Schaefer J R
Dr.-Pohl-Stiftungsprofessur für Präventive Kardiologie, Klinik für Innere Medizin - Kardiologie, UKGM Standort Marburg und Philipps-Universität Marburg, Baldingerstr., 35033, Marburg, Deutschland.
Herz. 2012 Feb;37(1):51-5. doi: 10.1007/s00059-011-3563-z.
The risk for myocardial infarction can be reduced by almost 50% solely by lowering LDL cholesterol. Despite success reducing LDL and cholesterol, atherosclerosis and myocardial infarction remain significant challenges. However, mechanisms of the reverse cholesterol transport system might be used more effectively in the foreseeable future. Although the benefit of high HDL cholesterol appears to be obvious, most clinical trials aimed at increasing HDL cholesterol failed to generate convincing results. Therefore, the question arises as to whether indeed only HDL level or perhaps rather more HDL function is of considerable therapeutic relevance. If function is the crucial issue drugs such as CETP (cholesteryl ester transfer protein) activators or SR-B1 (scavenger receptor type B-1) upregulators could be beneficial. These types of drugs could improve HDL metabolism and might have beneficial effects despite the fact that they lower HDL levels. Ongoing studies on next generation CETP inhibitors and nicotinic acid will clarify this question and might help in our struggle against atherosclerosis.
仅通过降低低密度脂蛋白胆固醇，心肌梗死风险可降低近50%。尽管在降低低密度脂蛋白和胆固醇方面取得了成功，但动脉粥样硬化和心肌梗死仍然是重大挑战。然而，在可预见的未来，逆向胆固醇转运系统的机制可能会得到更有效的利用。虽然高密度脂蛋白胆固醇水平高的益处似乎很明显，但大多数旨在提高高密度脂蛋白胆固醇水平的临床试验未能产生令人信服的结果。因此，问题在于，究竟是只有高密度脂蛋白水平，还是更确切地说，是高密度脂蛋白功能才具有相当大的治疗相关性。如果功能是关键问题，那么诸如胆固醇酯转运蛋白（CETP）激活剂或B1型清道夫受体（SR-B1）上调剂等药物可能会有益处。尽管这类药物会降低高密度脂蛋白水平，但它们可以改善高密度脂蛋白代谢，可能具有有益效果。正在进行的关于下一代CETP抑制剂和烟酸的研究将阐明这个问题，并可能有助于我们对抗动脉粥样硬化。
