Modulazione farmacologica delle HDL ed outcome clinici = HDL-raising therapies and clinical outcomes

Epidemiological studies showed an inverse correlation between plasma levels of high density lipoprotein cholesterol (HDL-C) and the incidence of cardiovascular events. The results of recent genetic studies questioned this relationship and highlighted that HDL metabolism is deeply connected with other lipids and lipoproteins. In addition, it has been postulated that HDL function more than plasma HDL-C level could be relevant for cardiovascular risk prediction. Fibrates, niacin and CETP inhibitors can increase plasma HDL-C levels as a part of an overall modulation of lipid metabolism. Treatment with fibrates and niacin has been associated with a reduction of cardiovascular events, especially in patients with low HDL-C and elevated triglycerides. However, no cardiovascular benefit was evident when fibrates and niacin were tested on top of statins. CETP inhibitors also failed in reducing cardiovascular events on top of statins. Therapeutic approaches aimed at specifically increasing HDL levels and function are needed, to be tested for cardiovascular benefit in selected population with low HDL.