The HDL paradox: what does it mean and how to manage low serum HDL cholesterol level?

Area of Science:

• Lipidology
• Cardiovascular Science
• Atherosclerosis Research

Background:

• Familial hypercholesterolemia and severe hypertriglyceridemia are significant lipidologic concerns.
• High-density lipoprotein cholesterol (HDL-C) levels are a focus in cardiovascular risk assessment.
• The role of HDL in atherogenesis requires further elucidation.

Purpose of the Study:

• To summarize current evidence on HDL's complex role in atherogenesis.
• To review therapeutic recommendations for patients with low HDL-C levels.
• To highlight the importance of HDL functionality over mere levels.

Main Methods:

• Review of current scientific evidence and expert views.
• Analysis of existing literature on HDL functionality in pathological conditions.
• Evaluation of therapeutic strategies targeting HDL.

Main Results:

• Available evidence suggests HDL's antiatherogenic properties are linked to functionality, not just quantity.
• HDL functionality is compromised in pathological conditions associated with inflammation.
• Low HDL-C levels may indicate dysfunctional HDL particles.

Conclusions:

• HDL's role in atherogenesis is complex and tied to its functionality.
• Inflammation significantly impacts HDL functionality, potentially impairing its protective effects.
• Future therapies should focus on increasing functional HDL to reduce cardiovascular events and improve clinical guidelines.