Effects of Reconstituted High-density Lipoprotein Infusions on Coronary Atherosclerosis

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Citation
US Cardiology, 2007;4(2):32-4

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Atherosclerotic cardiovascular disease is the result of a continuous and deleterious interaction between components of the vascular wall and the circulating blood. Circulating lipids and lipoproteins play a significant role in the initiation of fatty streaks and the subsequent progression to complex and vulnerable atherosclerotic plaques. The important role that circulating lipids play in altering the risk for cardiovascular disease has resulted in the development of strategies for altering these blood components through dietary changes, behavioral modifications, and pharmacological interventions. A greater understanding of the molecular relationships between lipid components and atherosclerosis initiation and progression has led to the identification of many effective medications to treat or prevent heart disease. These lipid-altering interventional strategies have resulted in a demonstrable decrease in the burden of atherosclerosis in individual patients, a decrease in the risk for subsequent cardiovascular morbidity and mortality, and a subsequent decrease in the overall societal burden of cardiovascular disease worldwide.1,2
While these therapies have proved effective for millions of patients, atherosclerotic cardiovascular disease is still a major contributor to global disease and disability. In fact, cardiovascular disease remains the primary cause of morbidity and mortality in developed and developing nations.3 Furthermore, the incidence of atherosclerotic cardiovascular disease is expected to remain high due to the increased proportion of elderly in the population, the rise of contributing conditions such as diabetes and obesity, and the trend toward decreased physical activity and increased caloric intake so prevalent in our society.
Therefore, strategies to decrease further the progression and burden of atherosclerosis remain necessary. The effect of high-density lipoprotein (HDL) levels on atherosclerotic disease has been an intriguing area of scientific evaluation. There is a strong inverse relationship between HDL cholesterol and risk of coronary heart disease, as demonstrated in several epidemiological studies.4,5 As a result, strategies to develop pharmacological interventions that confer protective effects on the circulatory system are important and relevant, and are actively being pursued by the scientific community. Efforts to raise HDL cholesterol levels have included the administration of oral agents that modify the lipid metabolic pathway in a manner that sustains HDL increases over time.6 Other strategies include short-term infusions of reconstituted HDL (rHDL), which utilizes native HDL biological properties.

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