The Science of HDL Therapy
Over the past two decades, there has been an intense focus on the lowering of low-density lipoproteins (LDL) cholesterol for the treatment of atherosclerotic cardiovascular disease (CVD). Nonetheless, and despite the great progress that was made in development of LDL-lowering drugs, there continues to be significant mortality and morbidity as a result of atherosclerosis.
The best clinical outcomes from LDL therapy only reduce cardiovascular events by 25-35%. There is a tremendous unmet need for therapies which can move beyond the focus on LDL reduction alone.
HDL and Reverse Lipid Transport (RLT)
A high LDL-to-HDL cholesterol ratio leads to the build up of lipid-rich plaques in the arterial walls. These plaques are highly vulnerable to rupture, leading to myocardial infarction or stroke. Conversely, researchers believe that regression of such plaques would have a major impact on reducing the risk of such acute coronary events.
HDL therapies are designed to increase or enhance HDL for the regression of atherosclerosis through the stimulation of the RLT system and increase cholesterol removal from vulnerable arterial plaques. HDL elevating therapies such as niacin can be combined with other lipid therapies, such as statin drugs, to further reduce the risk of cardiovascular events.
However, while efficacious, niacin therapies also causes significant side effects including, facial flushing along with burning and itching, that leads to patient non-compliance. Any therapies that elevate levels of HDL or act as HDL mimetics, without the side effects, have significant potential to treat CVD.