HDL cholesterol and ASCVD risk stratification: A debate

Area of Science:

• Cardiology
• Biochemistry
• Preventive Medicine

Background:

• High-density lipoproteins (HDLs) play a role in cardiovascular health.
• HDL cholesterol (HDL-C) has been a recognized predictor of atherosclerotic cardiovascular disease (ASCVD) events for decades.
• Recent research questions the direct protective role of HDLs despite HDL-C's predictive power.

Purpose of the Study:

• To review the clinical utility of HDL-C in predicting ASCVD risk.
• To evaluate the ongoing debate surrounding HDL-C's role in cardiovascular risk stratification.
• To discuss the limitations of HDL-C and the need for improved biomarkers.

Main Methods:

• Review of existing literature and clinical studies on HDL-C and ASCVD.
• Analysis of epidemiological data and Mendelian randomization studies.
• Discussion of pharmacological interventions targeting HDL-C.

Main Results:

• HDL-C concentration remains a robust, independent, inverse predictor of ASCVD events.
• The direct causal link between HDL-C levels and ASCVD protection is questioned by some studies.
• HDL's beneficial functions are only weakly correlated with HDL-C levels.
• Pharmacological attempts to increase HDL-C have not improved outcomes.

Conclusions:

• HDL-C is a valuable tool for ASCVD risk stratification.
• The direct causality and functional significance of HDL-C require further investigation.
• Developing better biomarkers for HDL function is crucial for future cardiovascular risk prediction and clinical decision-making.