With all the recent controversy about whether raising high-density lipoprotein (HDL) is actually a worthwhile strategy in the battle against heart disease, a new study has suggested that HDL particle concentration may be a better marker of risk.
While the failure of the first cholesterylester transfer protein (CETP) inhibitor, torcetrapib, was blamed on its side effect of raising blood pressure, three more negative trials have also now cast doubt on the value of boosting HDL – AIM-HIGH with niacin, dal-OUTCOMES with dalcetrapib, and a genetic study published earlier this year in The Lancet, showing that people carrying gene variants coding for increased HDL levels did not have a reduced risk of heart disease.
However, in a new analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), published on July 11 in the Journal of the American College of Cardiology (http://dx.doi.org/10.1016/j.jacc.2012.03.060), the concentration of HDL particles was independently associated with carotid intima-media thickness and coronary heart disease. Unlike HDL cholesterol itself, the association for HDL particles remained when adjusted for other atherogenic measures.
The results suggest that the quantification of HDL cholesterol might not “fully capture the HDL-related risk”, according to the researchers. The authors of an accompanying editorial agree that increasing HDL-particle concentrations might prove to be more appropriate than increasing HDL cholesterol for reducing the risk of cardiovascular events.
See also an editorial by Jonathan Morrell (pages 104–05) and a review on CETP inhibitors by Paul Durrington (pages 126–33) in this issue.