In the battle against atherosclerosis, the stakes remain high. Scientists
have made exciting medical advances, but the disease persists as a leading
cause of illness and death in the United States. This year alone,
atherosclerosis will contribute to about 1.2 million heart attacks among
“While we have very good therapies and tests to identify the disease and
predict the risk, none of them is perfect,” says Stephen Nicholls, MBBS
(bachelor of medicine/surgery), PhD, clinical director of The Cleveland Clinic
Center for Cardiovascular Diagnostics and Prevention. “We need better tools and
better therapies to have a greater effect on preventing heart disease.”
Scientists are striving continually to improve their understanding of how
atherosclerosis develops as well as the role of risk factors. Researchers hope
that, as a result, new therapies will emerge.
Atherosclerosis involves inflammation and buildup of fatty plaques, or
atheromas, within vessel walls, which eventually lead to the hardening and
narrowing of the arteries. When an atheroma ruptures, a blood clot can form to
trigger a heart attack or stroke.
Because development of atherosclerosis in the body is a complex process,
researchers are laboring on many fronts to find new ways to understand and
treat this serious disease.
Statin drugs, first on the market in 1987, offered a breakthrough in
atherosclerosis by working to lower LDL “bad” cholesterol and raise HDL “good”
cholesterol. Scientists are now testing other potential therapies -- for
example, novel ways to increase levels of protective HDL or new drugs that
target the inflammation in artery walls.
One area of intense interest: boosting HDL cholesterol’s role as an ally
against heart disease, Nicholls says. However, the failure and increased
mortality rates of one HDL-raising trial drug, torcetrapib, in 2006 highlights
the challenges of discovering the right therapy. “It has raised concerns that
maybe it’s not raising the right kinds of HDL,” Nicholls says. While doctors
agree all forms of LDL are bad, “HDL is a much more complicated story,” he
says. HDL is called the “good cholesterol,” but in truth, HDL particles vary in
size and composition, and “we don’t know if all forms of HDL are good,”