High-density lipoprotein and cardiovascular risk. Circulation 109

Low serum levels of high-density lipoprotein (HDL) arecommonly encountered in pa-tients with coronary artery disease (CAD). An example of this type of patient is a 42-year-old white man with a history of sudden-onset angina sec-ondary to a 90 % obstructive lesion along the proximal left anterior de-scending coronary artery. The family history was significant for his father, who died of a myocardial infarction (MI) at age 44 years. The patient underwent percutaneous transluminal angioplasty with stenting but devel-oped in-stent restenosis. He underwent cutting balloon angioplasty and brachytherapy and was asymptomatic for approximately 6 months. The stent then developed a high-grade occlusion with recurrence of angina, and the patient required single-vessel bypass surgery. The patient’s baseline serum lipid profile revealed low-density lipopro-tein (LDL) 128 mg/dL, HDL 27 mg/dL, and triglycerides 92 mg/dL. His lipopro-tein(a), C-reactive protein, and homo-cysteine levels were normal. He was not hypertensive, had no impairment of gly-cemic control, and did not smoke. With a combination of simvastatin 40 mg and niacin (Niaspan; Kos Pharmaceuticals) 1000 mg daily, the patient’s lipid profil