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New Drug May Safely Boost 'Good' Cholesterol

Anacetrapib Doubles HDL, Lowers LDL, While Hitting Safety Goals

Statins Don't Help Everyone: Enter HDL Boosters

Although credited with making a substantial dent in heart disease, statin drugs that lower LDL cholesterol don’t help everyone: Some statin users have heart attacks anyway.

That’s why the search is on for drugs that boost levels of HDL cholesterol, which is thought to ferry cholesterol from the bloodstream to the liver, where it can be reprocessed.

Like its predecessor torcetrapib, anacetrapib blocks an enzyme called CETP that is responsible for transforming good cholesterol into bad cholesterol. If you inhibit this enzyme, HDL goes up and LDL goes down.

"There was a big black cloud when torcetrapib increased deaths and cardiovascular disease," Cannon says.

Doctors told WebMD at the time that the failure doesn't necessarily rule out the possibility that another drug in the class, with no evidence of toxicity, could possibly work.

And at least in this research, that appears to be the case.

Another CETP blocker called dalcetrapib is already in late-stage phase III testing, although studies to date suggest it does not appear to have the same impact on cholesterol as anacetrapib.

Anacetrapib Boosts HDL, Lowers LDL

The new study involved 1,623 patients with or at high risk for coronary heart disease and whose LDL was in the recommended range of 50 and 100 milligrams per deciliter (mg/dL) on statin therapy. They were given either anacetrapib or placebo daily for 18 months.

HDL cholesterol levels more than doubled by 24 weeks in those given anacetrapib, shooting up from an average of 41 mg/dL to 101 mg/dL.  In contrast, they trickled up in the placebo group, from 40 mg/dL to 46 mg/dL.

Among patients on anacetrapib, LDL levels dropped from an average of 81 mg/dL to 45 mg/dL. Among the placebo group, LDL levels only declined from 82 mg/dL to 77 mg/dL.

There were no changes in blood pressure or aldosterone levels -- problems that plagued torcetrapib -- compared with placebo. Aldosterone is a hormone produced in the adrenal gland that affects kidney function and blood pressure.

Although the study wasn't long enough or large enough to look at anacetrapib's effect on cardiovascular events, statistical analysis that "compares what we have to what we know gave us 94% confidence" that  it would not increase the risk of heart attacks, deaths from cardiovascular disease, strokes, or hospitalizations for unstable angina, he says.

Anacetrapib Cuts Need for Heart Procedures

Of note, Cannon says, is that substantially fewer people on the new drug needed to undergo bypass surgery or angioplasty to open up blocked arteries: 8 vs. 28 in the placebo group.

Although the numbers are small, the two-thirds reduction in such procedures is a hint that over time, the drug will decrease cardiovascular events, he says.

In the study, people were taken off anacetrapib if their LDL levels dropped below 25 mg/dL; this occurred in 142 (17%) of patients. "We don't know [if lowering LDL to such low levels will cause harm], so we played it safe," Cannon says.

Participants were about 63 years old on average; 23% were women; 17% were Asian, African-American or multiracial, and 15% were Hispanic. Just over half already had heart disease or had suffered a heart attack; the rest were at risk for heart disease.

The study was funded by Merck Research Laboratories, maker of anacetrapib.

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Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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