High-density lipoprotein cholesterol in the cardiovascular equation: does the "good" still count?

Area of Science:

• Cardiovascular Medicine
• Lipidology
• Pharmacology

Background:

• Low high-density lipoprotein cholesterol (HDL-C) is a well-established, independent risk factor for coronary heart disease (CHD).
• Clinical and experimental data support the protective role of HDL-C and plausible biological mechanisms.
• The relevance of HDL-C in patients undergoing statin therapy requires continued investigation.

Purpose of the Study:

• To evaluate the continued significance of HDL-C in cardiovascular risk stratification during the statin era.
• To assess the relationship between HDL-C levels and CHD risk in patients treated with statins.
• To review the current evidence and guidelines regarding HDL-C as a therapeutic target.

Main Methods:

• Review of epidemiologic, clinical, and experimental data.
• Analysis of large statin trial data.
• Examination of recent cardiovascular guidelines.

Main Results:

• Epidemiologic data consistently show low HDL-C as an independent CHD risk factor.
• Interventions raising HDL-C correlate with reduced CHD risk.
• The association between HDL-C and CHD risk persists in statin-treated patients.
• HDL-C levels are relevant at baseline and in response to statin therapy.

Conclusions:

• HDL-C remains a significant independent predictor of cardiovascular disease, even with statin use.
• Current guidelines recognize low HDL-C as a target for intervention in high-risk individuals.
• Novel HDL-targeting therapies show promise but require further long-term evaluation.