Changing Perspectives on HDL: From Simple Quantity Measurements to Functional Quality Assessment

Area of Science:

• Cardiovascular Biology
• Lipid Metabolism
• Biomarker Discovery

Background:

• High-density lipoprotein (HDL) is a heterogeneous particle group with varying size, density, and composition.
• HDL cholesterol (HDL-C) levels were historically used to infer cardiovascular risk, but recent interventions and genetic studies challenge this notion.
• Current consensus suggests HDL-C is neither a reliable biomarker nor a direct cause of cardiovascular disorders.

Purpose of the Study:

• To shift focus from HDL quantity to HDL quality, specifically its atheroprotective functions.
• To explore novel laboratory assays for assessing HDL functions in cardiovascular risk prediction.
• To investigate HDL mimetics for cardiovascular risk modification.

Main Methods:

• Development of laboratory assays to evaluate HDL's functional capacity.
• Investigation of HDL mimetics based on key functional determinants.
• Analysis of HDL composition to understand its role in atheroprotection.

Main Results:

• Evidence questioning the direct link between HDL-C levels and cardiovascular risk.
• Emerging focus on HDL's functional properties over mere cholesterol content.
• Development of new methodologies for assessing HDL functionality.

Conclusions:

• HDL-C is an unreliable indicator of cardiovascular risk.
• Assessing HDL function is crucial for accurate cardiovascular risk prediction.
• Targeting HDL function through composition modification holds promise for reducing cardiovascular risk.