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Published on: October 12, 2017
Emerging importance of HDL cholesterol in developing high-risk coronary plaques in acute coronary syndromes
Juan F Viles-Gonzalez1, Valentin Fuster, Roberto Corti
1Cardiovascular Biology Research Laboratory, Zena and Michael A Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York 10029, USA.
Insights
High-density lipoprotein cholesterol (HDL-C) is crucial for preventing cardiovascular disease. Strategies to increase HDL-C are vital, as statins alone do not fully prevent coronary events.
Area of Science:
- Cardiology
- Biochemistry
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) is a leading cause of death globally.
- Hyperlipidemia, characterized by elevated LDL-C and triglycerides with low HDL-C, is a major CVD risk factor.
- Statins effectively lower LDL-C but have limited impact on HDL-C and triglycerides, leaving residual risk for coronary events.
Purpose of the Study:
- To review the evidence supporting high-density lipoprotein cholesterol (HDL-C) as a protective factor against coronary artery disease (CAD).
- To explore the multifaceted mechanisms by which HDL-C exerts its cardioprotective effects.
- To discuss current and emerging strategies for increasing HDL-C levels.
Main Methods:
- Review of experimental and clinical studies on HDL-C and cardiovascular disease.
- Analysis of data from clinical trials investigating statin efficacy and residual cardiovascular risk.
- Examination of National Cholesterol Education Program guidelines regarding lipid management.
Main Results:
- Low HDL-C levels (<40 mg/dL in men, <45 mg/dL in women) are independently associated with increased cardiovascular events.
- Despite significant LDL-C reduction (35%) with statins, 60-70% of coronary events persist.
- HDL-C plays a protective role through reverse cholesterol transport, antioxidant properties, and inhibition of endothelial dysfunction, monocyte homing, apoptosis, platelet activation, and factor X activation.
Conclusions:
- Increasing HDL-C is a critical therapeutic target for reducing residual cardiovascular risk.
- HDL-C's protective mechanisms extend beyond cholesterol transport, highlighting its comprehensive role in cardiovascular health.
- Further research and clinical strategies are needed to effectively raise HDL-C and mitigate cardiovascular events.
Abstract:
Cardiovascular disease is the principal cause of death in industrialized countries. Hyperlipidemia, with high low-density lipoprotein cholesterol and triglycerides, and low high-density lipoprotein cholesterol levels (<40 mg/dL in men and <45 mg/dL in women), is a known major cardiovascular risk factor. Statins are considered the most potent and effective agents to reduce low-density lipoprotein cholesterol, but they have a variable effect on high-density lipoprotein cholesterol and triglycerides. Different clinical trials with statins have shown a decrease in low-density lipoprotein cholesterol by 35% and a reduction of the incidence of coronary events by as much as 30%. However, 60 to 70% of events still occur, despite remarkable reduction of low-density lipoprotein cholesterol concentration. Recent National Cholesterol Education Program guidelines highlighted the importance of high-density lipoprotein cholesterol concentration in the prevention and treatment of cardiovascular disease. High-density lipoprotein cholesterol is considered an independent risk factor and has an inverse relation with coronary events. The association of low levels of high-density lipoprotein cholesterol with an increased incidence of cardiovascular events implies a critical role of high-density lipoprotein in the protection against atherosclerotic disease and in the progression of coronary atherosclerotic disease. High-density lipoprotein cholesterol appears to exert this protective effect through multiple mechanisms. High-density lipoprotein is not only involved in reverse cholesterol transport, but also prevents endothelial dysfunction; inhibits the homing of monocytes, apoptosis, platelet activation, and factor X activation; and has antioxidant properties. In this article the authors review the available experimental and clinical evidence supporting the importance of high-density lipoprotein cholesterol as a protective factor in coronary artery disease, and the strategies developed to increase high-density lipoprotein cholesterol.
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