HDL-cholesterol and treatment pathway

Adequate treatment of elevated LDL-cholesterol (LDL-C) with statins has led to an impressive decrease of cardiovascular disease. However the risk to suffer further events remains fairly high despite adequate achievement of LDL-C targets. Low HDLcholesterol (HDL-C) levels play a major role in this residual risk. Epidemiological studies have shown that each increase of HDL-C by 0.01g/l is associated with a diminished risk of cardiovascular disease by 3%. On top of lifestyle recommendations, drug therapy to increase HDL-cholesterol might contribute to decrease the residual risk. Two classes of drug can be associated to statin to increase HDL-C. Fibrates are associated with an up to 10% increase in HDL-C and a decrease in cardiovascular events only in the subgroup of patient with high triglyceride levels and/or low HDL-cholesterol levels. Nicotinic acid which is the most potent HDL-C increasing agent has also been shown to decrease events in a recent meta-analysis. New approaches including combination of nicotinic acid and laropiprant (an inhibitor of ush) and CETP inhibitor are now under development. (C) 2011 Elsevier Masson SAS. All rights reserved.