 GMT
 HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events

Quote:


> >It is vascular inflammation fueled by adipocytokines from VAT that
> >lowers HDL.

> Interesting concept.

It is the key to understanding why folks with VAT (especially those
with type-2 diabetes because of VAT) have low HDL.

Quote:
> Thanks.

You are welcome, Jim.

Redirecting all thanks and praises to GOD, Who is the Source of all
knowledge and wisdom, so that we will both be that much more blessed
(hungrier).

Be hungry... be healthy... be hungrier... be blessed:

http://HeartMDPhD.com/PressRelease

Prayerfully in the infinite power and might of the Holy Spirit,

Andrew <><
--
Andrew B. Chung, MD/PhD
Lawful steward of http://EmoryCardiology.com
Bondservant to the KING of kings and LORD of lords.



Mon, 15 Mar 2010 16:45:25 GMT
 
 [ 5 post ] 

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