Results of a study indicate, for patients with low levels of high-density lipoprotein (HDL) cholesterol and coronary heart disease, a treatment strategy aimed at increasing HDL levels is worthwhile,.

," Dr. Richard A. Krasuski stated that, "when our patients had their HDL increased with niacin, gemfibrozil and cholestyramine, we had direct evidence that not only did coronary plaques stop progressing but they actually regressed. "In addition, the risk of heart events went down by 52%."

In the double-blind study, investigators randomly assigned 143 retired military personnel with heart disease and low HDL to placebo or aggressive HDL-cholesterol-increasing therapy with gemfibrozil, niacin, and cholestyramine for 30 months. They also received diet and exercise counseling.

Individuals in the active treatment arm experienced a 20% decrease in total cholesterol, a 36% increase in HDL cholesterol, a 26% decrease in LDL cholesterol, and a 50% reduction in triglycerides, compared with individuals in the placebo arm.

Focal coronary stenosis fell 0.8% in individuals on active therapy and increased by 1.4% in those on placebo. Moreover, significantly more individuals on placebo than on active therapy reached the composite cardiovascular endpoint of hospitalization for angina, MI, transient ischemic attack, stroke, death, and cardiovascular procedures (26% vs 13%).

They point out that it is not known whether the improvements in angiographic findings are due to reductions in LDL or increases in HDL cholesterol, and that flushing may have inadvertently led to unblinding of subjects on active drug therapy.

"We know very well that lowering LDL makes plaques in arteries smaller and reduces the risk of heart attacks, stroke and death. We also know that naturally having higher levels of HDL is good for patients and places them at lower risk of heart disease," he explained.

Dr. Krasuski said he "strongly believes that HDL will soon become an important target in the treatment for patients with cardiovascular disease."

Source: Diabetes In Control.com: Ann Intern Med 2005;142:95-104.