Carta sobre HDL como factor de riesgo cardiovascular COMENTARIO MIO EN EL NEJM Julio 2014

Submitted to the New England Journal of Medicine

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HDL cholesterol as cardiovascular risk factor

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New England Journal of Medicine Draft Letter about NEJM Article

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Meneses, Fernando; Clínica Jerusalén,

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Lloyd-Jones DM (July17,2014) questioned the hypothesis of HDL-C as causal cardiovascular risk factor,noting that the increase in its plasma levels with various therapies has not generated cardiovascular benefit (1).However,studies in which he bases this did not quantify subpopulations of HDL-C with demonstrated anti-atherogenic properties nor measured the cholesterol efflux capacity. Indeed, it has been shown that the cholesterol efflux capacity from macrophages, a measure of HDL-C function, is independent of the plasma level of HDL (2), because only small, dense, protein-rich HDLs appear to display potent atheroprotective properties across the HDL subpopulation spectrum (3), and atheroprotective activity of HDL-C was strongly interrelated with the subpopulation HDL3-C, and not with HDL2-C (4). Also, a small prospective, randomized study, which measured plasma levels of HDL-C,cholesterol efflux capacity and HDL inflammatory index showed that the addition of niacin to statin therapy led to favorable changes in patients’ lipid profiles without a demonstrable effect on HDL functionality (5). It is even, therefore, premature to move to HDL-C as independent cardiovascular risk factor.

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Submitted to the New England Journal of Medicine

Confidential: Destroy when review is complete.