Androulakis Emmanuel, Zacharia Effimia, Papageorgiou Nikolaos, Lioudaki Eirini, Bertsias Dimitris, Charakida Marietta, Siasos Gerasimos, Tousoulis Dimitris
St George's University Hospital, London, United Kingdom.
1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece.
Curr Cardiol Rev. 2017;13(3):168-182. doi: 10.2174/1573403X13666170209145622.
Low-density lipoprotein cholesterol (LDL), and especially its oxidized form, renders the atherosclerotic plaque vulnerable to rupture in acute coronary syndromes (ACS). On the other hand, high-density lipoprotein (HDL) is considered an anti-atherogenic molecule. The more recent HDL-targeted drugs may prove to be superior to those used before. Indeed, delipidated HDL and HDL mimetics are efficient in increasing HDL levels, while the apoA-I upregulation with RVX-208 appears to offer a clinical benefit which is beyond the HDL related effects. HDL treatment however has not shown a significant improvement in the outcomes of patients with ACS so far, studies have therefore focused again on LDL. In addition to statins and ezetimibe, novel drugs such as PSCK9 inhibitors and apolipoprotein B inhibitors appear to be both effective and safe for patients with hyperlipidemia.
Data suggest these could potentially improve the cardiovascular outcomes of patient with ACS. Yet, there is still research to be done, in order to confirm whether ACS patients would benefit from LDL- or HDL-targeted therapies or a combination of both.
低密度脂蛋白胆固醇（LDL），尤其是其氧化形式，会使动脉粥样硬化斑块在急性冠状动脉综合征（ACS）中易于破裂。另一方面，高密度脂蛋白（HDL）被认为是一种抗动脉粥样硬化分子。最新的以HDL为靶点的药物可能被证明比以前使用的药物更具优势。事实上，脱脂HDL和HDL模拟物在提高HDL水平方面是有效的，而RVX-208上调载脂蛋白A-I似乎能带来超出HDL相关效应的临床益处。然而，迄今为止，HDL治疗尚未显示出ACS患者预后的显著改善，因此研究再次聚焦于LDL。除了他汀类药物和依泽替米贝外，新型药物如前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂和载脂蛋白B抑制剂对高脂血症患者似乎都是有效且安全的。
数据表明这些药物可能会改善ACS患者的心血管预后。然而，仍需开展研究，以确认ACS患者是否会从以LDL或HDL为靶点的治疗或两者联合治疗中获益。
