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Breakthroughs in Atherosclerosis Treatment

New research may lead to new drugs for heart disease.
WebMD the Magazine - Feature

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 Americans.

“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.

New drugs for heart 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,” Nicholls says.

Anti-inflammatories for the heart

Still, researchers are cautiously hopeful because other experiments continue to show promise, he adds, including one in which researchers infused HDL preparations into people who had the disease and found that atherosclerosis regressed in artery walls in as little as four or five weeks. “I think that there’s clear evidence that if you directly give HDL, it’s a good thing,” Nicholls says. “But the complexity of HDL is that it may be that not all forms of HDL are protective. For that reason, it’s going to be about finding the right therapy that raises the right kind of HDL and has the best chance at reducing cardiac risk.”

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