HDL-raising strategies in the treatment of coronary artery disease: perspectives from the Armed Forces Regression Study.

Journal Article (Review)

PURPOSE OF REVIEW: Even with the aggressive reduction of LDL-cholesterol, the risk of cardiovascular events in patients with coronary artery disease remains substantial. The Armed Forces Regression Study was a randomized, double-blind, placebo-controlled trial of combination drug therapy aimed at raising HDL-cholesterol in patients with angiographically evident coronary artery disease. Drug therapy ultimately resulted in regression of the angiographic lesions and a reduction in cardiovascular events. This review places the Armed Forces Regression Study within the context of other recent studies. RECENT FINDINGS: In the past few years a number of other important papers have further defined the important role HDL-cholesterol plays in the pathobiology of atherosclerosis. These studies have focused on three general areas: HDL-cholesterol metabolism and the reverse cholesterol transport pathway; novel therapeutic interventions and their effects on coronary artery disease as assessed through non-invasive imaging modalities; and finally a re-analysis of previous outcomes trials with established HDL-cholesterol modifying agents. SUMMARY: The results of the Armed Forces Regression Study fit nicely within the evolving paradigm of targeting HDL-cholesterol in patients at risk of cardiovascular events. The use of niacin and well-tolerated fibrates as an adjunct to statins or as primary therapy in patients intolerant of statins appears reasonable in patients with low levels of HDL-cholesterol and at high risk of cardiovascular events. The further development of novel therapeutic approaches, in addition to broadening our pharmacological armamentarium, should further advance our understanding of HDL-cholesterol.

Full Text

Duke Authors

Cited Authors

  • Krasuski, RA

Published Date

  • December 2005

Published In

Volume / Issue

  • 16 / 6

Start / End Page

  • 652 - 657

PubMed ID

  • 16276244

Electronic International Standard Serial Number (EISSN)

  • 1473-6535

International Standard Serial Number (ISSN)

  • 0957-9672

Digital Object Identifier (DOI)

  • 10.1097/01.mol.0000191503.39831.f3

Language

  • eng