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High-density Lipoprotein and Low-density Lipoprotein Therapeutic Approaches in Acute Coronary Syndromes

[ Vol. 13 , Issue. 3 ]

Author(s):

Emmanuel Androulakis, Effimia Zacharia, Nikolaos Papageorgiou, Eirini Lioudaki, Dimitris Bertsias, Marietta Charakida, Gerasimos Siasos and Dimitris Tousoulis   Pages 168 - 182 ( 15 )

Abstract:


Background: Low-density lipoprotein cholesterol (LDL), and especially its oxidized form, renders the atherosclerotic plaque vulnerable to rupture in acute coronary syndromes (ACS). On the other hand, high-density lipoprotein (HDL) is considered an anti-atherogenic molecule. The more recent HDL-targeted drugs may prove to be superior to those used before. Indeed, delipidated HDL and HDL mimetics are efficient in increasing HDL levels, while the apoA-I upregulation with RVX-208 appears to offer a clinical benefit which is beyond the HDL related effects. HDL treatment however has not shown a significant improvement in the outcomes of patients with ACS so far, studies have therefore focused again on LDL. In addition to statins and ezetimibe, novel drugs such as PSCK9 inhibitors and apolipoprotein B inhibitors appear to be both effective and safe for patients with hyperlipidemia.

Conclusion: Data suggest these could potentially improve the cardiovascular outcomes of patient with ACS. Yet, there is still research to be done, in order to confirm whether ACS patients would benefit from LDL- or HDL-targeted therapies or a combination of both.

Keywords:

High-density lipoprotein, low-density lipoprotein, acute coronary syndromes, outcomes, atherosclerosis, lipidlowering drugs, statins, ezetimibe.

Affiliation:

St George's University Hospital, London, 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens,, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, EC1A 7BE, London, Epsom and St Helier University Hospitals, London, 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Department of Cardiovascular Imaging, King's College London, 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens, 1st Department of Cardiology, Hippokration Hospital, University of Athens, Athens

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