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Editor's Correspondence
October 22, 2001

High Level of High-Density Lipoprotein Cholesterol (HDL-C) Does Not Attenuate Increased Risk of Elevated Triglycerides

Arch Intern Med. 2001;161(19):2385. doi:

In a recent and otherwise very thorough review of cardiovascular disease and dyslipidemia in women, the author makes the unreferenced statement that "[a]verage or high HDL cholesterol levels appear to attenuate triglyceride-associated CHD [coronary heart disease] risk."1 This follows the referenced and well-supported statement that low HDL-C levels in the presence of hypertriglyceridemia identifies particularly high-risk patients. While it is tempting to assume that higher HDL-C concentrations are uniformly protective, this has recently and specifically been shown not to be the case in the presence of elevated triglyceride concentrations. In a review of the 8-year Copenhagen Male Study, Jeppesen et al2 found that in patients with the highest tertile of triglyceride concentration (mean, 216 mg/dL [2.4 mmol/L]), both a low HDL-C level (mean, 38 mg/dL [0.98 mmol/L]) and a high HDL-C level (mean, 67 mg/dL [1.7 mmol/L]) were associated with a higher incidence of ischemic heart disease compared with average HDL-C concentrations. Similarly, in a rereview of their data, the authors of the PROCAM trial reported that in patients with elevated triglyceride concentrations (>200 mg/dL [2.3 mmol/L]), both a low HDL-C (<35 mg/dL [0.9 mmol/L) and a high HDL-C (>55 mg/dL [1.4 mmol/L]) level were associated with higher incidences of coronary events compared with average HDL-C concentrations.3

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