How are low HDL cholesterol (hypoalphalipoproteinemia) variants treated?

Updated: May 21, 2021
  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: George T Griffing, MD  more...
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Apo A-I Milano, an apo A-I variant identified in a rural Italian population, is associated with cardioprotection due to its "super-HDL" properties. Individuals possessing apo Milano were found to have very low levels of HDL and yet, as a group, had a very low prevalence of atherosclerotic disease because most of their HDL was apo A-I Milano.

In a study, ETC-216, a recombinant form of apo A-I Milano–phospholipid complex, was found to be effective in reducing coronary atheroma volume as measured by intravascular ultrasonography. The investigation showed that the atherosclerosis in the coronary vessel wall could be modified in a much shorter time than anticipated, ie, within 5-6 weeks. [43, 44, 45]

An apo A-I mimetic peptide under development, D-4F, is targeted not at raising HDL but at changing pro-inflammatory HDL into anti-inflammatory HDL in high-risk patients.

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