High-Density Lipoprotein and Coronary Heart Disease: Current and Future Therapies

Coronary heart disease remains a major cause of worldwide morbidity and mortality despite therapeutic advances that control many risk factors such as low-density lipoprotein cholesterol to levels lower than previously possible. Population studies have consistently demonstrated an inverse association between high-density lipoprotein cholesterol (HDL-C) levels with the risk of coronary heart disease. As a result, HDL-C is gaining increasing interest as a therapeutic target. In this review, we explore the protective mechanisms of HDL and how current and future therapies harness these beneficial properties. We offer a biological framework to understand treatment strategies as well as their resultant successes and failures to guide management and future directions. At present, raising HDL-C level holds great promise, on the basis of epidemiology and initial trials, but we await the outcomes of the many large clinical outcomes trials currently under way to define the clinical role of older and novel therapies to raise HDL-C level.