[HDL level or HDL function as the primary target in preventive cardiology]

Area of Science:

• Cardiovascular Science
• Biochemistry
• Pharmacology

Background:

• Lowering LDL cholesterol reduces myocardial infarction risk by nearly 50%.
• Despite advancements, atherosclerosis and myocardial infarction remain significant health challenges.
• The reverse cholesterol transport system holds future therapeutic potential.

Purpose of the Study:

• To investigate the therapeutic relevance of HDL function versus HDL levels in combating atherosclerosis.
• To explore novel drug targets within the reverse cholesterol transport system.

Main Methods:

• Review of clinical trial outcomes for HDL-raising therapies.
• Analysis of potential therapeutic strategies targeting CETP activators and SR-B1 upregulators.
• Discussion of ongoing studies on CETP inhibitors and nicotinic acid.

Main Results:

• Most clinical trials aiming to increase HDL cholesterol have yielded unconvincing results.
• HDL function, rather than solely HDL levels, may be more therapeutically relevant.
• Drugs targeting HDL metabolism (e.g., CETP activators, SR-B1 upregulators) could offer benefits.

Conclusions:

• Future atherosclerosis treatments may focus on enhancing HDL function.
• Targeting HDL metabolism pathways, even if they lower HDL levels, shows therapeutic promise.
• Further research on novel CETP inhibitors and nicotinic acid is crucial for managing atherosclerosis.