A drug raises HDL particle number by 30% but simultaneously inhibits the hepatic enzyme that converts cholesterol to bile acids, reducing bile secretion. Evaluate the likely net effect on arterial plaque progression.

• A. Net effect will be a dramatic increase in bile production and plaque removal because HDL directly converts cholesterol to bile in circulation.
• B. Net effect will be strongly protective because raising HDL particle number alone always guarantees plaque regression irrespective of hepatic processing.
• C. Net effect will be an immediate reduction in blood pressure and complete elimination of atherosclerotic risk unrelated to cholesterol handling.
• D. Net effect may be limited or unfavorable: although more HDL picks up cholesterol, impaired hepatic conversion to bile reduces excretion, which could blunt or reverse the benefit on plaque regression.

Answer: (D)