High-Density Lipoproteins and Cardiovascular Disease

In the search to develop new cardioprotective therapies, considerable interest has focussed on approaches for targeting the biological functions of high-density lipoproteins (HDL). This is based on data from population and animal studies demonstrating a potentially protective impact of HDL on cardiovascular risk. The findings of recent clinical trials of a range of therapeutic interventions aimed at promoting HDL have been disappointing and raise considerable uncertainty regarding the potential utility of this target. More recent evidence has highlighted the importance of HDL functionality, which may ultimately be important in terms of its association with cardiovascular risk. This has led to ongoing efforts to develop new risk markers and therapeutics focussing on HDL quality as opposed to quantity. The evidence supporting a protective role for HDL and findings of clinical trials of HDL-targeted therapies are reviewed here.