| Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels. | |
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MedLine Citation:
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PMID: 19858435 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The role of high-density lipoprotein cholesterol (HDL-C) as a therapeutic target to prevent cardiovascular (CV) events remains unclear. We examined data from the Framingham Offspring Study from 1975 through 2003 to determine whether increases in HDL-C levels after lipid therapy was started were independently associated with a reduction in CV events. METHODS: Using Cox proportional-hazards regression, we evaluated the risk of a CV event associated with changes in blood lipid levels among individuals who started lipid therapy. The independent effect of HDL-C levels on future CV risk (average follow-up, 8 years) was estimated after adjustment for changes in low-density lipoprotein cholesterol, plasma triglycerides, and pretreatment blood lipid levels. Potential confounders (eg, smoking status, weight, and the use of beta-blockers) were then added to the model. Interactions between blood lipid levels were also explored. RESULTS: The change in HDL-C level was a strong independent risk factor for CV events (hazard ratio, 0.79 per 5-mg/dL increase; 95% confidence interval, 0.67-0.93) after adjustment for the other lipid changes associated with treatment. This relationship remained stable across a wide range of patient subgroups and did not appear to be associated with a specific drug class. An important interaction was observed: the lower the pretreatment low-density lipoprotein cholesterol level, the greater the impact of raising the HDL-C. CONCLUSIONS: Raising HDL-C levels with commonly used lipid medications appears to be an important determinant of the benefits associated with lipid therapy. These results support the further evaluation of therapies to raise HDL-C levels to prevent CV events. |
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Authors:
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Steven A Grover; Mohammed Kaouache; Lawrence Joseph; Philip Barter; Jean Davignon |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Archives of internal medicine Volume: 169 ISSN: 1538-3679 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-27 Completed Date: 2009-11-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1775-80 Citation Subset: AIM; IM |
Affiliation:
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McGill Cardiovascular Health Improvement Program and Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada. steven.grover@mcgill.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Anticholesteremic Agents / therapeutic use Antilipemic Agents / therapeutic use* Biological Markers / blood Blood Pressure Body Mass Index Cardiovascular Diseases / blood, prevention & control* Cholesterol, HDL / blood*, drug effects* Cholesterol, LDL / blood Comorbidity Female Humans Kaplan-Meiers Estimate Male Middle Aged Multivariate Analysis Odds Ratio Predictive Value of Tests Proportional Hazards Models Treatment Outcome Triglycerides / blood |
| Chemical | |
Reg. No./Substance:
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0/Anticholesteremic Agents; 0/Antilipemic Agents; 0/Biological Markers; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Triglycerides |
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