Statins have revolutionised the treatment of coronary artery disease .Intensive lipid lowering is the fundamental prerequisite in the management of both acute and chronic coronary syndromes. One question is always difficult to answer , ( rather reluctant to find the answer ) “The effect of statins on the HDL cholesterol”. Logic and the mechanisms of action would suggest HDL is not much affected , but in reality I believe , in a given patient statins do reduce the HDL by at-least 10-20 % .This might have some significance. However , the marked reduction in LDL may nullify the adverse effects of lowering HDL. Does this happen in all
What does the scientific evidence say ?
It says the opposite . It seems HDL is raised by statins that too significantly . The following paper also suggests mechanism of HDL elevation by statins .It is Independent to that of LDL reduction , I believe .
This JAMA article adds more evidence
This paper from the premier Journal of Lipid research agrees to the mechanism of HDL reduction by statin is a complex process but still it vouches for it .
In spite of all these evidence . . . it remains a huge suspect . . . from my personal point of view ( My patients are my evidence ! )
The above articles also raise an important concept of dysfunctional HDL. Simple raise in HDL is not suffice . . .it should be functional as well !