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Return to "Bad" Cholesterol May Not Be the Best Predictor of Heart Disease Risk in Generally Healthy Individuals Overview

More on "Bad" Cholesterol May Not Be the Best Predictor of Heart Disease Risk in Generally Healthy Individuals

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Return to "Bad" Cholesterol May Not Be the Best Predictor of Heart Disease Risk in Generally Healthy Individuals Overview

More on "Bad" Cholesterol May Not Be the Best Predictor of Heart Disease Risk in Generally Healthy Individuals

"Bad" Cholesterol May Not Be the Best Predictor of Heart Disease Risk in Generally Healthy Individuals

New Insights from Landmark Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) of Lovastatin (Mevacor)

NEW YORK (Feb 7, 2000)

New information published this week in Circulation: Journal of the American Heart Association, from the landmark AFCAPS/TexCAPS study of lovastatin (Mevacor), suggests that low-density lipoprotein cholesterol (LDL-C, the "bad" cholesterol) is not the best predictor of risk for a major coronary event in generally healthy persons with average LDL-C and below average high-density lipoprotein cholesterol (HDL-C, the "good" cholesterol) levels.

Rather, as presented by Antonio M. Gotto, Jr., MD, DPhil, Dean of the Weill Medical College of Cornell University, and co-authors, concentrations of the proteins apolipoprotein (apo) B and apo AI were better predictors, especially when combined to form the apo B/AI ratio. These apolipoproteins are major components of LDL and HDL, respectively, and may be more sensitive measures of risk than LDL and HDL themselves.

In those without pre-existing heart disease who have average to mildly elevated total cholesterol and LDL-C, and below average HDL-C, LDL-C was not predictive of a major heart disease event unless it was considered in conjunction with HDL-C. Therefore, HDL-C measurement should be an essential component of risk assessment in men and women with average to mildly elevated LDL-C, in accord with previously reported epidemiological studies, such as the Framingham Heart Study.

Even in this cohort with a mean LDL-C at baseline of 150 mg/dL (lower than the initiation level recommended by current guidelines for drug treatment), there is no evidence to indicate a level of LDL-C below which lowering LDL-C and increasing HDL-C is not of coronary benefit.

After one year of treatment with lovastatin (Mevacor), on-treatment apo AI, apo B, and the ratio of apo B to apo AI were the best predictors of subsequent major coronary events. These findings suggest that further consideration should be given to measuring apos B and AI in risk assessment and treatment evaluation, and to incorporating them into future guidelines and goals in the United States.

Funding for this study was provided by Merck & Co Inc.

Disclaimer: The opinions expressed in this release are those of the authors and do not reflect those of the Department of Defense or the United States Air Force.

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