JCL Roundtable: HDL in the primary care setting

►This Roundtable discussion involves experts in clinical medicine, clinical trials and epidemiology who express opinions on the current status of HDL as a marker of risk for cardiovascular disease and as a potential target for drug therapy.►They conclude that both HDL cholesterol and the number of HDL particles offer important tools for assessing risk but confirm that no interventional study has demonstrated benefit from raising either of these measures with pharmacotherapy.►The continued use of HDL measures is recommended for determining the importance of reducing apoB containing lipoproteins.►The potential importance of assessing both cholesterol content and number of HDL particles is under current study in large community based studies. These measures appear to give different and supplemental messages regarding CVD risk.

One of the most difficult and confusing issues for clinical lipidologists and physicians in general has been the management of low concentrations of high-density lipoprotein cholesterol. We know this to be a very powerful predictor of risk in scores of community-based and clinical trial cohorts. Raising this number in many patients would seem to provide a great therapeutic opportunity, but so far this concept has been very difficult to prove. I have been joined for this discussion by a cardiovascular epidemiologist, Dr. Rachel Mackey, from the University of Pittsburgh and two clinical lipidologists who have studied and written in depth about this problem. These are Dr. Benjamin Ansell from the University of California in Los Angeles and Dr. Peter Toth from Johns Hopkins University School of Medicine. Our objective in this discussion is to give primary care clinicians our thoughts about the recent research findings and the implications of these data on the best clinical practice.