Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels Export

@article{citeulike:6013060, abstract = {Background The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events. Methods Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (average follow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides, and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of {beta}-blockers) were then added to the model. Interactions between blood lipid levels were also explored. Results The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95\% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C. Conclusions Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events. 10.1001/archinternmed.2009.328}, author = {Grover, Steven A. and Kaouache, Mohammed and Joseph, Lawrence and Barter, Philip and Davignon, Jean}, citeulike-article-id = {6013060}, citeulike-linkout-0 = {http://dx.doi.org/10.1001/archinternmed.2009.328}, citeulike-linkout-1 = {http://archinte.ama-assn.org/content/169/19/1775.abstract}, citeulike-linkout-2 = {http://archinte.ama-assn.org/content/169/19/1775.full.pdf}, day = {26}, doi = {10.1001/archinternmed.2009.328}, journal = {Arch Intern Med}, keywords = {encdr-journal-club}, month = {October}, number = {19}, pages = {1775--1780}, posted-at = {2009-10-26 22:56:12}, priority = {2}, title = {Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels}, url = {http://dx.doi.org/10.1001/archinternmed.2009.328}, volume = {169}, year = {2009} }

TY - JOUR ID - citeulike:6013060 L3 - citeulike-article-id:6013060 N2 - Background The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events. Methods Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (average follow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides, and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of {beta}-blockers) were then added to the model. Interactions between blood lipid levels were also explored. Results The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C. Conclusions Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events. 10.1001/archinternmed.2009.328 IS - 19 JF - Arch Intern Med EP - 1780 TI - Evaluating the Incremental Benefits of Raising High-Density Lipoprotein Cholesterol Levels During Lipid Therapy After Adjustment for the Reductions in Other Blood Lipid Levels VL - 169 SP - 1775 KW - encdr-journal-club AU - Grover, Steven AU - Kaouache, Mohammed AU - Joseph, Lawrence AU - Barter, Philip AU - Davignon, Jean PY - 2009/10/26/ UR - http://dx.doi.org/10.1001/archinternmed.2009.328 ER -