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2017 ; 106
(9
): 663-675
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HDL cholesterol: reappraisal of its clinical relevance
#MMPMID28342064
März W
; Kleber ME
; Scharnagl H
; Speer T
; Zewinger S
; Ritsch A
; Parhofer KG
; von Eckardstein A
; Landmesser U
; Laufs U
Clin Res Cardiol
2017[Sep]; 106
(9
): 663-675
PMID28342064
show ga
BACKGROUND: While several lines of evidence prove that elevated concentrations of
low-density lipoproteins (LDL) causally contribute to the development of
atherosclerosis and its clinical consequences, high-density lipoproteins are
still widely believed to exert atheroprotective effects. Hence, HDL cholesterol
(HDL-C) is in general still considered as "good cholesterol". Recent research,
however, suggests that this might not always be the case and that a fundamental
reassessment of the clinical significance of HDL-C is warranted. METHOD: This
review article is based on a selective literature review. RESULTS: In individuals
without a history of cardiovascular events, low concentrations of HDL-C are
inversely associated with the risk of future cardiovascular events. This
relationship may, however, not apply to patients with metabolic disorders or
manifest cardiovascular disease. The classical function of HDL is to mobilise
cholesterol from extrahepatic tissues for delivery to the liver for excretion.
These roles in cholesterol metabolism as well as many other biological functions
of HDL particles are dependent on the number as well as protein and lipid
composition of HDL particles. They are poorly reflected by the HDL-C
concentration. HDL can even exert negative vascular effects, if its composition
is pathologically altered. High serum HDL-C is therefore no longer regarded
protective. In line with this, recent pharmacological approaches to raise HDL-C
concentration have not been able to show reductions of cardiovascular outcomes.
CONCLUSION: In contrast to LDL cholesterol (LDL-C), HDL-C correlates with
cardiovascular risk only in healthy individuals. The calculation of the ratio of
LDL-C to HDL-C is not useful for all patients. Low HDL-C should prompt
examination of additional metabolic and inflammatory pathologies. An increase in
HDL-C through lifestyle change (smoking cessation, physical exercise) has
positive effects and is recommended. However, HDL-C is currently not a valid
target for drug therapy.
|Animals
[MESH]
|Atherosclerosis/etiology/*prevention & control
[MESH]
|Cardiovascular Diseases/etiology/prevention & control
[MESH]
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