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HDL cholesterol useful in targeting statin therapy for elderly patients
NEW YORK (Reuters Health) - Findings from a new study suggest that HDL cholesterol (HDL) levels should be used to determine which elderly patients are most likely to benefit from statin therapy.
According to the report, which appears in the November 15th issue of Circulation: Journal of the American Heart Association, statin therapy is probably indicated if the HDL level falls below 45 mg/dL or if the LDL cholesterol (LDL)/HDL ratio is greater than 3.3. The results suggest that with higher HDL levels, little benefit is achieved with statin therapy.
"This was quite a surprise," lead author Dr. Christopher J. Packard, from the University of Glasgow in the UK, said in a statement. "We did not expect the benefits of statin therapy to vary according to starting HDL level. Also, unlike statin studies in younger persons, LDL was not what mattered."
Using data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), the researchers assessed the ability of LDL and HDL to predict the combined endpoint of coronary heart disease death, nonfatal MI, and stroke in 5804 subjects between 70 and 82 years of age.
Baseline LDL was not predictive of the combined endpoint in patients randomized to placebo or in those given pravastatin. HDL, by contrast, was inversely associated with risk among subjects in the placebo group, but not in pravastatin-treated patients. Moreover, risk reduction on pravastatin treatment was only linked to levels of HDL, not LDL (p = 0.012).
Subjects with an HDL level of < 45 mg/dL experienced a 33% reduction in risk when treated with pravastatin. By contrast, subjects with higher HDL levels derived no benefit from the drug.
"If statin therapy could be targeted to at-risk elderly with low HDL levels who would benefit most, fewer people would have to be treated -- a substantial time and cost savings," Dr. Packard emphasized.
Circulation 2005;112.
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