A shot of good cholesterol: synthetic HDL, a new intervention for atherosclerosis

One of the American Heart Association's Top 10 Research Advances for the Treatment of Heart Disease is the use of a synthetic form of high-density lipoprotein (HDL) to reduce coronary atherosclerosis (JAMA. 2003;290:2292-2300). While HDL has not been a target for therapy for dyslipidemias, new insight into the major protein component of HDL, apolipoprotein A-I, may lead to new therapies. Apolipoprotein A-I was recently found to be a better predictor of cardiovascular events than is low-density lipoprotein (Am Heart J. 2003;146:227-233; J Intern Med. 2004;255:188-205). This article reviews the recent study by Nissen and colleagues describing the finding of a genetic mutation in HDL in some persons in Italy and the subsequent development of a synthetic form of HDL to be used as an infusion to successfully target atherosclerotic lesions (JAMA. 2003;290:2292-2300). In addition, controversies related to HDL cholesterol as a target for therapy are reviewed. Implications for nursing research, education, and practice are also described.