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High-density lipoprotein: pot of gold or box of Pandora?


In this session Dr Kastelein, Dr Barter, Dr Nicholls and Dr Ruschitzka discussed the future of treatment of low HDL cholesterol. The room was crowded so obviously the topic was interesting for the audience of the congress.

There are large numbers of epidemiological studies that have identified HDL cholesterol as a strong, independent, inverse predictor of risk of coronary heart disease. There are several possible mechanisms but we really do not know how this potential protective effect is mediated. Evidence that raising HDL cholesterol will reduce cardiovascular adverse outcomes remains controversial. Obviously, treatment with torcetrapib is harmful, with an increased rate of cardiovascular events despite an increased HDL level. The reason for this failure is not completely understood. Torcetrapib increased blood pressure in the Illuminate study but this was not enough to explain the poor outcome in the torcetrapib group.

The speakers discussed whether HDL treatment is a dead-end now, but all of them had some optimism about the future with different drug suggestions that may be effective not only in raising HDL cholesterol but also in decreasing cardiovascular events. Certainly, we need studies with hard end-points comparing statin treatment vs combination therapy (statin + a drug that raises HDL cholesterol). There are such studies ongoing but we will have to wait some years before we can achieve those results. Until then, we do not know if treatment of low HDL cholesterol is a pot of gold or Pandora’s box.





High-density lipoprotein: pot of gold or box of Pandora?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.