Would Janus' view on HDL be useful?

Area of Science:

• Cardiovascular Medicine
• Lipidology
• Biochemistry

Background:

• Low-density lipoprotein cholesterol (LDL-C) is pro-atherogenic; high-density lipoprotein cholesterol (HDL-C) is considered anti-atherogenic.
• Current clinical practice primarily measures HDL cholesterol concentration to assess cardiovascular risk and hypolipidemic therapy effectiveness.
• This approach may lack sufficient detail regarding HDL's functional role in atherosclerosis.

Purpose of the Study:

• To evaluate the adequacy of measuring only HDL cholesterol concentration in routine clinical practice.
• To investigate the significance of HDL particle size shifts in atherosclerotic cardiovascular diseases (CVD).
• To propose a re-evaluation of the diagnostic and therapeutic strategies for cardiovascular risk assessment.

Main Methods:

• Review of recent studies on lipoprotein profiles in atherosclerotic cardiovascular diseases (CVD).
• Analysis of the association between HDL particle size distribution and cardiovascular pathology.
• Comparison of traditional lipid spectrum analysis with emerging lipoprotein constellation insights.

Main Results:

• A shift from large to small HDL particles is observed in patients with atherosclerotic CVD.
• This change in HDL particle distribution is indicative of a dysfunctional lipoprotein profile.
• The current focus on HDL cholesterol concentration may underestimate cardiovascular risk.

Conclusions:

• The traditional "good" cholesterol concept based solely on HDL-C concentration is insufficient for comprehensive cardiovascular risk assessment.
• Changes in HDL particle size are a potential biomarker for pathological cardiovascular states.
• Diagnostic and therapeutic approaches for atherosclerosis require refinement to include HDL particle analysis.