HDL metabolism and the role of HDL in the treatment of high-risk patients with cardiovascular disease.

Developing new therapeutic approaches to treating residual cardiovascular risk of recurrent clinical events in statin-treated patients has been a major challenge for the cardiovascular field. Data from epidemiological evidence, animal models, and initial clinical trials indicate that increasing high-density lipoprotein (HDL) may be an effective new target for treating residual cardiovascular risk. Over the past several years, major advances have occurred in our understanding of HDL metabolism and of the important roles of the ABCA1 and ABCG1 transporters as well as the SR-BI receptor in cholesterol transport. Current approaches to HDL therapy include acute HDL infusion therapy in acute coronary syndrome patients and chronic oral HDL therapy in stable patients with cardiovascular disease. Definitive clinical trials will now be required to establish the safety and efficacy of increasing HDL in the treatment of patients with cardiovascular disease.