Emerging strategies for increasing high-density lipoprotein.
High-density lipoprotein cholesterol is a potent and independent epidemiologic risk factor and is a proved antiatherosclerotic agent in animal models of atherosclerosis, acting through the principal mechanisms of accelerating cholesterol efflux and inhibiting oxidation and inflammation. Lifestyle modification increases serum levels by 5% to 15%, whereas niacin, the drug most widely used to increase high-density lipoprotein cholesterol, increases it by 25% to 35% at the highest doses. This review examines the potent methods of increasing high-density lipoprotein and/or enhancing reverse cholesterol transport, including cholesterol ester transfer protein inhibitors, apolipoprotein A-I Milano, D4F, the dual peroxisome proliferator-activated receptor agonists, and rimonabant, that are now in clinical trials. In conclusion, these new agents, used alone or in combination with existing therapies, carry the potential to markedly reduce the incidence of new coronary disease and cardiac events in this decade.
Forrester
James S
JS
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA. forrester@cshs.org
Shah
Prediman K
PK
D000818:Animals; D016632:Apolipoprotein A-I / Q000097:blood / Q000494:pharmacology; D050197:Atherosclerosis / Q000097:blood; D063387:Cannabinoid Receptor Antagonists; D053480:Cholesterol Ester Transfer Proteins / Q000502:physiology; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000517:prevention & control; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood* / Q000502:physiology; D047492:Peroxisome Proliferator-Activated Receptors / Q000819:agonists; D010880:Piperidines / Q000494:pharmacology; D011720:Pyrazoles / Q000494:pharmacology; D000077285:Rimonabant; D012307:Risk Factors
D016632:Apolipoprotein A-I; D063387:Cannabinoid Receptor Antagonists; D053480:Cholesterol Ester Transfer Proteins; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; C465468:D-4F peptide; D008075:Lipoproteins, HDL; D047492:Peroxisome Proliferator-Activated Receptors; D010880:Piperidines; D011720:Pyrazoles; D000077285:Rimonabant