The VA HDL intervention trial: clinical implications.

Clinical trials have clearly shown that low density lipoprotein (LDL)-cholesterol lowering reduces coronary heart disease morbidity and mortality in patients with established coronary heart disease and LDL-cholesterol above 3·4 mmol . l . However, about 40% of coronary heart disease patients do not have elevated levels of LDL-cholesterol and many of them have low levels of high density lipoprotein (HDL) cholesterol as their primary lipid abnormality. Overall, about 25% of patients with coronary heart disease have low HDL-cholesterol in the absence of elevated LDL-cholesterol. Low HDL-cholesterol, even in the absence of elevated total LDL-cholesterol, has been shown to be an important risk factor for the development of new or recurrent coronary heart disease events in observational epidemiological studies. However, there have been no clinical trial data to guide therapeutic decisions in these patients. Therefore, we initiated the VA (Veterans Affairs) HDL Intervention Trial (VA-HIT) in order to determine whether coronary heart disease patients whose primary lipid abnormality is a low level of HDL-cholesterol benefit from lipid therapy designed primarily to raise their HDL-cholesterol.