Treatment of low high-density lipoprotein cholesterol

The prevention of atherosclerotic vascular disease has changed considerably with the recognition that modifying cardiovascular risk factors (smoking, obesity, physical inactivity, elevated blood pressure, poor dietary habits, diabetes and elevated cholesterol levels) leads to a marked reduction in cardiovascular events. Reducing low-density lipoprotein cholesterol in high-risk subjects reduces cardiac events, cardiovascular mortality and total mortality. While epidemiological studies have consistently shown an inverse relationship between a low high-density lipoprotein cholesterol (HDL-C) level and the risk of coronary artery disease (CAD), there is a paucity of data showing unambiguously that raising HDL-C by pharmacological means reduces cardiac events. Lifestyle changes associated with an increase in HDL-C (smoking cessation, weight reduction, exercise, moderate alcohol intake) stand on their own merits with respect to cardiovascular benefits. Currently, the only available medication to raise HDL-C is nicotinic acid (niacin), taken in gram quantities. The data supporting niacin use for CAD prevention are much weaker than that for statins. Novel therapies aimed at raising HDL-C are the direct result of research in the complex mechanisms that modulate HDL in humans. These novel therapies will need to be tested not only for their ability to effectively and safely raise HDL-C, but for their ability to prevent CAD as well.