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(Circulation. 2008;118:1120-1122.)
© 2008 American Heart Association, Inc.

Editorial

Inhibition of Lipoprotein-Associated Phospholipase Activity by Darapladib

Shifting Gears in Cardiovascular Drug Development: Are Antiinflammatory Drugs the Next Frontier?

S. Matthijs Boekholdt, MD, PhD; Robbert J. de Winter, MD, PhD; John J.P. Kastelein, MD, PhD

From the Departments of Vascular Medicine (S.M.B., J.J.P.K.) and Cardiology (S.M.B., R.J.d.W.), Academic Medical Center, Amsterdam, the Netherlands.

Correspondence to John J.P. Kastelein, MD, PhD, Professor of Medicine, Chairman, Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room F4-159.2, 1105 AZ Amsterdam, Netherlands. E-mail j.j.kastelein@amc.uva.nl or j.s.jansen@amc.uva.nl

Key Words: Editorials • atherosclerosis • drugs • inflammation • lipids

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Over the past 3 decades, we have witnessed in the Western world a remarkable reduction in morbidity and mortality resulting from coronary heart disease (CHD). For example, in Finland, the dramatic decrease in CHD mortality is estimated to be 50%, at least one third of which can be accredited to a reduction in cholesterol levels in the general population.¹ An even more impressive reduction in the incidence of cardiovascular events has been observed among patients with prevalent CHD, as can be deduced from a comparison between the control arm of one of the earliest statin trials, the Scandinavian Simvastatin Survival Study (4S),² and the aggressive lipid-lowering arm of one of the latest intervention trials, the Treating to New Targets (TNT) study.³ Major cardiovascular events occurred in 36.2% of patients in the placebo arm of 4S and in 8.7% of patients in the intensive lipid-lowering arm of TNT, an astounding 76% relative risk reduction that occurred in the last 15 years. Among patients with type 2 diabetes, another highly prevalent and high-risk population, a similarly impressive risk reduction was achieved with an intensified multifactorial intervention.⁴ However, a cursory glance at the event rates in the experimental arms of these trials alerts us to the fact that even under current state-of-the-art treatment, cardiovascular events are still common. This leaves us with a large and unmet medical need to develop new strategies to combat atherosclerotic vascular disease, and this quest often starts with the identification of novel cardiovascular risk factors as potential targets. . . . [Full Text of this Article]

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