<International Circulation>:  So you really believe that if LDL is low that raising HDL could not be beneficial?  One of the criticisms of AIM HIGH was that it was underpowered， that the number of events was not enough to show a difference.  Do you really believe that AIM HIGH demonstrates that raising HDL when LDL is low that it does not show a great benefit?

　　Prof. Eckel:  When you calculate how many additional patients may be necessary to bring up the power of the study it turns out to be quite a few patients.  The study may be underpowered but it is a result that we have no choice but to interpret this way.  HPS II THRIVE will be a better study to answer this question.

　　<International Circulation>:  Do you believe， as it stands right now， that if we intervene in a patient who has low HDL and high triglycerides that you would ask for lifestyle changes if they are not already doing so?  If the LDL is low and triglycerides are high， are you not going to ask for medical interventions?

　　Prof. Hu:If the levels are too high then you have to treat them.  First they certainly should be put on lifestyle interventions including modifications to exercise routines and dietary changes.  If the levels are very high then it is necessary to treat medically.

　　Prof. Eckel:  In my opinion lifestyle modifications are over-rated.  It is very important that patients lose weight， eat better， and become more active， however if you look at the amount of change in cholesterol levels and triglycerides that comes from lifestyle modification it is statistically significant but not necessarily great enough to modify the risk that remains.  That is not to say that lifestyle interventions may not be beneficial in other ways without the alterations in lipid profile， rather that the changes in cholesterol and triglyceride changes are in the right direction.  The question comes up whether a physician should provide drug therapy for these patients?  A number of post-hoc analyses of a number of the fibrate trials have shown that fibrates may work when triglycerides are above 200 or in the range of 2.2 mmol.  That is the situation where I would tend to use a fibrate， where the LDL level is already adequately treated with a statin.  This is my opinion only and we don’t have a trial to support that decision.  With regard to raising HDL， my plan is to be more patient and wait for HPS II THRIVE to come out and to see if those interventions might be successful.  Of course， now we do not have a CETP inhibitor approved yet in The United States. 

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