Aims: Fibrates or nicotinic acid are usually recommended for secondary prevention of coronary heart disease in patients with low plasma levels of both low-density lipoprotein cholesterol (LDL-C) ⩽140 mg/dL (⩽3.6 mmol/L) and high-density lipoprotein cholesterol (HDL-C) ⩽40 mg/dL (⩽1.03 mmol/L). The LIPID trial, a randomised, placebo-controlled trial in 9014 patients at 87 centres in Australia and New Zealand, provided an opportunity to investigate the effects of an HMG-CoA reductase inhibitor in patients with low LDL-C and low HDL-C.

Methods and results: Participants in this post hoc substudy were 2073 patients aged 31–75 years with baseline LDL-C ⩽140 mg/dL (⩽3.6 mmol/L), HDL-C ⩽40 mg/dL (⩽1.03 mmol/L), and triglyceride ⩽300 mg/dL (⩽3.4 mmol/L). The relative risk reduction with pravastatin treatment was 27% for major coronary events (95% CI 8–42%), 27% for coronary heart disease mortality (95% CI 0–47%), 21% for all-cause mortality (95% CI 0–38%), and 51% for stroke (95% CI 24–69%). The number needed to treat to prevent a major coronary event over 6 years was 22.

Conclusions: Treatment with pravastatin in patients with both low LDL-C and low HDL-C significantly reduced major coronary events, stroke, and all-cause mortality. The level of HDL-C is crucial to the risk of recurrent CHD events and, consequently, the benefit of lowering LDL-C.