High-density lipoprotein cholesterol: origins and the path ahead

Area of Science:

• Cardiovascular Medicine
• Lipid Metabolism
• Biochemistry

Background:

• High-density lipoprotein (HDL) cholesterol is a widely used clinical marker.
• Its role as a proxy for HDL's antiatherogenic properties has been questioned.
• Understanding HDL's functional capacity is crucial for accurate cardiovascular risk assessment.

Purpose of the Study:

• To trace the historical development of HDL cholesterol as a clinical standard.
• To review evidence supporting HDL function over HDL cholesterol levels.
• To explore future directions and available methods for assessing HDL function.

Main Methods:

• Historical review of clinical guidelines and research.
• Analysis of recent epidemiological studies on HDL function and cardiovascular disease (CVD).
• Evaluation of current and emerging assays for measuring HDL function.

Main Results:

• Recent studies show a strong correlation between plasma cholesterol efflux capacity and prevalent CVD.
• HDL function, measured by efflux capacity, is a significant predictor of CVD event risk.
• This highlights the diagnostic and prognostic utility of assessing HDL function.

Conclusions:

• HDL cholesterol became the standard measure due to historical convenience.
• Key findings challenge the clinical relevance of HDL cholesterol alone.
• The pros and cons of current HDL function assays are discussed, paving the way for improved CVD risk stratification.