Editor’s note: This is one in a series of Cardiovascular Genome-Phenome Study Discovery grants to more precise treatments and prevention for heart disease.

In the world of arteries, LDL cholesterol is public enemy No. 1 — with good reason. It’s the kind that contributes to artery-clogging plaque that can lead to a deadly cardiovascular event.

“Heart attacks and strokes remain leading causes of death in the United States,” said Xue-Qiao Zhao, M.D., research professor of medicine and cardiology at the University of Washington. “Despite the current aggressive treatment guidelines, including lowering cholesterol to reduce heart attacks and strokes, some people continue to suffer cardiovascular problems leading to a poor quality of life and high cost of health care.”

Zhao is conducting research funded by the American Heart Association to identify people who are treated with statin therapy in need of new or more aggressive treatment to reduce their chances of heart attack or stroke.

Last November, Zhao was among 10 researchers each awarded about $160,000 to study ways to individualize the treatment and prevention of heart disease. These grants, which are funded by AstraZeneca, probe three areas: heart failure, “good” HDL cholesterol and predicting cardiovascular disease.

Although cholesterol-lowering statin drugs can control risk in most cardiovascular patients, research suggests some patients continue to have recurrent problems. Identifying those people is a challenge, Zhao said.

She and her colleague, Jay Heinecke, M.D., will investigate the role “good” HDL cholesterol plays in predicting recurrent heart attacks and strokes. Their investigation will assess HDL’s ability to remove cholesterol and protein composition, then link these HDL function assessments with the occurrence of heart attacks or strokes.

“We aim to determine whether HDL function assessments at baseline or on intensive [cholesterol] therapy is associated with increased risk of future cardiovascular events,” she said.

HDL is considered a good guy. It acts as a scavenger, carrying LDL cholesterol from the blood to the liver, where it’s broken down and removed from the body.

“Currently, we don’t have a good way to identify those at increased risk for residual events,” Zhao said. “The new knowledge and better understanding will help to identify the subjects who are at increased risk for recurrent heart attacks or strokes under the optimal medical management who may benefit most from more aggressive or new therapies.”

In the meantime, doctors and patients should talk about the possibility of another heart attack or stroke, and what to do about it, Zhao said.

“It is very important to address and control all possible risk factors to lower residual CVD events [until] we have a better way to identify the high-risk population,” she said.

Read other stories in this series.