After LDL cholesterol lowering, low HDL cholesterol may represent a residual risk that needs to be addressed.

Data collected from the Framingham Heart Study reveals that those with high LDL of 220 and normal HDL of 45 have the same risk as those with low LDL of 100 and low HDL of 25.

In high risk patients, untreated low HDL represents a residual risk after optimal treatment of LDL.

Unlike LDL cholesterol treatment, where 50 mg reduction or more is common, HDL raising is usually limited to much smaller quantity like shown above. But even small increases in HDL can result in significant risk reduction.

HDL's primary role is reverse cholesterol transport. HDL cholesterol removes cholesterol from the plaque and transports it back to the liver for elimination.

Raising HDL cholesterol has other beneficial effects as listed above.

HATS Trial showed that in patients with CHD, combination treatment consisting of statin and niacin, resulted in reduction in the degree of obstruction as shown by cardiac catheterization (yellow). Those patients with regression also had the largest event reduction of -89%! (yellow).