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JUPITER: HDL not predictive of residual vascular risk among patients with low LDL levels
Ridker PM. Lancet. 2010; doi:10.1016/S0140-6736(10)60713-1.
Hausenloy DJ. Lancet. 2010; doi:10.1016/ S0140-6736(10)61021-5.
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HDL concentrations were not indicative of residual vascular risk in patients who received statin therapy and attained very low LDL concentration, despite HDL being useful as part of initial CV risk assessment, according to new data from the JUPITER trial.
Participants in this randomized, placebo-controlled trial were adults (n=17,802) without diabetes or previous CV disease with baseline LDL concentrations less than 3.37 mmol/L and high-sensitivity CRP of at least 2 mg/L. Researchers randomly allocated patients by a computer-generated sequence to receive either 20 mg rosuvastatin (Crestor, AstraZeneca) per day or placebo. Both participants and adjudicators were masked to treatment assignment.
Primary endpoint incidence — including the first occurrence of non-fatal MI, non-fatal stroke, hospitalization for unstable angina, arterial revascularization or CV death — decreased in the rosuvastatin group (n=8,900) by 44% (P<.0001). In the patients given placebo (n=8,901), HDL concentrations were inversely associated with vascular risk at both baseline (top quartile vs. bottom quartile, HR=0.54; 95% CI, 0.35-0.83) and on-treatment (HR=0.55; 95% CI, 0.35-0.87). Conversely, patients given rosuvastatin (with a median on-treatment LDL concentration of 1.42 mmol/L) had no significant relationships between quartiles of HDL concentration and vascular risk either at baseline (HR=1.12; 95% CI, 0.62-2.03) or on-treatment (HR=1.03; 95% CI, 0.57-1.87).
Derek J. Hausenloy, PhD, Lionel Opie, MD, and Derek M. Yellon, PhD, all with the Hatter Institute, London, hypothesized in an accompanying editorial on why HDL levels did not predict CV risk at low concentrations of LDL.
“Perhaps, in patients with a low CV risk … who are treated to very low concentrations of LDL cholesterol, the relation between HDL cholesterol and CV risk is lessened,” they wrote. “Possibly, at very low LDL cholesterol concentrations, other lipid measures (such as the apolipoprotein B and apolipoprotein A-I ratio) will provide more accurate prediction of CV risk than do HDL cholesterol concentrations.”
According to study researchers, additional research testing the actual cause for their findings is needed.
To read previous Cardiology Today coverage of the JUPITER trial, click here.
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