HDL in CKD-The Devil Is in the Detail

Area of Science:

• Cardiovascular Science
• Nephrology
• Biochemistry

Background:

• High-density lipoprotein cholesterol (HDL-C) was traditionally considered
• good
• cholesterol
• but this notion is being challenged.
• Despite strong associations between HDL-C and cardiovascular disease (CVD), therapies targeting HDL-C and genetic variants influencing HDL-C levels have largely failed to reduce CVD events.
• HDL particles are complex, containing over 80 proteins and numerous lipid species, suggesting that simple cholesterol measurement may not capture their diverse biological effects.

Purpose of the Study:

• To investigate the role of HDL particle functionality, beyond cholesterol levels, in cardiovascular risk.
• To explore the specific behavior and implications of HDL functionality in patients with chronic kidney disease (CKD).

Main Methods:

• Focus on functional studies of HDL components, particularly cholesterol efflux capacity.
• Comparison of HDL functionality and its association with outcomes in CKD versus non-CKD populations.

Main Results:

• HDL particle functionality is demonstrably disturbed in CKD populations.
• These functional disturbances in HDL have not consistently translated into clear associations with clinical outcomes in CKD patients.

Conclusions:

• Measuring HDL cholesterol alone is insufficient for assessing cardiovascular risk due to HDL particle heterogeneity.
• Further research into HDL functionality, especially cholesterol efflux capacity, is needed to understand its role in CVD, particularly in the context of CKD.