Acute decrease in HDL-C moderately increases long-term risk of cardiovascular events

  • Requena G & al.
  • Clin Drug Investig
  • 18 Jun 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Patients with a short-term, drug-induced decrease in high-density lipoprotein-cholesterol (HDL-C) levels had a moderately increased long-term risk of subsequent major adverse cardiovascular events (MACE) compared with those with constant HDL-C levels.

Why this matters

  • Findings warrant future prospective studies with systematically collected measures of HDL-C and confounding factors to further understand the potential causal associations between acute decrease in HDL-C and long-term cardiovascular (CV) outcomes.

Study design

  • This retrospective cohort study included 17,543 patients who initiated statin therapy for a short duration (≤ 9 months) (aged, 18-85 years; HDL-C decrease group, n=6454; HDL-C constant group, n=11,089) using data from the Clinical Practice Research Datalink (CPRD) between 2006 and 2014.
  • Primary outcome: composite of MACE (CV death, myocardial infarction, revascularisation, and hospitalised ischaemic stroke).
  • Funding: GSK.

Key results

  • The 5-year cumulative incidence of MACE was 7.14% in the HDL-C decrease group vs 5.91% in the HDL-C constant group.
  • The corresponding risk difference between the HDL-C decrease and HDL-C constant groups was 1.23% (95% CI, 0.28-2.18).
  • In line with the analysis of risk difference, the HR for the composite MACE endpoint in the HDL-C decrease vs HDL-C constant group was elevated 1.20 (95% CI, 1.04–1.39) over the follow-up period.
  • The increase in MACE risk was mainly driven by an increased risk in ischaemic stroke (HR, 1.44; 95% CI, 1.08-1.90) and CV death (HR, 1.23; 95% CI, 0.93-1.63).


  • Retrospective design.
  • Potential for unmeasured and time-varying confounding.