Department of Cardiology and Pneumology, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
Curr Pharm Des. 2010 May;16(13):1517-30. doi: 10.2174/138161210791050988.
Population studies have consistently shown that high-density lipoprotein (HDL) cholesterol levels are a strong, independent inverse predictor of cardiovascular disease. Every 1 mg/dl increase in HDL cholesterol is associated with a 2% to 3% decrease in coronary artery disease risk, independent of low-density lipoprotein (LDL) cholesterol and triglyceride levels. The primary mechanism for this protective effect is believed to be reverse cholesterol transport, but several other anti-inflammatory, anti-apoptotic, anti-oxidative functions for HDL have also been identified. Low HDL cholesterol is predictive of cardiovascular events in statin-treated patients with low LDL cholesterol, indicating that intensive lipid lowering strategies with statins alone are not sufficient to prevent cardiovascular events, and merging for additional effective HDL-raising therapy. This review focuses at giving an overview of current established HDL-raising pharmaca, including statins, fibrates, thiazolidinediones, and nicotinic acids, and of novel therapies including cholesterol ester transfer protein-inhibitors, liver X receptor agonists, reconstituted HDL, and apolipoprotein A-I mimetics. Working mechanisms are described and results from clinical trials of monotherapy and combination therapy are discussed.
人群研究一直表明,高密度脂蛋白(HDL)胆固醇水平是心血管疾病的一个强有力的、独立的负向预测因子。每增加 1 毫克/分升的 HDL 胆固醇,冠心病风险就会降低 2%至 3%,而与低密度脂蛋白(LDL)胆固醇和甘油三酯水平无关。这种保护作用的主要机制被认为是胆固醇逆转运,但也发现了 HDL 的其他几种抗炎、抗凋亡、抗氧化功能。在 LDL 胆固醇水平低的他汀类药物治疗患者中,低 HDL 胆固醇可预测心血管事件,这表明仅用他汀类药物进行强化降脂策略不足以预防心血管事件,需要合并其他有效的升高 HDL 治疗。本文综述了目前已确立的升高 HDL 的药物,包括他汀类药物、贝特类药物、噻唑烷二酮类药物和烟酸类药物,以及新型治疗方法,包括胆固醇酯转移蛋白抑制剂、肝 X 受体激动剂、重组 HDL 和载脂蛋白 A-I 模拟物。本文描述了它们的作用机制,并讨论了单药和联合治疗的临床试验结果。