Pro and con: high-density lipoprotein, triglycerides, and other lipid subfractions are the future of lipid management

Risk assessment limited to low-density lipoprotein cholesterol (LDL-C) levels fails to identify a substantial proportion of individuals at risk for coronary artery disease. Data from the Prospective Cardiovascular Münster (PROCAM) study indicate that triglyceride levels and high-density lipoprotein cholesterol levels are important determinants of risk irrespective of LDL-C level. Risk is most accurately predicted using an algorithm incorporating multiple risk factors, as shown by the multiple logistic function analysis using the independent risk variables identified on multivariate analysis in PROCAM. It remains unclear what effect statin therapy to decrease LDL-C has in individuals with risk associated with factors other than elevated LDL-C. Such individuals might derive preferential benefit from treatments targeting such risk factors.