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 associated with increased coronary heart disease (CHD) risk.
• Therapeutic strategies aimed to increase HDL-C concentrations based on this association.
• Recent high-intensity statin trials challenge the direct link between HDL-C levels and cardiovascular events.

Purpose of the Study:

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

Main Methods:

• Review of prospective population studies and clinical trials.
• Analysis of data from high-intensity statin therapy trials.
• Examination of emerging therapeutic approaches for HDL modulation.

Main Results:

• Low HDL-C association with CHD risk is not consistently supported by high-intensity statin trials.
• Low HDL particle concentration (HDL-P) is linked to increased cardiovascular event risk in these trials.
• Strategies increasing HDL-C without enhancing HDL-P function may be ineffective.

Conclusions:

• The focus in cardiovascular risk reduction should shift from solely increasing HDL-C to improving HDL particle number and functional capacity.
• Emerging therapies aim to enhance the concentration and functional properties of HDL particles.
• Understanding HDL's proteome and lipidome is crucial for developing effective anti-atherogenic strategies.