That Health Rules

We know the bad effects of cholesterol in our body.  Marketing strategies have incorporated cholesterol as part of the game plan: low fat,  low cholesterol, no cholestrol in their products.  As physicians, we also take note of patients lipid profile which gives us the whole picture on patients cholesterol profile.  It is therefore not sufficient to jut check a total cholesterol because ones total cholesterol may be high because of a high Good cholesterol or HDL.  Targeting the BAD cholesterol or LDL has been the mainstay in our practice especially among our patients with high blood pressure and diabetes.  Our goal is to reduce a patient’s risk to suffer from a stroke or heart attack! 

But is lowering LDL or the bad cholesterol enough to decrease a patients risk?  And how important is the Good cholesterol in the equation?

Recently a study published in the NEJM September issue  looked at this specific question and showed that Both should be addressed.  

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Background High-density lipoprotein (HDL) cholesterol levels are a strong inverse predictor of cardiovascular events. However, it is not clear whether this association is maintained at very low levels of low-density lipoprotein (LDL) cholesterol.

Methods : A post hoc analysis of the recently completed Treating to New Targets (TNT) study assessed the predictive value of HDL cholesterol levels in 9770 patients.

Results : The HDL cholesterol level in patients receiving statins was predictive of major cardiovascular events across the TNT study cohort, both when HDL cholesterol was considered as a continuous variable and when subjects were stratified according to quintiles of HDL cholesterol level.

Even among study subjects with LDL cholesterol levels below 70 mg per deciliter, those in the highest quintile of HDL cholesterol level were at less risk for major cardiovascular events than those in the lowest quintile (P=0.03).

Conclusions: 

•  In this post hoc analysis, HDL cholesterol levels were predictive of major cardiovascular events in patients treated with statins.
• This relationship was also observed among patients with LDL cholesterol levels below 70 mg per deciliter.

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Lowering the LDL or bad cholesterol will remain the primary goal of therapy while not neglecting to make sure that the HDL should be made higher than 45 mg/dl.  Dietery intervention can only do so much in lowering LDL but we have ways to increase the HDL by dietary and behavioral means including exercise.Do check my post on How to Increase Your HDL for further tips in what to eat and do to improve your HDL!