certainly do not know which subpopulations are
clinically important.
Nevertheless, “I have moved from being pessimistic about HDL, to being less pessimistic, to now
actually having some optimism.”
Finally, what about non-HDL cholesterol? Growing evidence suggests that non-HDL-C is a better risk
predictor than LDL, can be performed in a nonfasting state, and does not incur any additional costs
to the health care system. Yet surveys suggest that
physicians cannot calculate non–HDL-C levels when
provided a standard lipid profile, and cardiologists
were just as likely as primary care physicians to not
understand the calculation or know the non–HDL-C
goal of therapy.8 Non–HDL-C is simply calculated by
subtracting HDL-C from total cholesterol.
Dr. Barter said non-HDL-C has been a better
risk predictor when evaluated against LDL-C, but
he understands the reluctance to embrace non-HDLC due to concerns that a sudden shift away from
concentrating on LDL may cause great confusion.
Having said that, he quickly added that in the next
3 to 5 years, non-HDL-C will likely replace LDL as
the chief measure of CV risk. Until then, it remains
a secondary target and the goal should be a nonHDL-C of <130 mg/dL. ■
AATAC on AF and HF
Ablation vs amiodarone for a dual epidemic
H
eart failure and AF are on the rise and often
coexist. The prevalence of AF increases
with HF severity, ranging from 5% in NYHA
functional class I patients to approximately 50% in
class IV patients. Overall, the prevalence of HF in
patients with AF has been estimated at 42% with
the combination of HF and AF leading to deleterious
hemodynamic and symptomatic consequences.
Not surprisingly, evidence suggests that AF may
adversely affect mortality, mainly in mild-to-moderate HF, but not in very advanced HF where survival
is already limited. Interestingly, new-onset AF
appears to portend a particularly dismal prognosis
compared with no AF or chronic AF in H