THURSDAY, July 22 (HealthDay News) -- Low high-density lipoprotein (HDL) levels are associated with increased cardiovascular risk in patients untreated by statins, but in treated patients who achieve very low low-density lipoprotein (LDL) levels, HDL level is no longer associated with level of risk, according to research published online July 22 in The Lancet.

Paul M. Ridker, M.D., of Harvard Medical School in Boston, and colleagues analyzed data from 17,802 patients in the JUPITER trial, dividing the participants into quartiles of HDL cholesterol or apolipoprotein A1. The researchers looked for evidence of an association between these quartiles and the JUPITER primary end points of first nonfatal myocardial infarction or stroke, hospitalization due to unstable angina, arterial revascularization, or cardiovascular death.

The authors note that, in the JUPITER trial, treatment with rosuvastatin resulted in a 54 percent reduction in myocardial infarction, as well as substantial reductions in the other primary end points compared to the placebo group. In this new analysis, patients in the placebo group with the highest quartile of HDL levels had about half of the cardiovascular risk as those in the lowest quartile of HDL. However, for patients treated with rosuvastatin, there was no significant relationship between HDL level and cardiovascular risk. The researchers concluded that HDL is useful as a risk marker in initial evaluation of an untreated patient, but that after statin treatment, which reduces LDL to a low level, HDL is no longer a good predictor of cardiovascular risk.

"Our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment; as shown here among those allocated to placebo, HDL cholesterol was a powerful inverse risk predictor. However, these primary prevention data and recent secondary prevention data from the TNT and PROVE IT trials provide little evidence to support the hypotheses that HDL-cholesterol levels predict risk of vascular events in the setting of high-dose statin therapy," the authors write.

The JUPITER study was supported by AstraZeneca. Several authors disclosed financial relationships with the pharmaceutical industry, including AstraZeneca. One author is listed as a co-inventor on patents held by the Brigham and Women's Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease.

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