EDITORIALS
Time to rethink high-density lipoprotein?
1 Public Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, UK
2 Southampton General Hospital, Southampton, UK
Correspondence to:
Professor C D Byrne, Department of Endocrinology and Metabolism, Mail Point 113, Level F, Centre Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; C.D.Byrne@soton.ac.uk
| The first 150 words of the full text of this article appear below. |
Decreasing low-density lipoprotein cholesterol (LDL-C) concentrations with statin treatment represents a key therapeutic strategy for primary and secondary prevention of cardiovascular disease, as summarised in the Joint British Societies 2 guidelines.1 However, the relative risk reduction for major vascular events for each mmol/l reduction in LDL-C associated with use of statins is only approximately 20%2 and many people treated with statins will go on to have their first or subsequent cardiovascular disease event. Consequently, there is a pressing need to develop alternative strategies to decrease risk of vascular disease.
A wealth of epidemiological observational data suggests there is a strong inverse causal relation between concentrations of high-density lipoprotein cholesterol (HDL-C) and risk of cardiovascular disease. For example, a review of four large prospective studies suggests that every increase of 0.03 mmol/l in HDL-C is associated with a 2–3% decreased risk of cardiovascular disease.3 This suggests that raising HDL-C could be
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