Emerging role of high-density lipoprotein in the prevention of cardiovascular disease

In major statin trials, the relative risk reduction is typically in the range 25-35%, thus indicating that the majority of cardiac events continues to occur despite statin therapy. Hence, there is a considerable interest in identifying novel therapies capable of further reducing cardiovascular disease risk. One such potential therapeutic target is a low level of high-density lipoprotein (HDL) cholesterol. Emerging targets involved in HDL metabolism are: (i) liver X receptor and peroxisome proliferator-activated receptor agonists; (ii) cholesteryl ester transfer protein inhibitors; (iii) HDL mimetics (ETC-216); (iv) apolipoprotein A-I synthetic peptides; and (v) HDL delipidation and reinfusion. Although they are at various stages of development, each of these therapies has promise for the treatment of cardiovascular disease in humans.