LIPOPROTEIN CLASSES AND CORONARY-DISEASE REGRESSION

Lowering LDL cholesterol (LDL-C) levels to reduce or prevent coronary artery disease (CAD) progression and cardiac events in hypercholestero lemic subjects is now widely accepted. The clinical benefit of lowerin g LDL-C has recently been extended to individuals with normal or mildl y elevated LDL-C. Recent analyses of large primary and secondary CAD p revention trials, however, clearly demonstrated that reducing LDL-C le vels does not entirely account for the coronary event reduction associ ated with lipid-lowering therapy. Growing and compelling evidence is e merging on the role of triglyceride-rich lipoproteins (VLDL and IDL), high density lipoproteins (HDL), and small, dense LDL, as well as non lipid risk factors, in the regression or stabilization of atherosclero tic plaques of mild/moderate severity, which are associated with clini cal cardiac events. Enzymes involved in the tight metabolic interrelat ionship between triglyceride-rich lipoproteins, small, dense LDL and H DL levels may represent potential therapeutic targets for CAD preventi on by favourably altering lipoprotein composition and physical propert ies in addition to the current therapeutic focus on lipoprotein levels . Curr Opin Lipidol 9:329-336. (C) 1998 Lippincott Raven-Publishers.