HDL Particle Concentration is a Better Predictor of Coronary Heart Disease - Honigberg

HDL Particle Concentration is a Better Predictor of Coronary Heart Disease Risk than HDL Cholesterol

       

Robert Honigberg, MD

Several recent, high-profile clinical trial failures of experimental high density lipoprotein (HDL)-raising therapies has prompted members of the scientific and medical communities to question the prognostic value of HDL as an indicator of coronary heart disease (CHD) risk. However, new research suggests that we should update clinical guidelines with a more predictive measurement of HDL-related risk.

The study, which evaluated the independent associations of high density lipoprotein cholesterol (HDL-C) and high density lipoprotein particle (HDL-P) concentrations with CHD, suggests that HDL-P may be a more accurate indicator of cardiovascular risk than HDL-C. The findings were published in the current issue of the Journal of the American College of Cardiology.

Researchers analyzed blood samples obtained at study onset from 5,598 middle-aged men and women free of cardiovascular disease who participated in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective observational study initiated and overseen by the National Heart, Lung and Blood Institute. Participants were followed for a mean of six years for incident CHD events—including angina, heart attack, and coronary heart disease death.

The researchers concluded that baseline levels of HDL-C and HDL-P were both inversely associated with CHD events and carotid atherosclerosis in this study population. However, after adjusting each HDL measure for the other and for LDL-P, joint analysis demonstrated that the inverse relationship for CV risk persisted for HDL-P but no longer existed for HDL-C. The more consistent inverse association between cardiovascular endpoints and HDL-P has also been shown in other studies including the HPS, MR-FIT, EPIC-NORFOLK and VA-HIT trials. In the accompanying editorial, Emil deGoma and Dan Rader noted that HDL-P may be more useful to refine cardiovascular risk and to evaluate novel HDL-directed therapies.

In light of this study’s findings, it is likely that more research will be conducted which extends beyond traditional HDL-C measurement to sort out the different functional properties of HDL. We at LipoScience contend that measuring HDL-P in clinical practice can lead to better patient treatment decisions, particularly as the LDL particle number is brought under control. Obviously this is a provocative subject, and I’d love for you share your thoughts in the comment section.
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