Low high-density lipoprotein cholesterol as the possible risk factor for stroke

Area of Science:

• Cardiovascular Medicine
• Lipidology
• Preventive Cardiology

Background:

• Lower high-density lipoprotein cholesterol (HDL-C) is linked to increased inflammation and atherosclerosis progression.
• Carotid intima-media thickness (CIMT) serves as a marker for early atherosclerosis and predicts vascular events.
• Low HDL-C is an independent risk factor for stroke, particularly in patients with recent cerebrovascular events.

Purpose of the Study:

• To review the role of HDL-C in atherosclerosis and cardiovascular risk.
• To evaluate therapeutic strategies for increasing HDL-C and reducing residual cardiovascular risk.
• To emphasize the importance of managing HDL-C levels in stroke prevention.

Main Methods:

• Literature review of studies investigating HDL-C, atherosclerosis, and cardiovascular events.
• Analysis of the impact of lipid parameters, including LDL-C, HDL-C, and triglycerides, on vascular risk.
• Evaluation of pharmacological (niacin, statins, fibrates) and non-pharmacological interventions.

Main Results:

• Lower HDL-C levels correlate with a higher risk of stroke and cardiovascular events.
• Optimal management of LDL-C, HDL-C, triglycerides, and blood pressure reduces recurrent stroke and major cardiovascular events.
• Niacin effectively increases HDL-C, reduces cardiovascular risk, and, when combined with statins, slows atherosclerosis progression.
• Residual cardiovascular risk persists with statin therapy alone due to low HDL-C and elevated triglycerides.

Conclusions:

• Higher HDL-C levels are protective against atherosclerosis and stroke.
• Combination therapy with niacin and statins, along with lifestyle modifications, is crucial for managing residual cardiovascular risk.
• Therapeutic strategies targeting HDL-C, such as niacin or fibrates, are important for patients with low HDL-C, especially those with high triglycerides or established cardiovascular disease.