ABSTRACTBACKGROUND: Through many epidemiological studies it is established that levels of HDL-cholesterol are inversely related to the risk of cardiovascular disease. Pharmacological intervention to increase the level of HDL-cholesterol therefore has potentially great benefit in patients at high risk. This review gives an update on interventions towards raising HDL-cholesterol.
METHODS: Non-systematic literature searches were conducted in PubMed and Embase.
RESULTS: Lifestyle interventions, like aerobic exercise, smoking cessation, weight reduction and moderate alcohol consumption are all able, though modestly, to raise the level of HDL-cholesterol. For many patients this effect will be inadequate to achieve a significant risk reduction. Established lipid-modifying agents like statins and fibrates raise the HDL-cholesterol to some extent. It is, however, difficult to decide whether their positive impact on cardiovascular disease is to any extent due to the effect on HDL-cholesterol. Niacin is today the most potent drug for elevating HDL-cholesterol. Clinical trials have suggested good effect, but there is a lack of new large-scale randomised controlled trials. CETP inhibition with torcetrapib has been shown to raise the levels of HDL-cholesterol with more than 70 %. However, torcetrapib significantly increased the mortality in patients at high risk of cardiovascular events. New evidence indicates that this was most likely due to off-target effects. Another CETP-inhibitor (dalcetrapib) is now undergoing a phase 3 trial.
CONCLUSION: It has not been shown that pharmacological interventions to raise the levels of HDL-cholesterol reduce morbidity and/or mortality.