IDEAL, which included 8888 patients, assessed the benefits of high-dose statin therapy for preventing the recurrence of cardiovascular events.

In IDEAL, very high levels of HDL cholesterol were tied to an increased risk of a major coronary event, the researchers found. After making adjustment for levels of apoA-I and other factors, each 12point increase in HDL cholesterol raised the risk by 21 percent.

A persistently negative association was noted between apoA-I levels and the risk of a major coronary event, the researchers report.

In an editorial, Dr. Jacques Genest, from McGill University in Montreal, points out some of the implications of the apparent link between very high levels of HDL cholesterol and elevated cardiovascular risk. "First, naturally-occurring high levels of HDL cholesterol may not protect against heart disease, and second, and herein lies the most important and provocative finding, HDL cholesterol as a therapeutic goal may be fraught with potential dangers."

SOURCE: Journal of the American College of Cardiology, February 12, 2008.

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