doiSerbia

Treatment of low HDL-cholesterol levels in the reduction of cardiovascular risk

Stokić Edita (Klinički centar 'Novi Sad', Institut za interne bolesti, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Novi Sad)
Marinkov Jela (Klinički centar 'Novi Sad', Institut za interne bolesti, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Novi Sad)

Introduction. Although reduction of LDL-C levels is a priority in the treatment of dyslipidemia, not all coronary events are prevented despite aggressive LDL-C lowering, and risk reduction can be improved by treating additional lipid abnormalities. The Framingham Study was the first to demonstrate the inverse relationship between HDL-C and risk of coronary heart disease (CHD). This relationship was present at all levels of LDL-C, whereas the highest risk was associated with low HDL-C and high LDL-C. The antiatherogenic actions of HDL-cholesterol. The antiatherogenic actions of HDL-C are complex. HDL-C plays a major role in reverse cholesterol transport, mobilizing cholesterol from the periphery to the liver. In addition, cardioprotective effects of HDL-C include endothelial protection, anti-inflammatory activity, as well as antioxidant and antithrombotic effects. Treatment of low HDL cholesterol. In addition to lowering LDL-C, statins increase HDL-C by 5 to 15% by increasing apolipoprotein A-I synthesis. Fibrate therapy results in an increase in HDL-C of 10 to 25 % by activating PPAR-, which stimulates hepatic apolipoprotein A-I gene expression. Niacin is the most effective agent used for increasing HDL-C, causing increase of 15 to 35%. The side effects of niacin therapy, which is largely mediated by prostaglandins, may be minimized by the use of prolonged-release formulation of nicotinic acid. Combination therapy with HDL-raising agents, such as nicotinic acid and statin, markedly increases HDL-C, lowers LDL-C and improves the lipoproteins subclass distribution. Conclusion. New therapeutic modalities in the treatment of low HDL-C and lowering LDL-C, either in combination or as a monotherapy, may provide additional benefits in reducing CHD risk. .

Keywords: lipoproteins, HDL cholesterol, cardiovascular diseases, antilipidemic agents, lipoproteins, LDL