According to the Framingham Heart Study1
Risk of coronary artery disease in men aged 50 to 70 years according to HDL and LDL cholesterol levels over 4 years follow-up in the Framingham Heart Study.
Epidemiological investigations have established that cardiovascular morbidity and mortality vary directly with the level of TC and LDL-C, and inversely with the level of HDL-C.
"Amongst the various lipid parameters evaluated in the Framingham Study, HDL-C appeared to have the strongest relationship to CHD."2
Raising HDL-C is one of the strongest predictors of risk reduction in lipid intervention trials3
*CHD defined as fatal and nonfatal myocardial infarction (MI).
Relationship between on-treatment percent change in lipid parameters and RRR in CHD; univariate curvilinear regression. Data from 17 prospective randomized trials, combining a total of 44,170 patients and 3,869 CHD events.
The independent effect of raising HDL-C or lowering TG on the risk of coronary and cardiovascular morbidity and mortality has not been determined.
"Every change of 10 mg/dL in the HDL cholesterol level is associated with a 50% change in risk."4 —Kannel WB.
The NCEP ATP III Treatment Panel goals for HDL and HDL-cholesterol - adopted by the AHA5,6
| LDL-C Levels | ||
|---|---|---|
| <100 mg/dL | <130 mg/dL | <160 mg/dL |
| For patients with CHD or CHD risk equivalents | For patients with 2+ risk factors | For patients with 0-1 risk factor |
| HDL-C Levels | ||
|---|---|---|
| <40 mg/dL (men) < 50 mg/dL (women) | 60 mg/dL and above | |
| A major risk factor for heart disease | HDL-C >60 mg/dL is considered protective against heart disease | |
Next: Studies and reviews demonstrating the importance of HDL-C
References
1. Castelli WP. Cholesterol and lipids in the risk of coronary artery disease - the Framingham Heart Study. Can J Cardiol. 1988;4(Suppl A):5A-10A.
2. Alsheikh-Ali AA, Kuvin JT, Karas RH. High-density lipoprotein cholesterol in the cardiovascular equation: does the good still count? Atherosclerosis. 2005;180:217-233.
3. Alsheikh-Ali AA, Abourjaily HM, Stanek EJ, McGovern ME, Kuvin JT, Karas RH. Increases in HDL-cholesterol are the strongest predictors of risk reduction in lipid intervention trials. Poster presented at: American Heart Association Scientific Sessions 2004. November 7-10; New Orleans, LA.
4. Kannel WB. High-density lipoproteins: epidemiologic profile and risks of coronary artery disease. Am J Cardiol. 1983;52:9B-12B.
5. National Heart, Lung, and Blood Institute. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. Bethesda, MD: National Institutes of Health, US Dept of Health and Human Services, 2002. NIH Publication 02-5215.
6. American Heart Association. Cholesterol Levels. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4500. Accessed August 14, 2007.
