The news that torcetrapib, Pfizer's HDL-increasing CETP drug, slightly increases blood pressure is highly problematic for the world's largest pharmaceutical company. Torcetrapib was supposed to compensate for a string of patent expirations in the next few years (Zoloft, Zyrtec, Norvasc and Aricept – and Lipitor in 2011). But it is also extremely bad news for other companies developing CETP drugs -- particularly Roche. Several questions: what are the regulatory hurdles posed today by this kind of problem? Are the traditional lipid targets overplayed--and should companies be focusing on the less obvious targets in atherosclerosis, like inflammation or vulnerable plaque?