Background: Low-density lipoprotein cholesterol (LDL), and especially its oxidized
form, renders the atherosclerotic plaque vulnerable to rupture in acute coronary syndromes (ACS).
On the other hand, high-density lipoprotein (HDL) is considered an anti-atherogenic molecule. The
more recent HDL-targeted drugs may prove to be superior to those used before. Indeed, delipidated
HDL and HDL mimetics are efficient in increasing HDL levels, while the apoA-I upregulation with
RVX-208 appears to offer a clinical benefit which is beyond the HDL related effects. HDL treatment
however has not shown a significant improvement in the outcomes of patients with ACS so far, studies
have therefore focused again on LDL. In addition to statins and ezetimibe, novel drugs such as
PSCK9 inhibitors and apolipoprotein B inhibitors appear to be both effective and safe for patients
Conclusion: Data suggest these could potentially improve the cardiovascular outcomes of patient
with ACS. Yet, there is still research to be done, in order to confirm whether ACS patients would
benefit from LDL- or HDL-targeted therapies or a combination of both.
Keywords: High-density lipoprotein, low-density lipoprotein, acute coronary syndromes, outcomes, atherosclerosis, lipidlowering
drugs, statins, ezetimibe.
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