Whayne Thomas F
Gill Heart Institute, University of Kentucky, Lexington, Kentucky 40536, USA.
Angiology. 2009 Oct-Nov;60(5):644-9. doi: 10.1177/0003319709331392. Epub 2009 Feb 23.
High-density lipoproteins are regarded as ''good guys'' but not always. Situations involving high-density lipoproteins are discussed and medication results are considered. Clinicians usually consider high-density lipoprotein cholesterol. Nicotinic acid is the best available medication to elevate high-density lipoprotein cholesterol and this appears beneficial for cardiovascular risk. The major problem with nicotinic acid is that many patients do not tolerate the associated flushing. Laropiprant decreases this flushing and has an approval in Europe but not in the United States. The most potent medications for increasing high-density lipoprotein cholesterol are cholesteryl ester transfer protein inhibitors. The initial drug in this class, torcetrapib, was eliminated by excess cardiovascular problems. Two newer cholesteryl ester transfer protein inhibitors, R1658 and anacetrapib, initially appear promising. High-density lipoprotein cholesterol may play an important role in improving cardiovascular risk in the 60% of patients who do not receive cardiovascular mortality/morbidity benefit from low-density lipoproteins reduction by statins.
高密度脂蛋白被视为“好人”，但并非总是如此。本文讨论了与高密度脂蛋白相关的情况，并考虑了药物治疗效果。临床医生通常会考虑高密度脂蛋白胆固醇。烟酸是目前提升高密度脂蛋白胆固醇的最佳药物，这似乎对心血管风险有益。烟酸的主要问题在于许多患者无法耐受其伴随的潮红反应。拉罗匹坦可减轻这种潮红反应，已在欧洲获批，但在美国未获批。增加高密度脂蛋白胆固醇最有效的药物是胆固醇酯转运蛋白抑制剂。该类药物中的首个药物托彻普贝因过多的心血管问题而被淘汰。两种较新的胆固醇酯转运蛋白抑制剂，R1658和阿那曲普贝，最初看起来很有前景。在60%未从他汀类药物降低低密度脂蛋白中获得心血管死亡率/发病率益处的患者中，高密度脂蛋白胆固醇可能在改善心血管风险方面发挥重要作用。
