Is HDL function as important as HDL quantity in the coronary artery disease risk assessment?

Area of Science:

• Cardiovascular Medicine
• Biochemistry
• Lipid Metabolism

Background:

• High plasma concentrations of high-density lipoprotein (HDL) are traditionally linked to reduced coronary artery disease (CAD) risk.
• Low HDL levels (<40 mg/dL) are recognized as a CAD risk predictor by NCEP ATP III guidelines.
• Emerging research highlights HDL quality, not just quantity, as crucial for CAD risk assessment.

Purpose of the Study:

• To review the concept and implications of dysfunctional HDL in cardiovascular disease.
• To explore the role of HDL quality in atherosclerosis pathophysiology.
• To summarize recent findings on dysfunctional HDL and its association with CAD.

Main Methods:

• Review of existing literature on HDL function and dysfunction.
• Analysis of studies investigating HDL's role in inflammation and atherosclerosis.
• Examination of cell-based and cell-free assays for assessing HDL anti-inflammatory functions.

Main Results:

• Chronic inflammation can lead to loss of HDL's protective functions, creating "dysfunctional HDL" or "proinflammatory HDL."
• Dysfunctional HDL may paradoxically promote atherogenesis, shifting from a cardioprotective to a pro-atherosclerotic role.
• Assays measuring HDL's anti-inflammatory capacity can potentially link cellular changes to in vivo vascular disease.

Conclusions:

• HDL's functional capacity, beyond mere concentration, is critical for cardiovascular health.
• Dysfunctional HDL represents a novel pathway in atherosclerosis development.
• Further research into dysfunctional HDL may offer new avenues for CAD risk stratification and therapeutic strategies.