November 8, 2005

Statins of little benefit in those with high HDL

NEW YORK (Reuters Health) - Findings from a new study
suggest that doctors should use "good" (HDL) cholesterol levels
to determine which elderly patients are most likely to benefit
from statin therapy.

According to the study, statin therapy is probably
indicated if the HDL level falls below 45 mg/dL or if the ratio
between "bad" (LDL) cholesterol and HDL is greater than 3.3.

In a nutshell, the results suggest that with higher HDL
levels, little benefit is achieved with statin therapy.

"This was quite a surprise," lead author Dr. Christopher J.
Packard, from the University of Glasgow in the UK, admitted in
a statement. "We did not expect the benefits of statin therapy
to vary according to starting HDL level. Also, unlike statin
studies in younger persons, LDL was not what mattered."

According to a report in Circulation: Journal of the
American Heart Association, Packard and colleagues assessed the
ability of LDL and HDL to predict the combined endpoint of
heart disease death, nonfatal heart attack, and stroke in some
5,800 subjects between 70 and 82 years of age.

Subjects with an HDL level of less than 45 mg/dL
experienced a 33 percent reduction in risk of heart disease
death, nonfatal heart attack and stroke when treated with
pravastatin. By contrast, subjects with higher HDL levels
derived no benefit from the drug.

Baseline LDL was not predictive of the combined endpoint in
patients randomized to placebo or in those given pravastatin.

"If statin therapy could be targeted to at-risk elderly
with low HDL levels who would benefit most, fewer people would
have to be treated -- a substantial time and cost savings,"
Packard emphasized.

SOURCE: Circulation November 15, 2005.