March 29, 2014 – Emil Hagstrom analyses data from the TRILOGY ACS trial.
Results from a recent study presented at the American College of Cardiology’s Scientific Sessions conference in Washington, DC show that in patients with acute coronary syndrome (ACS), lower levels and especially very-low levels of high-density lipoprotein (HDL) cholesterol are associated with a higher long-term risk of both all-cause and cardiovascular death. Researchers found, however, that patients with low HDL cholesterol were not at an increased risk of myocardial infarction (MI) or stroke.
The study was led by DCRI fellow Emil Hagstrom, MD, PhD, (pictured right) and drew patient data from the TRILOGY ACS trial. The patient cohort, which included more than 9000 individuals, were given standard medical care but did not receive the usual percutaneous coronary intervention or coronary artery bypass graft surgery as part of their treatment. Each patient’s HDL cholesterol levels were assessed at baseline and then subsequently reexamined for up to 30 months of follow-up.
Hagstrom explained that since there was no significant relation between low HDL cholesterol and MI, it remains unclear what the primary cause of cardiovascular death was among these patients. He pointed out that although many researchers suspect low HDL levels can increase the chances of developing a blood clot, there was no apparent correlation between baseline HDL levels and platelet reactivity in either treatment group. Thus, the underlying mechanism for increased risk of death could possibly be related to atherosclerosis rather than thrombosis.
According to Hagstrom, the study findings show the need for ongoing research into the influences of HDL cholesterol and the best ways to affect its levels in patients. He said that this study shows a strong correlation between very-low HDL levels and patient death, and this is a finding that certainly warrants further exploration.
“In previous clinical trials, patients have been given the same treatment regimens regardless of their HDL baseline levels,” said Hagstrom. “Based on our findings in this study, we would recommend that future trials explore the advantages of specifically identifying patients with low HDL levels and designing targeted therapies for this group.”