Department of Medicine and Department of Genetics, Institute for Translational Medicine and Therapeutics, and Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Lancet. 2014 Aug 16;384(9943):618-625. doi: 10.1016/S0140-6736(14)61217-4.
The cholesterol contained within HDL is inversely associated with risk of coronary heart disease and is a key component of predicting cardiovascular risk. However, despite its properties consistent with atheroprotection, the causal relation between HDL and atherosclerosis is uncertain. Human genetics and failed clinical trials have created scepticism about the HDL hypothesis. Nevertheless, drugs that raise HDL-C concentrations, cholesteryl ester transfer protein inhibitors, are in late-stage clinical development, and other approaches that promote HDL function, including reverse cholesterol transport, are in early-stage clinical development. The final chapters regarding the effect of HDL-targeted therapeutic interventions on coronary heart disease events remain to be written.
高密度脂蛋白（HDL）所含胆固醇与冠心病风险呈负相关，是预测心血管风险的关键因素。然而，尽管 HDL 具有抗动脉粥样硬化作用，但它与动脉粥样硬化之间的因果关系尚不确定。人类遗传学和失败的临床试验使人们对高密度脂蛋白假说产生了怀疑。尽管如此，仍有一些药物在进行后期临床试验，这些药物可以提高高密度脂蛋白胆固醇浓度，如胆固醇酯转移蛋白抑制剂；还有一些药物可以促进高密度脂蛋白功能，如逆向胆固醇转运，这些药物处于早期临床试验阶段。关于针对高密度脂蛋白的治疗干预对冠心病事件的影响，还有待书写。
