Cor Vasa 2003, 44(3):141-144
HDL-cholesterol as the therapeutic goal
- Dom srdca, Martin, Slovenská republika
The aim of the review is to highlight the high efficacy of therapeutic modulation of low HDL-cholesterol (HDL-C) levels in patients at risk for developing clinical complications of atherosclerosis, and to present new concepts in this field. By definition, therapy includes both drug therapy and lifestyle intervention.
Low HDL-C levels are currently the main risk factors for coronary heart disease (CHD). They have an adverse effect both on the prevalence and prognosis of CHD, independently of and across all LDL-levels. The beneficial effects of therapy in patients with low HDL-C levels have been shown mainly in what is referred to as fibrate trials. However, the efficacy was related to clinical manifestations and/or angiographic markers whereas evidence of effects on overall mortality was not available. Recently, the results of subanalyses of some studies have been published, which show a beneficial effect not only on cardiovascular but, also, overall mortality in subpopulations of patients with hyperinsulinemia and type-2 diabetes. In addition, fibrates have been shown to reduce the incidence of cardiovascular events in patients with abdominal obesity, low HDL-C levels, and hyperinsulinemia as well as type-2 diabetes (i. e., in metabolic syndrome patients).
The paper includes data on the prevalence of the metabolic syndrome, a review of the causes of low HDL-C levels, mechanisms resulting in decreased HDL-C levels, protective properties of HDL-C, and the therapeutic options available to patients with low HDL-C levels. The effects of diet composition, the "training" nature of exercise are discussed. The section on fibrate therapy also discusses the mechanisms leading to increased HDL-C levels.
Keywords: Fibrates; HDL-cholesterol; Metabolic syndrome
Published: March 1, 2003 Show citation