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Published on: October 12, 2017

Beyond LDL-cholesterol: HDL-cholesterol as a target for atherosclerosis prevention

K G Parhofer1

  • 1Department of Internal Medicine II, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany. Klaus.Parhofer@med.uni-muenchen.de

Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [And] German Diabetes Association
|September 10, 2005
PubMed

Insights

Dyslipoproteinemias, like high LDL-cholesterol and low HDL-cholesterol, are key to atherosclerosis. While LDL reduction is primary, optimizing all lipid parameters, including HDL, may benefit many patients.

Area of Science:

  • Cardiovascular Medicine
  • Lipid Metabolism
  • Atherosclerosis Research

Background:

  • Dyslipoproteinemias, including elevated LDL-cholesterol, reduced HDL-cholesterol, elevated triglycerides, and elevated lipoprotein(a), are central to atherosclerosis development.
  • Elevated LDL (low-density lipoprotein) is pro-atherogenic, promoting oxidative and inflammatory processes in the arterial wall.
  • HDL (high-density lipoprotein) is anti-atherogenic, facilitating cholesterol efflux, modulating atherogenic lipoproteins, and supporting endothelial function.

Purpose of the Study:

  • To review the role of various dyslipoproteinemias in atherosclerosis.
  • To discuss the therapeutic strategies focusing on LDL reduction and HDL elevation.
  • To highlight the potential benefits of combination therapy for optimizing lipid profiles.

Main Methods:

  • Literature review of dyslipoproteinemias and their role in atherosclerosis.
  • Analysis of current therapeutic approaches targeting lipid parameters.
  • Evaluation of the impact of LDL reduction and HDL elevation on cardiovascular outcomes.

Main Results:

  • Elevated LDL is pro-atherogenic, while HDL is anti-atherogenic.
  • Current therapy prioritizes LDL reduction, with less focus on HDL elevation.
  • Fibrates and nicotinic acid/niacin effectively increase HDL-cholesterol and have shown benefits in large studies.

Conclusions:

  • Statin-based LDL reduction is the cornerstone for patients with established atherosclerosis or high risk.
  • Combination therapy targeting multiple lipid parameters may offer additional benefits.
  • Development of new HDL-raising drugs is ongoing, expanding therapeutic options.

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