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
Reducing LDL With Statins continued...
And despite his finding that HDL may not matter in those with very low LDL levels, he emphasizes that "HDL remains an important predictor of risk in the general population." The LDL levels of the JUPITER participants on drug therapy, he says, are very low and not typically achieved in Western populations without intensive drug treatment.
In the study, the median LDL for those on Crestor was 55 mg/dL.
Lifestyle matters, too, he tells WebMD. "If you are at increased risk [of cardiovascular disease] due to increased LDL, a low HDL, or an elevated high sensitivity C-reactive protein [another marker for heart disease], the real message should be to go to the gym, throw out the cigarettes, and lose some weight. Next, talk to your doctor about statin therapy."
The new finding supports what cardiac specialists believe about treatment of heart disease risk factors, says Sidney C. Smith, Jr., MD, professor of medicine and director of the Center of Cardiovascular Science and Medicine at the University of North Carolina, Chapel Hill, who reviewed the findings for WebMD.
"The primary focus of our treatment strategies should be reduction of LDL, and this article certainly supports that,'' says Smith, a past president of the American Heart Association.
However, he had a caveat. "I do not think that the evidence in this study is sufficient to say that addition of therapy focusing on HDL would not help. I think the jury is still out on whether there might be therapies which increase HDL that could have additional benefit."
In a comment accompanying the study, Derek J. Hausenloy MD, PhD, of the University College London Hospital and two co-authors point out that other research has found that even in patients with very low LDL levels, HDL cholesterol was still predictive of heart attack and stroke risk. So why the new findings didn't reach this conclusion is unclear, he writes.
He, too, called for more research. And he writes that paying attention to HDL remains "a major treatment strategy for the reduction of cardiovascular risk in the large majority of patients who do not have very low LDL cholesterol."