Is it Time for HDL to Change its Tune?
Over the course of the last century, increasing evidence has accumulated to implicate a central role for atherogenic lipoproteins in the pathogenesis of atherosclerotic cardiovascular disease. This is supported by the importance of cholesterol measurement for risk prediction and use of lipid modifying therapies in primary and secondary prevention. Recent reports have suggested that particle based measurements of atherogenic lipoproteins may provide additional information in risk stratification.1 In particular, persistently elevated measures of low-density lipoprotein (LDL) particles, in patients whose LDL-cholesterol (C) appears optimally controlled, may identify individuals more likely to benefit from more intensive lipid lowering.
In parallel, there has been considerable interest in the potential protective properties of high-density lipoproteins (HDL) for the development of new risk prediction markers and cardiovascular therapeutics. This is based upon observations from large population cohorts of an inverse relationship between HDL-C levels and prospective risk of cardiovascular events2 and of favorable effects with HDL targeted interventions in animal models of atherosclerosis.3 While HDL-C is used in traditional risk stratification, and raising HDL-C may contribute to the clinical benefit of current therapies,4 it remains to be determined whether substantial HDL-C raising will be protective of incident cardiovascular events.
- Received August 5, 2013.
- Accepted August 5, 2013.