Badimón Juan José, Santos-Gallego Carlos G, Badimón Lina
Unidad de Investigación de Aterotrombosis, Instituto Cardiovascular, Mount Sinai School of Medicine, Nueva York, NY 10029, Estados Unidos.
Rev Esp Cardiol. 2010 Jun;63 Suppl 2:20-35. doi: 10.1016/s0300-8932(10)70150-0.
The association between cardiovascular events and a high low-density lipoprotein (LDL) cholesterol level has been clearly established by numerous clinical trials. Moreover, reducing the LDL-cholesterol level using statins has been shown to be highly effective in both primary and secondary prevention. Nevertheless, despite statin treatment, the residual cardiovascular risk remains high and a large number of cardiovascular events still occur. On the other hand, a growing number of studies have demonstrated that there is an inverse association between the high-density lipoprotein (HDL) cholesterol level and cardiovascular risk. The most recent observations indicate that increasing the HDL-cholesterol level confers an additional benefit to reducing the LDL-cholesterol level with statins. Together, these findings justify turning our attention to HDL-cholesterol to provide a novel additional strategy for reducing cardiovascular risk. This review article describes: firstly, epidemiological studies that endorse HDL cholesterol as a therapeutic target; secondly, the different alternative treatments available for increasing the HDL-cholesterol level; and, finally, the benefits associated with such an increase.
大量临床试验已明确证实心血管事件与高低密度脂蛋白（LDL）胆固醇水平之间的关联。此外，使用他汀类药物降低LDL胆固醇水平在一级和二级预防中均显示出高效性。然而，尽管进行了他汀类药物治疗，残余心血管风险仍然很高，大量心血管事件仍会发生。另一方面，越来越多的研究表明，高密度脂蛋白（HDL）胆固醇水平与心血管风险呈负相关。最新观察结果表明，提高HDL胆固醇水平在使用他汀类药物降低LDL胆固醇水平的基础上还能带来额外益处。综上所述，这些发现使得我们有理由将注意力转向HDL胆固醇，以提供一种降低心血管风险的新型额外策略。这篇综述文章描述了：第一，支持将HDL胆固醇作为治疗靶点的流行病学研究；第二，可用于提高HDL胆固醇水平的不同替代治疗方法；最后，提高HDL胆固醇水平所带来的益处。
