Role of HDL in those with diabetes

Area of Science:

• Cardiovascular Medicine
• Lipid Metabolism
• Pharmacology

Background:

• Low high-density lipoprotein cholesterol (HDL-C) was historically linked to increased coronary heart disease (CHD) risk.
• Therapeutic strategies aimed to raise HDL-C levels.
• Recent high-intensity statin trials challenge the direct association between HDL-C and CHD risk.

Purpose of the Study:

• To review the anti-atherogenic mechanisms of HDL.
• To evaluate the impact of therapies on HDL particle concentration (HDL-P) and function.
• To discuss emerging therapies targeting HDL's functional capacity.

Main Methods:

• Review of prospective population studies and clinical trials.
• Analysis of findings from low-to-moderate and high-intensity statin therapies.
• Examination of emerging therapeutic strategies for HDL modulation.

Main Results:

• High-intensity statin trials did not support the prior HDL-C association with CHD risk.
• Low HDL particle concentration (HDL-P) is associated with increased cardiovascular event risk.
• Increasing HDL-C without enhancing HDL-P may not be effective.

Conclusions:

• Focus should shift from solely increasing HDL-C to improving HDL particle concentration and functional properties.
• Emerging therapies aim to enhance both the quantity and functional capacity of HDL.
• Understanding HDL's proteome/lipidome is crucial for effective cardiovascular risk reduction.