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[Relations between HDL-cholesterol and cardiovascular diseases]
J Emmerich1, E Bruckert, F Delahaye
1Service de pathologie vasculaire, hôpital Broussais, Paris.
Insights
High-density lipoprotein cholesterol (HDL-C) inversely correlates with coronary risk. While genetic factors can cause low HDL-C, its complex role in preventing atherosclerosis is key.
Area of Science:
- Cardiovascular Epidemiology
- Lipid Metabolism
- Genetics
Context:
- Epidemiological studies consistently show an inverse relationship between high-density lipoprotein cholesterol (HDL-C) levels and coronary heart disease risk.
- This association is significant in both healthy individuals and those with prior vascular events.
- Genetic factors can lead to low HDL-C or hypoalphalipoproteinemia, highlighting the complexity of HDL metabolism.
Purpose:
- To review the epidemiological evidence linking HDL-C to coronary risk.
- To explore the mechanisms underlying HDL's protective role.
- To discuss the therapeutic implications for managing low HDL-C.
Summary:
- HDL-C is a strong inverse predictor of coronary risk across diverse populations.
- Key protective mechanisms include reverse cholesterol transport, antioxidant effects, and prostacyclin modulation.
- While rare genetic HDL deficiencies exist, not all are atherogenic, underscoring metabolic complexity.
Impact:
- Understanding HDL-C's role is crucial for cardiovascular risk assessment.
- Further research into HDL metabolism may reveal novel therapeutic targets.
- Management strategies for hypoalphalipoproteinemia remain debated, especially in isolated cases.
Abstract:
Many retrospective and prospective epidemiological studies have demonstrated an inverse relationship between HDL-cholesterol and coronary risk. The predictive value of HDL-cholesterol is observed both in asymptomatic subjects and those with a primary vascular event. Several genetic abnormalities may be responsible for low HDL cholesterol (under 100 mg/dl or 0.26 mmol/l) or for a less severe hypoalphalipoproteinaemia. Despite some very low values, these rare causes of HDL deficiency are not all atherogenic and serve to emphasize the complexity of HDL metabolism. The protective role of HDL is explained by a number of mechanisms such as their role in the reverse transport from the peripheral tissues to the liver, their anti-oxidant effect and the increase in prostacyclin levels. The correction of isolated hypoalphalipoproteinaemia by drugs is controversial, but associated hyperlipidaemic states would be an indication to use drugs which increase the HDl-cholesterol the most.