The potential role of HDL- and LDL-cholesterol modulation in atheromatous plaque development.

Research into the management of dyslipidaemia has increasingly focussed on the importance of high-density lipoprotein cholesterol (HDL-C) levels. It is well known that low levels of HDL are associated with an increased risk of cardiovascular events. Recent data have highlighted the anti-atherogenic actions of HDL such as anti-inflammatory, anti-oxidative activities, and of course, reverse cholesterol transport. This latter observation may explain certain effects on atherosclerotic plaques, in particular the observation that plaque regression can occur when treatments augment HDL-C levels. This review will outline the beneficial effects of HDL, along with the detrimental effects of other lipoproteins involved in atherosclerotic processes. This manuscript will also describe the therapeutic effects of nicotinic acid, a treatment that raises HDL-C levels. Studies show that using nicotinic acid as a monotherapy or in combination with other agents halts plaque progression and translates as a significant reduction in cardiovascular events.