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New Annals of Internal Medicine study shows low levels of “good cholesterol” pose the same risks to patients regardless of whether or not they are taking statins


Boston, MA – A new study published today in the Annals of Internal Medicine finds that, even in patients treated with statins, low HDL is an important contributor to cardiovascular risk.  The study, conducted by Investigators from the Preventive Cardiology Center at Tufts Medical Center, was designed to explore whether statin treatment negates the need to focus on HDL levels in patients at risk for heart disease by comparing the risks posed by low levels of HDL in statin-treated patients vs non-statin patients.

“Our study dispels the prevailing myth that statins are so powerful in lowering LDL that once a patient is on a statin, their HDL becomes irrelevant,”  said lipidologist Richard Karas, MD, PhD, Professor of Medicine, Tufts University School of Medicine and Executive Director, Molecular Cardiology Research Institute, Tufts Medical Center.  “While clinicians have traditionally focused on lowering ‘bad cholesterol’, this large scale analysis demonstrates the need for clinicians and patients to also consider boosting ‘good cholesterol’ levels in order to further reduce the risk of cardiac events.”

Findings demonstrate that, while statins are critical for lowering LDL or “bad cholesterol”, there is no halo effect for HDL or “good cholesterol”.  According to the data, statins did not alter the risk conferred by having low levels of HDL.

The study, a meta-analysis of 20 large randomized, controlled trials conducted by Tufts Medical Center involving statin therapy, which consisted of 543,210 person-years of follow-up, found that every 10 point decrease in good cholesterol resulted in approximately 7 additional heart attacks and 4 additional cardiovascular events per 1000 person-years in patients taking statins, which is approximately equivalent to these events in patients who are not taking statins.

“My hope is that this will help clinicians see that while statins are an important part of preventive care, other factors are critical as well.” continued Dr. Karas.

The need for focusing on HDL is well documented.  Previous studies show statins only prevent 25 - 30% of episodes of heart disease. And, 83% of people who have heart attacks with controlled LDL, have low HDL according to a study, also lead by Dr. Karas, published earlier this year in the Journal of Clinical Lipidology that examined admissions to the Tufts Medical Center cardiac unit. Additionally, an American Journal of Cardiology study from 2007 found that despite aggressive LDL cholesterol goals and statin treatments, HDL levels remain low in high-risk patients with CHD.

Funding Sources and Disclosures

No specific corporate funding was requested or obtained for data collection, analysis and publication of these findings. Dr. Karas has received speaker’s fees and/or consulting fees from Merck, Abbott, and Schering-Plough.


About Tufts Medical Center and Floating Hospital for Children

Tufts Medical Center is an exceptional, not-for-profit, 415-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Conveniently located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Floating Hospital for Children is the full-service children's hospital of Tufts Medical Center and the principal pediatric teaching hospital of Tufts University School of Medicine. Tufts Medical Center is affiliated with the New England Quality Care Alliance, a network of more than 1,800 physicians throughout Eastern Massachusetts. For more information, please visit

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