This is an important, new conclusion in regard to HDL.
For many years, many practicing internists would say to their patients
"Because your HDL is high, you don't have to worry about some elevation of LDL cholesterol."
Some 20 years ago it was suggested that the high HDL does not protect the patient from heart attack
when the LDL cholesterol is high. In other words, HDL does not neutralize the LDL.
So we cardiologists have been treating the elevated LDL with statins, etc, even when the patient's
HDL is very high, or regardless of the level of HDL.
If I may give an example, my longtime secretary who lived to be over 90 years of age used to have
HDL over 100 since she was in her 40's. However, she also had elevated LDL and family history of CAD.
When she became 70 years of age, she required CABG and retired and lived to be over 90.
In order words, her super high HDL did not prevent CAD.

All the studies with statins, etc, in the last quarter century have proved only one thing, i.e.
lowering LDL is the only way preventing heart attacks and strokes and atherosclerosis.
Incidentally, there is a drug in phase 2 trial that can lower LDL another 40 to 50 % on top of
what statins lower so that doctors can lower LDL to 40's and 50's relatively easily.
I look forward to this new agent successfully making it through phase 3 so that we doctors
can do more for their patients.

A Very Good Article To Remember, Sir.

 

Whatever we believe today may no longer be true tomorrow.
We are a bunch of confused intellectuals with wrong and deviated confidence.
We know so little about ourselves.

This could be a good place to leave everything to your favorite God.

I like your statement, "We know so little about ourselves."
How true?
So many times a day I feel that way.
I don't seem to know anything about anything.
I don't seem to have any answers for anything.
That may be why I often find myself in that mood of praying to HIM.

Following are some specific informations supporting the conclusion that raising HDL does not seem to
prevent atherosclerosis.

1. NIH-sponsored 3,414 patient Atherothrombosis Intervention in Metabolic Syndrome With Low HDL
Cholesterol/High Triglyceride and Impact on Gobal Health Outcome(AIM-HIGH)Trial randomized 1500 -2000 mg
of extended release niacin daily in patients on background simvastatin, and if need be, ezetimide(Zetia).
The results show no impact on major CV events.(NEJM, 2011;365:2255-67)in spite of the raised HDL.

2.THRIVE Trial involving 26000 subjects with CV disease and/or diabetes in United Kingdom, Scandinavia,
and China. randomized to 2000mg of extended release niacin plus antiflushing agent laropiprant daily or placebo
on top of background therapy with simvastatin plus or minus ezetimide.
During 3.9 years of prospective follow-up, niacin boosted HDL by 17% and reduced LDL by 20%, but niacin
had no impact upon CV events and was associated with increased risk of serious adverse events.

3.ILLUMINATE Trial used CETP inhibitor torcetrapib which raised HDL by 70% and lowered LDL by 30%.
Yet it increased all cause mortality by 60%.

4. dal-OUTCOMES Trial used CETP modulator dalcetrapib and showed no benefit.
This trial involved 15,871 patients

5. As for fibrates, a meta-analysis of six major randomized trials showed that these HDL raisers
had no impact on CHD mortality.

6. The hallowed and robust inverse relation between HDL level and CV risk described 27 years ago
in the Framingham Heart Study has come under question.
The Framingham data are not quite so right. In these large clinical trials, the inverse relationship
between HDL and CV evnts was seen only at very low HDL levels - below 30 mg% and
not across the broad spectrum.

7. The most persuasive evidence was shown in a recent, most ambitious project, sponsored by NIH,
The Wellcome Trust,, the European Union, the British Heart Foundation, and the German government.
They tracked the prevalence of 14 genetic variants associated with increased HDL in 20 studies totalling
 more than 100,000 subjects, including nearly 21,000 with a myocardial infarction.
The presence of these HDL-raising genes was not associated with reduced risk of MI(Lancet 2012;380:572-80).

8. As for lifestyle modification as a means of boosting HDL, moderate alcohol consumption, exercise,
smoking cessation, and weight loss have all been shown to increase HDL.
There is very little hard data to show that the cardiovascular benefits have anything to do with the raised HDL.
Perhaps the benefits are from some other mechanisms other than the raised HDL, which may well be a marker
for some other underlying primary mechanisms.