By what mechanism does HDL reduce plaque formation? Is the pharmaceutical industry working on medications that will raise HDL?
—Chagai Dubrawsky, MD, Houston
The anti-atherogenic effect of HDL may involve reversal of LDL transport, inhibition of lipoprotein oxidation, and anti-inflammatory endothelial activity, all of which can turn lipid-rich plaques into more stable fibrotic lesions as demonstrated in a Norwegian study (Circulation. 2005;112:498-504). Attempts at finding drugs that raise HDL (besides niacin) so far have not proven successful. Torcetrapib, widely heralded as the new wonder drug in this regard (J Am Coll Cardiol. 2006;48:1774-1781), has failed to receive FDA approval.
—Peter F. Cohn, MD (115-25)
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