High-Density Lipoprotein Cholesterol, Triglycerides, and Coronary Artery Disease

Abstract

Epidemiological studies have identified high-density lipoproteins (HDLs) and triglycerides (TGs) as independent risk factors that modulate cardiovascular disease (CVD) risk (1). During the past decade, clinical trials of low-density lipoprotein (LDL)-lowering drugs have clearly established that reductions in LDL are associated with a 30 to 45% reduction in clinical events. However, despite lowered LDL levels, many patients continue to have cardiac events. This implies that a greater improvement could be achieved through further interventional measures, including therapy that modifies lipids other than LDL. Indeed, low HDL and high TG levels are often present in high-risk patients with CVD. In fact, a low level of HDL-cholesterol (C), rather than a high level of LDL-C, is currently the most common lipid abnormality in patients with coronary artery disease (CAD) in the United States. As a result, a great deal of research interest recently has been focused on raising plasma HDL levels as well as lowering TG levels by dietary, pharmacological, or genetic manipulations, as a potential strategy for the treatment of CVD. In addition to epidemiological studies, other lines of evidence suggest that modifying HDL and TG levels would reduce the risk of CVD.