High-density lipoprotein-raising strategies: update 2010

Area of Science:

• Cardiology
• Lipidology
• Pharmacology

Background:

• High-density lipoprotein (HDL) cholesterol is a key inverse predictor of cardiovascular disease (CVD).
• HDL's protective effects extend beyond reverse cholesterol transport to include anti-inflammatory and anti-oxidative functions.
• Low HDL cholesterol predicts events even in patients on statins with low LDL cholesterol, highlighting unmet needs.

Purpose of the Study:

• To review established and novel pharmacotherapies aimed at increasing HDL cholesterol levels.
• To discuss the mechanisms of action for various HDL-raising agents.
• To analyze clinical trial data for monotherapy and combination therapy approaches.

Main Methods:

• Literature review of population studies and clinical trials.
• Analysis of pharmacological mechanisms for HDL-raising drugs.
• Synthesis of data on established and emerging HDL-targeting therapies.

Main Results:

• Established therapies include statins, fibrates, thiazolidinediones, and nicotinic acids.
• Novel therapies under investigation include CETP inhibitors, LXR agonists, reconstituted HDL, and apoA-I mimetics.
• Both monotherapy and combination strategies are being evaluated for efficacy.

Conclusions:

• Increasing HDL cholesterol is a vital therapeutic strategy for CVD prevention.
• Statins alone are insufficient for all patients, necessitating exploration of HDL-raising agents.
• A range of established and novel pharmacological interventions offer potential for enhancing HDL levels and reducing cardiovascular risk.