New Insights into the Potential of Obicetrapib, a Cholesteryl Ester Transfer Protein Inhibitor, to Reduce Vascular Contributions to Cognitive Impairment and Dementia

Alzheimer’s disease (AD) remains a leading cause of dementia worldwide, with complex pathophysiology involving amyloid deposition and tau pathology that precedes cognitive decline. Cardiovascular risk factors, including hypertension, type II diabetes, and dyslipidemia, are recognized as modifiable risk factors of AD, especially during midlife, underscoring the close interplay between AD and vascular contributions to cognitive impairment and dementia (VCID). Anti-amyloid immunotherapies offer potential for disease modification; however, they can transiently increase cerebral amyloid angiopathy (CAA), which may lead to serious and potentially fatal adverse effects known as amyloid-related imaging abnormalities (ARIA). These risks are particularly elevated in apolipoprotein E4 (APOE4) carriers, the major genetic risk factor for late-onset AD, underscoring the urgent need for improved safety measures and patient stratification strategies. Notably, the vascular pathways implicated in ARIA may overlap with mechanisms of amyloid clearance influenced by lipid metabolism. The objective of this study is to review how lipoproteins, including low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), influence amyloid clearance and vascular health, and discuss how cholesteryl ester transfer protein (CETP), a key regulator of lipoprotein exchange, has emerged as a potential therapeutic target in dementia. In addition to effectively lowering LDL-C and increasing HDL-C, the CETP inhibitor obicetrapib has recently shown promising results in slowing progression of a key AD biomarker, p-tau-217, over 12-month of treatment in patients with atherosclerotic cardiovascular disease, with more pronounced effects in APOE4 carriers. This minireview thus highlights the intersection of cardiovascular and neurodegenerative pathways and supports further exploration of lipid-modulating therapies in AD and VCID.