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Low density lipoprotein (LDL) cholesterol and high density lipoprotein (HDL) cholesterol are both important determinants of cardiovascular risk. Doctors treating patients with heart disease tend to concentrate most of their efforts on bringing down serum concentrations of LDL cholesterol with statins. But HDL cholesterol matters too, even in patients with LDL cholesterol concentrations below the recommended targetstargets.
In a reanalysis of data from one statin trial, researchers found a clear inverse relation between the risk of serious cardiovascular events and HDL cholesterol concentration in patients with heart disease who were taking atorvastatin. Patients were divided into five groups according to HDL concentration. Patients in the highest fifth were significantly less likely to have heart attacks or strokes or to die from coronary disease than those in the lowest fifth. The inverse relation persisted across all concentrations of LDL cholesterol and in a subgroup of patients with concentrations of LDL cholesterol below 1.8 mmol/l (hazard ratio 0.61; 95% CI 0.38 to 0.97 when comparing the highest fifth with the lowest fifth).
These findings suggest that the two types of cholesterol can independently predict serious cardiovascular events in patients treated with statins, say the authors. The 9770 patients in this trial took either 10 mg or 80 mg atorvastatin a day.