Chicago, IL—A meta-regression analysis found that adding a therapy that raises high-density lipoprotein cholesterol (HDL-C) to a statin is unlikely to produce a substantial clinical benefit, said Brian A. Ference, MD, MPhil, MSc, FACC, Associate Chief of Translational Research and Clinical Epidemiology, Director of the Cardio vascular Genomic Research Center and Assistant Professor of Medicine at Wayne State University School of Medicine, Detroit, MI, at the 2012 American College of Cardiology meeting.
Dr Ference and colleagues analyzed 26 statin trials, which included 169,138 participants. The investigators estimated the effect of raising HDL-C on major adverse cardiovascular events, controlling for the effect of reducing the level of low-density lipoprotein cholesterol (LDL-C) with the statin.
The risk of major adverse cardiac events (MACE) was reduced by 19% per each mmol/L reduction in LDL-C independent of any change in HDLC. No reduction in the risk of MACE was found per mmol/L increase in HDL-C after controlling for the effect of lowering HDL-C.
In a meta-analysis of 5 clinical trials that included almost 27,000 participants, adding either fenofibrate (Trior, Trilipix), niacin (Niacor, Niaspan), torcetrapib, or anacetrapib to a statin to increase the level of HDL-C did not reduce the risk of MACE, despite a weighted mean increase in HDL-C of 24.5 mg/dL (0.63 mmol/L) and a weighted mean additional reduction in LDL-C of 16.0 mg/dL (0.41 mmol/L).
“Raising HDL is not associated with any clinical benefit in the presence of statin therapy to lower HDL,” concluded Dr Ference. “Increasing HDL may be deleterious if raised too high. Large ongoing randomized trials may give more information.”—WK