HDL Deficiency, Atherosclerosis, and Stimulation of HDL Synthesis: Role of Gemfibrozil

Abstract

The accretion of cholesterol in tissues (e.g., the arterial wall) is influenced by (a) the deposition of atherogenic lipoproteins, e.g., low density lipoproteins (LDL) and (b) removal by reverse cholesterol transport, a process mediated by HDL. The process of atherosclerosis may thus be retarded or reversed by (a) lowering plasma concentrations of atherogenic lipoproteins and/or (b) stimulating reverse cholesterol transport. During the last few decades clinical as well as basic experimental evidence has been obtained to indicate that decreasing plasma levels of atherogenic lipoproteins, especially low density lipoproteins, is unequivocally associated with decreased risk for coronary heart disease. The results of the Coronary Primary Prevention Trial (1,2) attest to the value of lowering LDL cholesterol in the prevention of coronary disease in man. More recent studies have also shown that lowering atherogenic lipoproteins (while raising HDL) can also result in lack of progression of coronary lesions (3).