New promising potential in fighting atherosclerosis: HDL and reverse cholesterol transport

Abstract

Atherogenesis and cardiovascular disease (CVD) mortality remain an outstanding population health risk. Its importance grows with rising affl uence leading to obesity in the developing countries. Inspite of an enormous initial enthusiasm related to the breakthrough success with the statins, there remains a substantial residual risk of CVD. While statins are effective in lowering the low density lipoproteins, LDL (the "bad" cholesterol), the residual risk is also related to unsatisfactorily low levels of high density lipoprotein, HDL (the "good" cholesterol). It has been long known that low levels of HDL are associated with CVD as an independent risk factor. The original concept of a direct transfer of cholesterol from LDL to HDL has been proved to be oversimplifi ed. Recent studies confi rm direct participation of HDL in anti-atherogenesis by promoting the effl ux of cholesterol contained in the foam cells that constitute atherosclerotic lesions. The challenge is to identify therapeutic interventions aimed at raising HDL, thus assisting statins that have until recently been mostly used as a monotherapy.