Findings from a new study suggest that doctors should use “good” (HDL) cholesterol levels to determine which elderly patients are most likely to benefit from statin therapy.
According to the study, statin therapy is probably indicated if the HDL level falls below 45 mg/dL or if the ratio between “bad” (LDL) cholesterol and HDL is greater than 3.3.
In a nutshell, 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, admitted 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.”
According to a report in Circulation: Journal of the American Heart Association, Packard and colleagues assessed the ability of LDL and HDL to predict the combined endpoint of Heart disease death, nonfatal Heart Attack, and Stroke in some 5,800 subjects between 70 and 82 years of age.
Subjects with an HDL level of less than 45 mg/dL experienced a 33 percent reduction in risk of heart disease death, nonfatal heart attack and stroke when treated with pravastatin. By contrast, subjects with higher HDL levels derived no benefit from the drug.
Baseline LDL was not predictive of the combined endpoint in patients randomized to placebo or in those given pravastatin.
“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,” Packard emphasized.
SOURCE: Circulation November 15, 2005.
Revision date: June 14, 2011
Last revised: by Jorge P. Ribeiro, MD