Raising HDL may limit heart disease progression

For people with low levels of "good" (HDL) cholesterol and coronary disease, treatment aimed at increasing HDL levels is worthwhile, researchers report.

Dr. Richard A. Krasuski told AMN Health that when patients' HDL was increased in a study, "we had direct evidence that not only did coronary plaques stop progressing but they actually regressed."

In addition, "the risk of heart events went down by 52 percent."

Krasuski, from the Wilford Hall Medical Center at Lackland Air Force Base in Houston, Texas, and his colleagues studied 143 retired military personnel with heart disease and low HDL who were randomly assigned to inactive "placebo" treatment or aggressive HDL-cholesterol-raising therapy with gemfibrozil, niacin, and cholestyramine for 30 months. They also received diet and exercise counseling.

Individuals in the active treatment arm had a 20 percent decrease in total cholesterol, a 36 percent increase in HDL cholesterol, a 26 percent decrease in LDL ("bad") cholesterol, and a 50 percent reduction in triglycerides, compared with the placebo group.

Narrowing of the coronary arteries improved by 0.8 percent in individuals on active therapy and worsened by 1.4 percent in those on placebo, the team found.

Moreover, significantly more individuals on placebo than on active therapy experienced events such as a heart attack, stroke or the need for heart surgery (26 percent vs 13 percent).

Side effects such as flushing and stomach upsets were reported more often with active therapy "but rarely led to withdrawal from the study," the investigators report in the Annals of Internal Medicine.

They point out that it is not known whether the improvements were due to reductions in LDL or increases in HDL cholesterol. Nonetheless, Krasuski told Reuters Health that he believes this study is "extremely important."

"We know very well that lowering LDL makes plaques in arteries smaller and reduces the risk of heart attacks, stroke and death. We also know that naturally having higher levels of HDL is good for patients and places them at lower risk of heart disease," he explained.

"Previous studies focusing on heart disease patients have shown that raising HDL with medications either stop plaques in the arteries from getting larger or prevents heart events, but no previous study focusing on HDL has shown both - until this study. Our study finally ties this together," he said.

Krasuski said he "strongly believes that HDL will soon become an important target in the treatment for patients with cardiovascular disease."

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SOURCE: Annals of Internal Medicine, January 18, 2005.