Data from the Framingham Offspring study support HDL cholesterol as a therapeutic target. Raising HDL cholesterol reduced cardiovascular risk across the spectrum of patients receiving lipid therapy. Clinical benefits were greater at lower HDL cholesterol values. These data reinforce the value of treating low HDL cholesterol to reduce lipid-related cardiovascular risk.

Evaluating the incremental benefits of raising high-density lipoprotein cholesterol levels during lipid therapy after adjustment for the reductions in other blood lipid levels
Grover SA;Kaouache M;Joseph L;Barter P;Davignon J;
Archives of Internal Medicine 2009;169:1775-80.

A high TG/HDL cholesterol ratio is a strong epidemiological measure of atherogenic dyslipidemia as well as a surrogate marker of insulin resistance. It better predicts occurrence of a first heart attack than LDL cholesterol, according to data from the MEtabolic Syndrome Active Subjects (MESYAS) study. In overweight male patients, a high TG/HDL cholesterol ratio increases coronary risk by up to 50%. These data not only highlight the role of non-LDL lipids in coronary risk, but also underline the usefulness of this simple BMI-independent cardiometabolic risk predictor.

Usefulness of triglycerides-to-high-density lipoprotein cholesterol ratio for predicting the first coronary event in men
Cordero A;Andres E;Ordonez B;Leon M;Laclaustra M;Grima A;Luengo E;Moreno J;Bes M;Pascual I;Civeira F;Pocovi M;Alegria E;Casasnovas JA;MEtabolic Syndrome Active Subjects Study Investigators;
American Journal of Cardiology 2009;104:1393-7.

The Dyslipidemia International Study (DYSIS) evaluated over 22,000 statin-treated outpatients aged 45 years or older in Europe and Canada. Patients with diabetes represented 39.5% of that population. 58.5% were at LDL-C goal. Of those not at LDL-C goal, 16.2% had normal HDL-C and TGs. 3.9% had high TGs, 8.3% had low HDL-C with high TGs and 3.2% had low HDL-C. 25.4% had low HDL-C and/or high TGs. The CEntralized Pan-European survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS) also showed that only 55.3% of patients using lipid-lowering drugs achieved the LDL-C target recommended in the 2003 European guidelines. Therefore, patients with diabetes who are treated with a statin remain at high risk for cardiovascular events based on their achieved lipid values. A need for wider and more intensive lipid therapy with lifestyle management is demonstrated.

Centralized Pan-European survey on the under-treatment of hypercholesterolaemia (CEPHEUS): overall findings from eight countries.
Hermans MP, Castro Cabezas M, Strandberg T, Ferrieres J, Feely J, Elisaf M, Michel G, Sansoy V.
Curr Med Res Opin. 2010 Feb;26(2):445-54.

A total of 686 consecutive patients hospitalized in Pisa, Italy, as a result of left ventricular dysfunction (73% classified as New York Heart Association [NYHA] class I-II), completed a lipid profile and underwent coronary angiography, and were followed for a mean period of 23 months. Half of the patients (52%) had HDL-C values less than 40 mg/dl; in multivariate analysis, they showed the greater risk for cumulative mortality (hazard ratio (HR) 1.77, P<0.05) and for cardiac death (HR 2.06, P<0.05). This greater risk was observed in particular in patients with low HDL-C levels but without significant coronary stenosis.

Low high-density lipoprotein predicts death in patients with mild left ventricular dysfunction regardless of coronary atherosclerosis
Sampietro T;Bigazzi F;Puntoni M;Minichilli F;Landi P;Dal Pino B;Carpeggiani C;LAbbate A;
Journal of Cardiovascular Medicine (Hagerstown, Md.) 2009;10:898-905.