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Low high-density lipoprotein cholesterol disorders and cardiovascular risk: contribution of associated low-density
1Preventive Cardiology Center, Northwestern University, The Feinberg School of Medicine, Galter Pavilion 11-120, 201 East Huron Street, Chicago, IL 60611, USA. r-rosenson@northwestern.edu
Insights
Low high-density lipoprotein cholesterol is linked to increased cardiovascular risk due to abnormal low-density lipoprotein (LDL) subclasses. Elevated LDL particle numbers, particularly small, cholesterol-depleted LDL, signify higher risk for atherosclerotic vascular disease.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Atherosclerosis Research
Background:
- Low high-density lipoprotein cholesterol (HDL-C) is prevalent in patients with premature cardiovascular disease (CVD).
- Low HDL-C often coexists with other dyslipidemias, complicating risk assessment.
Purpose of the Study:
- To examine the role of low-density lipoprotein (LDL) subclass abnormalities in cardiovascular risk.
- To understand the contribution of LDL subclasses in individuals with low HDL-C levels.
Main Methods:
- Analysis of data from the Framingham Offspring Study.
- Assessment of LDL particle number and size in relation to HDL-C levels.
Main Results:
- Individuals with low HDL-C (≤1.0 mmol/L) exhibited higher LDL particle numbers than predicted by LDL-C levels alone.
- An excess of small, cholesterol-depleted LDL particles was observed in this cohort.
- Elevated LDL particle numbers are a strong indicator of risk for atherosclerotic vascular disease and CVD events.
Conclusions:
- High LDL particle levels are a significant predictor of cardiovascular events.
- Therapeutic strategies for low HDL-C must consider the impact of LDL particle abnormalities and interactions.
Purpose Of Review:
Discuss the contribution of low-density lipoprotein subclass abnormalities to cardiovascular risk among individuals with low high-density lipoprotein cholesterol levels.
Recent Findings:
Low high-density lipoprotein cholesterol levels are commonly encountered among patients with early onset cardiovascular disease. Most often, a low high-density lipoprotein cholesterol level is not an isolated abnormality, but it is usually associated with a number of other lipoprotein abnormalities. Data from the Framingham Offspring Study demonstrate that among subjects with high-density lipoprotein cholesterol, 1.0 mmol/L (39 mg/dL), low-density lipoprotein particle numbers were considerably higher than indicated by the level of low-density lipoprotein cholesterol because these subjects had excess numbers of small cholesterol-depleted low-density lipoprotein particles. Elevated numbers of low-density lipoprotein particles identify individuals at highest risk for atherosclerotic vascular disease and cardiovascular events.
Summary:
As high levels of low-density lipoprotein particles are a robust predictor of cardiovascular events, strategies targeted at raising low levels of high-density lipoprotein cholesterol must account for low-density lipoprotein particle interactions.
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