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HDL-targeted therapies: progress, failures and future
Abstract
Since the discovery in the 1970s that plasma levels of high-density lipoprotein cholesterol (HDL-C) are inversely associated with cardiovascular outcome, it has been postulated that HDL is anti-atherogenic and that increasing HDL-C levels is a promising therapeutic strategy. However, the recent failure of three orally active, HDL-C-raising agents has introduced considerable controversy, prompting the question of whether increasing the cholesterol cargo of HDL in a non-selective manner is an effective pharmacological approach for the translation of its atheroprotective and vasculoprotective activities. The interrelationships between HDL-C concentration, HDL particle number and levels of diverse HDL particle subpopulations of defined composition are complex, as are their relationships with reverse cholesterol transport and other anti-atherogenic functions. Such complexity highlights the incompleteness of our understanding of the biology of HDL particles. This article examines the HDL hypothesis in molecular and mechanistic terms, focusing on features that have been addressed, those that remain to be tested, and potential new targets for future pharmacological interventions.
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“whereas results from studies on treatment that increase HDL-cholesterol levels have so far been disappointing (41)”
From Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials (2016) · cites this paper as [41]
In the citing paper
“Both in vitro and in vivo, these approaches can achieve a transient acceleration of RCT, sometimes without causing any significant change in HDL-C.”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [111]
In the citing paper
“Recent approaches primarily aim to optimise the function of HDL in RCT [110, 111].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [111]
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Metadata
- Authors
- Kingwell, B. A., Chapman, M. J., Kontush, A., & Miller, N. E.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Inserm (FR)
- University of Oxford (GB)
- Corresponding author
- Kingwell, Bronwyn A.
- Venue
- Nature Reviews Drug Discovery
- Published
- 2014-05-23
- Volume
- 13
- Issue
- 6
- Pages
- 445-464
- ISSN
- 1474-1776 (ISSN-L)
- 1474-1784
- OpenAlex
- W1993577107
- Cited by
- 354
- References
- 228
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 9 · 2023: 28 · 2022: 22 · 2021: 21 · 2020: 22 · 2019: 33 · 2018: 33 · 2017: 43 · 2016: 53 · 2015: 51 · 2014: 12
- FWCI
- 10.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Drug Discovery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Keywords
- HDL cholesterol, HDL-targeted therapy, HDL particle number, reverse cholesterol transport, atheroprotection, cardiovascular disease, clinical trial failure
- MeSH terms
- Animals, Hypolipidemic Agents, Cardiovascular Diseases, Clinical Trials as Topic, Humans, Phosphatidylcholine-Sterol O-Acyltransferase, Lipoproteins, HDL, Models, Biological, Niacin, Recombinant Proteins, Drugs, Investigational, Up-Regulation, Apolipoprotein A-I, Cholesterol Ester Transfer Proteins, Molecular Targeted Therapy
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