Prevention and Treatment of Atherosclerotic Vascular Disease: Hypolipidemic Agents

Abstract

While the quality and quantity of lipids and lipoproteins provide a window on cardiovascular health, in some cases, they are also therapeutic targets that when treated can reduce or reverse the underlying cause of most cardiovascular disease (CVD), including atherosclerosis. We summarize in this chapter the current strategies and attendant mechanisms for reducing CVD risk. Clearly, for most patients, CVD risk can be reduced by the statin class of hypocholesterolemic drugs. However, even after receiving statin therapy, there is residual CVD risk for which current therapies are inadequate. In this context, we discuss the now unsupported “higher HDL-C concentration is better” approach, the reasons for its failure, possible new approaches that will reduce residual CVD risk, and the molecular mechanisms that give rise to a major CVD risk factor, metabolic syndrome in atherogenesis. We also describe the mechanisms and attendant CVD targets of the major classes of lipid-lowering drugs—statins, fibrates, niacin, bile acid sequestrants, ezetimibe, and n-3 fatty acids.