Therapy and clinical trials; nicotinic acid in the management of atherosclerotic disease

摘要

Cardiovascular disease (GVD) is the leading cause of morbidity and mortality, accounting for up to 10 million deaths globally each year and is characterised by the development of atherosclerotic plaques resulting from endothelial damage. The inflammatory response thereby induced results in the recruitment and activation of macrophages into the intimal layer of the blood vessel, which absorb large amounts of oxidised low-density lipoprotein (LDL) heralding the onset of the cellular elements of a plaque. The major focus of drug development has been towards addressing the atherogenic triad characterised by raised small, dense low-density lipoprotein-cholesterol (sdLDL-C), elevated triglycerides and low high-density lipoprotein cholesterol (HDL-G). Statin therapy has revolutionised the management of cardiovascular risk and results in approximately a 21% relative risk reduction for every 1 mmol/l reduction in LDL-G. Despite significant reduction in LDL-C by statin treatment, there remains a significant residual risk of GVD events in these patients. One hypothesis is that a significant proportion of this residual risk can be attributed to low HDL-G levels.