J Clin Outcomes Manage
High-density lipoprotein-targeted therapies: hope or disappointment?
Abstract Objective: To discuss therapies that have been used to target high-density lipoprotein cholesterol (HDL-C), studies that have examined their effects, and implications for practice. Methods: Review of the literature. Results: Observational studies and monotherapy studies with fibrates and niacin suggest a reduction in cardiovascular disease (CVD) events with interventions that modify HDL-C, particularly in patients with metabolic syndrome. Meta-analyses and trials utilizing surrogate markers of CVD risk further support benefits when these medications are added to statin therapy. However, larger controlled trials have not demonstrated reduction in CVD adverse events when therapies to modulate HDL-C such as fibrates, niacin, or investigational cholesteryl ester transfer protein inhibitors have been added to well-treated individuals on statin therapy. Problems with study design, relatively small HDL-C increases with current therapies, and the selected well-treated populations tested limit applying these results to all patients. Conclusion: Statin therapy remains the primary treatment choice to reduce CVD events and although the hunt for HDL-modulating therapies still goes on, there should be restraint in uniformly raising HDL-C with current therapies. In selected populations inadequately treated to recommend low-density lipoprotein cholesterol or non-HDL-C goals, addition of these therapies may offer further benefit.
Clinical Review Article
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