High-Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Risk Assessment: Exploring and...

Area of Science:

• Cardiovascular Medicine
• Lipid Metabolism
• Atherosclerosis Research

Background:

• High-density lipoprotein cholesterol (HDL-C) plays a complex role in cardiovascular health.
• Traditional risk factors do not fully explain all ASCVD events.
• The independent prognostic value of HDL-C has been debated.

Purpose of the Study:

• To review current understanding of HDL-C's association with atherosclerotic cardiovascular disease (ASCVD).
• To discuss the integration of HDL-C into cardiovascular risk assessment strategies.

Main Methods:

• Review of existing literature on HDL-C and ASCVD.
• Analysis of epidemiological data and genetic studies (Mendelian randomization).
• Evaluation of HDL-C's role in primary and secondary prevention.

Main Results:

• A U-shaped relationship exists between HDL-C levels and ASCVD risk.
• Low HDL-C (<40 mg/dL men, <50 mg/dL women) and very-high HDL-C (≥80 mg/dL men) are linked to increased all-cause and ASCVD mortality.
• The causality of very-high HDL-C's association with mortality is uncertain, especially in women.

Conclusions:

• HDL-C is a significant risk factor or enhancer for ASCVD, particularly at low levels in both sexes and very high levels in men.
• Risk assessment models should incorporate the U-shaped nature of HDL-C's association with mortality.
• Further research is needed to clarify the causal role of very-high HDL-C.