Dysfunctional high-density lipoprotein: an updated review.

Area of Science:

• Cardiovascular Health
• Lipid Metabolism
• Biochemistry

Background:

• High-density lipoprotein (HDL) is recognized for its cardioprotective effects, primarily linked to cholesterol transport.
• HDL's atheroprotective functions extend beyond cholesterol efflux, including anti-inflammatory and antioxidant properties.
• Inflammation and oxidative stress can impair HDL functionality, potentially promoting cardiovascular disease (CVD).

Purpose of the Study:

• To review the multifaceted roles of HDL in cardiovascular health.
• To emphasize the importance of HDL functionality and quality alongside HDL cholesterol (HDL-C) levels.
• To highlight cholesterol efflux capacity (CEC) as a critical determinant of HDL's atheroprotective potential.

Main Methods:

• Literature review of studies investigating HDL cholesterol, HDL functionality, and cardiovascular outcomes.
• Analysis of mechanisms by which HDL exerts atheroprotective and potentially pro-inflammatory effects.
• Synthesis of evidence comparing HDL-C concentration with HDL functionality (e.g., CEC) in predicting CVD risk.

Main Results:

• HDL's protective capacity is influenced by its structural and functional integrity, not just concentration.
• Dysfunctional HDL, often induced by inflammation, may lose atheroprotective properties and contribute to CVD.
• Cholesterol efflux capacity (CEC) may be a more accurate marker of cardiovascular protection than HDL-C levels alone.

Conclusions:

• Effective cardiovascular risk reduction requires attention to both HDL quantity and quality.
• Understanding HDL's functional mechanisms offers insights into heart health and therapeutic targets.
• Assessing HDL functionality, particularly CEC, is crucial for a comprehensive evaluation of cardiovascular risk.