The aim of this paper was to investigate whether residual risk after initiation of high-dose statin treatment was associated with baseline or on-treatment concentrations of HDL cholesterol. The study population was derived from JUPITER, a randomized, double-blind, placebo-controlled trial, that recruited 17,802 adults without diabetes or previous cardiovascular disease (CVD) who presented baseline concentrations of LDL cholesterol of less than 3.37 mmol/l and high C-reactive protein of 2 mg/l or more. The analysis revealed that residual risk after aggressive use of statin therapy was not related to HDL cholesterol concentrations. However, levels of HDL cholesterol were strongly predictive of vascular events among those receiving placebo. Similar results were observed for apolipoprotein AI. Thus, these results suggest that HDL cholesterol concentrations are not major determinants of residual cardiovascular risk in patients treated with potent statin therapy, but is useful as part of an initial cardiovascular risk assessment. In their comment Hausenloy DJ et al. underlined the fact that these findings must no deviate the focus of research to find strategies to raise HDL cholesterol for the reduction of cardiovascular risk and to determine the appropriate way to achieve this strategy.
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