Big Pharma has struggled of late to demonstrate the availability & safety of a product that can raise HDL & prevent cardiovascular events. Initial efforts to raise HDL via cholesterylester transferase protein (CETP) inhibitors have not been very successful, eg torcetrapib in 2006. More recently, witness the debacles that were fenofibrate and niacin.
So why the push to raise HDL? Well, we've gotten pretty good a lowering LDL w/statins. But more importantly, for any given LDL, cardiovascular events still occur, demonstrating residual risk. From a different perspective, the higher the HDL, the lower the risk of events.
For instance, in a prospective cohort study published last week in the Annals of Internal Medicine, the authors followed for 11yrs 26,861 healthy women participating in the Women's Health Study and concluded that HDL is inversely related to cardiovascular events, even in those with low LDL. And just how much HDL does one need to appreciate benefit? More than 61.6mg/dL even in women w/median LDL <89mg/dL!
So if we don't have any drugs in our armamenterium, what do we do? Fall back upon our old standby and exercise!
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