Update of HDL in atherosclerotic cardiovascular disease

Area of Science:

• Cardiovascular Science
• Lipid Metabolism
• Atherosclerosis Research

Background:

• Epidemiologic studies show inverse association between HDL cholesterol (HDL-C) and atherosclerotic cardiovascular disease (ASCVD).
• HDL particles possess cardioprotective functions beyond reverse cholesterol transport.
• Clinical trials targeting increased HDL-C levels have yielded questionable results.

Purpose of the Study:

• To review the current understanding of HDL's role in ASCVD.
• To explore the heterogeneity and composition of HDL particles.
• To discuss clinical outcomes of HDL-C-raising therapies, including CETP inhibitors.

Main Methods:

• Literature review of recent studies on HDL function and composition.
• Analysis of clinical trial data concerning HDL-C-raising drugs.
• Focus on cholesteryl ester transfer protein (CETP) inhibitors.

Main Results:

• Evidence suggests HDL's protective functions depend on particle composition, not just cholesterol content.
• The "HDL quality over quantity" hypothesis is gaining traction.
• Clinical outcomes of HDL-C-raising drugs, particularly CETP inhibitors, require careful consideration.

Conclusions:

• The effectiveness of increasing HDL-C requires a nuanced view, emphasizing particle quality and composition.
• Further research into HDL heterogeneity is crucial for developing effective cardiovascular therapies.
• Targeting specific HDL components may offer a more promising strategy for ASCVD prevention.