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For Some, Low Levels of 'Good' Cholesterol May Not Be Bad

Very Low LDL 'Bad' Cholesterol May Cut Heart Risk Even if HDL 'Good' Cholesterol Is Also Low
By
WebMD Health News
Reviewed by Laura J. Martin, MD

July 23, 2010 -- Traditionally, patients at risk of heart disease are told to lower their levels of "bad" LDL cholesterol while raising their levels of "good" HDL cholesterol. But patients taking statin drugs who reduce their LDL cholesterol to very low levels may not need to boost their HDL cholesterol levels, according to a new study.

''Once we get the levels of LDL down to very low levels, it becomes unclear whether HDL is an important determinant of [cardiovascular] risk," says researcher Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham & Women's Hospital, and professor of medicine at Harvard Medical School, Boston.

Ridker led the JUPITER trial (Justification for the Use of Statins in Primary Prevention), which previously found that the statin drug Crestor reduced heart attacks and strokes by 44% in men and women with average to low LDL at the study start and no history of cardiovascular disease. In this follow-up analysis, Ridker and colleagues divided the JUPITER participants into four groups depending on their HDL levels.

The question, Ridker tells WebMD, is: "Does HDL remain an important predictor of risk when we drop the LDL to low ranges?" Based on this new analysis, he says, "the answer looks to be no."

The findings are published online in The Lancet.

The JUPITER trial was funded by AstraZeneca, which makes Crestor. Ridker reports receiving research grants from AstraZeneca, Novartis, Merck, Abbott, Roche, and Sanofi-Aventis.

Reducing LDL With Statins

As studies of statin therapy have accumulated, the drugs have been established as the ''intervention of choice" for most patients with cardiovascular disease or at risk of it, the researchers write.

The statin Crestor reduces LDL up to 52%, according to the manufacturer. It also raises HDL, but not as much as it reduces LDL. Typically, Crestor increases HDL by up to 14%.

But a ''residual" risk for cardiovascular disease remains in the patients on statin therapy even after they have lower LDL levels, and the researchers wanted to see if it was due to the HDL levels.

Because low HDL levels are a strong predictor of heart disease risk in the general population, Ridker says, he wanted to see if boosting it might take care of this residual risk for the patients on statin therapy with low LDL levels.

In the new analysis, Ridker says, those on placebo with high HDL levels were protected from cardiovascular events, with those in the highest group having about half the risk of cardiovascular events as those in the group with the lowest HDL levels.

But among the patients who took Crestor, no links were seen between their HDL levels and their risk of heart attack or stroke.

Despite the finding, Ridker says the issue must be further studied. Studies of new drugs to boost HDL are under way, he says.

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Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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