While population studies indicate that increased statin usage has produced a progressive decrease in average LDLc levels between 1999 and 2002 compared to the LDLc levels observed in 1988-94, average HDLc levels remained unchanged over the same time period.77 These data likely reflect a lack of comparable safe therapies for raising HDLc. Low HDLc represents a significant independent risk factor for CHD. In those patients at risk for CHD because of low HDLc, increases of 50% or more in HDLc may be required. The maximal response observed with fibrates or niacin led to much smaller percentage elevations, and severe side effects limit their use. To date, no large populations have been examined in secondary prevention trials to correlate HDLc increases greater than 30% through direct pharmacological intervention with an improved cardiovascular benefit. The choices in drug intervention for safely elevating HDLc to restore a cardioprotective level are currently quite limited.
Was this article helpful?