Background: Low HDL cholesterol is a risk factor for development of atherosclerotic disease. The possibility of increasing HDL cholesterol levels to prevent cardiovascular disease is an issue of great interest.
Material and methods: Literature was retrieved from Pubmed and Embase and relevant literature and reference lists were reviewed.
Results: Physical exercise, smoking cessation, weight control and moderate alcohol intake has been shown to increase HDL cholesterol levels. Of today's available drugs, Niacin has the greatest HDL cholesterol-enhancing effect, but clinical effects have not been adequately documented. Fibrates increase HDL cholesterol, but it has not been documented that this results in clinical benefit. Statins increase HDL cholesterol moderately, but it is not clear whether such increase has been crucial for the reduction of cardiovascular events in the large statin trials. Combinations of various lipid-lowering agents can increase HDL cholesterol additively, but clinical benefit has not been proven. Inhibition of cholesterol ester transfer protein with torcetrapib raised HDL cholesterol markedly, but increased the risk of death and cardiovascular events. Infusion of a apolipoprotein A-I Milano/phospholipid complex was associated with regression of coronary atherosclerosis. New HDL-modifying therapies are under investigation.
Interpretation: HDL cholesterol can be used for assessment of cardiovascular risk, but it has not been documented that drug-induced enhancement of HDL cholesterol can reduce the occurrence of cardiovascular events.