High-density lipoprotein particles, coronary heart disease, and niacin

The use of statins in patients with high risk for cardiovascular disease (CVD) has resulted in a 30-40% decrease in clinical events in the last couple of decades. However, despite of a marked reduction (up to 60%) in LDL-C, about 30% of patients continue to have CVD events. This high residual risk in statin-treated patients initiated the search for new ways to reduce CVD risk. HDL is the next logical target. Epidemiological and cross-sectional studies identified low HDL-C level as an independent risk for CVD.1,2 Based on the Framingham Heart Study data, HDL-C <35 mg/dl was established an independent risk factor and HDL-C >60 mg/dl as protective.3 Presently the cut point is <40 mg/dl for men and <50 mg/dl for women.