Impact of lipid treatment on cardiovascular risk reduction: New therapeutic targets

Abstract

High levels of LDL cholesterol (LDL-c) are causally related to the development of atherosclerosis. A large body of epidemiological evidence supports a direct relationship between the level of serum LDL-c and the risk of cardiovascular disease, and clinical trials have shown that lowering LDL-c with statins leads to a 30% decrease in the risk of cardiovascular events. However, many patients taking statins continue to suffer cardiovascular disease, highlighting the need both to improve the number of patients reaching LDL-c therapeutic goals and to develop new therapeutic targets. The apoB/apoA-I ratio has been shown to be a major contributor to the risk of myocardial infarction and hence increasing HDL-cholesterol (HDL-c) offers a promising approach to further decrease cardiovascular risk. Clinical trial data with fibrates and nicotinic acid, together with preliminary data on potent new treatments, support HDL-c as a therapeutic target. The cardioprotective effect of HDL-c may not solely be related to its role in reverse cholesterol transport. © The European Society of Cardiology 2005. All rights reserved.