The Changing Face of HDL and the Best Way to Measure It

Area of Science:

• Lipidology
• Cardiovascular Research
• Biomarker Development

Background:

• High-density lipoprotein cholesterol (HDL-C) is a key lipid biomarker for cardiovascular health assessment.
• While HDL's role in reverse cholesterol transport (RCT) is established, its broader cardioprotective functions are increasingly recognized.
• Novel assays are emerging to evaluate diverse HDL functions, potentially leading to new diagnostic tools.

Purpose of the Study:

• To review the current understanding of HDL particle formation and maturation through RCT.
• To explore the non-RCT-related cardioprotective roles of HDL, including antioxidative, anti-inflammatory, and vasoprotective effects.
• To discuss methodologies for assessing HDL function and the potential for new diagnostic assays based on HDL composition.

Main Methods:

• Literature review of HDL formation, maturation, and function.
• Analysis of existing and emerging methodologies for assessing HDL functions.
• Discussion of HDL's protein and lipid composition in health and disease.

Main Results:

• HDL possesses multiple cardioprotective properties beyond RCT, such as antioxidative, anti-inflammatory, antiapoptotic, antithrombotic, anti-infective, and vasoprotective effects.
• The composition of HDL particles (proteins and lipids) is crucial for its function in both health and disease.
• Current methods for assessing HDL function are evolving, with potential for new diagnostic applications.

Conclusions:

• Epidemiological studies consistently link lower HDL-C to increased cardiovascular disease risk.
• Clinical and experimental data on HDL-C's direct antiatherogenic role remain inconsistent.
• Translating the expanded understanding of HDL biology into effective therapies requires developing new methods to measure HDL beyond its cholesterol content.