HDL Cholesterol Independently Predicts Major Adverse Coronary Events

Dr. Tierney and colleagues assessed the independent effect in everyday clinical practice of HDL cholesterol and its change over time on the incidence of major adverse coronary events among 6928 patients receiving care in a large urban academic primary care, general internal medicine practice.

HDL cholesterol was significantly lower at the first two measurements for patients with subsequent coronary events compared with those without an event, the authors report, but there was no significant difference in LDL cholesterol values between those with and without subsequent major adverse coronary events.

Higher values for total cholesterol at the first measurement and higher triglycerides and the first and second measurements were also associated with subsequent major adverse coronary events, the results indicate.

In a multivariable analysis, HDL cholesterol was the only lipid measurement that significantly predicted coronary events, the researchers note. It was the third strongest predictor behind prior coronary heart disease and age.

Each 10 mg/dL increase in the baseline HDL cholesterol value was associated with an 11% decrease in the risk of an acute coronary event, the report indicates. Similarly, a positive change of 10 mg/dL between the two measurements was associated with a 7% lower risk of subsequent major adverse coronary events.

"We have repeated this study for the outcome of acute stroke, and found similar findings (HDL seeming to be the more important lipid fraction in predicting stroke risk)," Dr. Tierney said. "This paper is being prepared for submission to a journal."

"More, better prospective research needs to be done on this issue (rather than the retrospective research we did, which has its inherent biases), and drug companies need to begin looking at drugs that specifically target HDL," Dr. Tierney concluded.

Source: Diabetes In Control: Am Heart J 2006;151:755.e1-755.e6