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Current Opinion in Cardiology:
doi: 10.1097/HCO.0b013e328362210d
LIPIDS AND HEART DISEASE: Edited by Anthony S. Wierzbicki and Dimitri P. Mikhailidis

High-density lipoprotein cholesterol raising: does it matter?

Schofield, Jonathan D.a,b; France, Michaela,b,c; Ammori, Basilb,d; Liu, Yifenb; Soran, Handreana,b,e

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Abstract

Purpose of review: Cardiovascular disease (CVD) is the leading cause of morbidity and premature mortality in Europe and the United States, and is increasingly common in developing countries. High-density lipoprotein cholesterol (HDL-C) is an independent risk factor for CVD and is superior to low-density lipoprotein cholesterol (LDL-C) as a predictor of cardiovascular events. The residual risk conferred by low HDL-C in patients with a satisfactory LDL-C was recently highlighted by the European Atherosclerosis Society. Despite the lack of randomized controlled trials, it has been suggested that raising the level of HDL-C should be considered as a therapeutic strategy in high-risk patients because of the strong epidemiological evidence, compelling biological plausibility, and both experimental and clinical research supporting its cardioprotective effects.

Recent findings: Three recent large randomized clinical trials investigating the effect of HDL-C raising with niacin and dalcetrapib in statin-treated patients failed to demonstrate an improvement in cardiovascular outcomes.

Summary: There is evidence to support the view that HDL functionality and the mechanism by which a therapeutic agent raises HDL-C are more important than plasma HDL-C levels. Future therapeutic agents will be required to improve this functionality rather than simply raising the cholesterol cargo.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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