Emerging HDL-based therapies for atherothrombotic vascular disease.

Statin therapy has been a significant advance in the management of dyslipidemia and atherothrombotic cardiovascular disease with a resultant 30% to 40% reduction in cardiovascular events; however, a significant number of events continue to occur in statin-treated patients, including in patients treated with high-dose statins targeted to achieve mean low-density lipoprotein cholesterol levels in the range of 60 to 80 mg/dL. Therefore, development and testing of new therapies that exploit the vascular protective effects of high-density lipoprotein (HDL) constitutes a rational and complementary approach. A number of HDL-based therapies are in various stages of development and testing. It is hoped that one or more of these new HDL-based therapies, if proven effective and safe, will become a part of our armamentarium against vaso-occlusive cardiovascular disease. A paradigm could emerge in which patients recovering from acute coronary syndromes and at high risk of recurrent events could be treated with rapid-acting HDL-based therapy, such as infusions of recombinant HDL or even HDL delipidation, followed by more sustained long-term HDL-based therapies, such as oral agents and perhaps even HDL-based gene therapy.