<International Circulation>:You have given a presentation here at WCC on novel strategies for raising HDL. Could you tell us a little bit as to why it is important to raise HDL?

　　Dr Chapman: We are becoming aware of the fact that despite the success of statin therapy， which targets LDL， there are a number of other lipid risk factors and a number of other modifiable risk factors that we frequently do not address and if we do， we may be able to further decrease cardiovascular risk events in the future particularly in our very high- and high-risk patients. At the present time we have three groups of agents (niacin， fibrates and statins) which all， to some degree， frequently variable， raise levels of HDL-C. We have realized that when HDL-C is subnormal (i.e. below the 50th percentile and which occurs frequently around the world particularly in several major countries in the Asian region)， it not only is a strong risk factor， it is independent of other lipid risk factors. Recently we have also come to understand that it is not simply the quantity of HDL， but it is also the functionality of those particles that comes to bear on cardiovascular disease and cardiovascular risk. So with respect to HDL-C， we have come to realize over the last two to three years that the situation is rather more complex than previously thought. In addition to HDL there are other lipid risk factors that we don’t sufficiently address. One of those is lipoprotein (a)， which is largely genetically determined and for which the European Atherosclerosis Society has recently issued a consensus paper calling attention to the risk associated with elevated levels of lipoprotein (a) above 50mg/dl. We have also called attention to elevated levels of triglyceride-rich lipoproteins which equally may not be corrected in many high-risk patients when they are treated with a statin， as is classically the case now. So amongst triglycerides， lipoprotein (a) and HDL we see several new therapeutic approaches appearing and with respect to HDL-C， given the frequency around the world of low HDL in association with the atherogenic lipid triad (elevated triglyceride， moderate elevation of LDL with a preponderance of small dense LDL) we believe that that particular atherogenic dyslipidemia is a major public health problem and we are starting to see the emergence of new efficacious therapies for raising HDL and those therapies are currently being tested in a series of major prospective intervention trials around the world. 

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