Abstract
Cardiovascular disease (CVD) is the leading cause of global mortality and the study of high-density lipoproteins (HDL) particle composition and functionality has become a matter of high interest, particularly in light to the disappointing clinical data for HDL-cholesterol (HDL-C) raising therapies in CVD secondary prevention and the lack of association between HDL-C and the risk of CVD. Recent evidences suggest that HDL composition and functionality could be modulated by diet. The purpose of this systematic review was to investigate the effect of Mediterranean diet (MD) on changes in HDL structure and functionality in humans. A comprehensive search was conducted in four databases (PubMed, Scopus, Cochrane library and Web of Science) and 13 records were chosen. MD showed favorable effects on HDL functionality, particularly by improving HDL cholesterol efflux capacity and decreasing HDL oxidation. In addition, HDL composition and size were influenced by MD. Thus, MD is a protective factor against CVD associated with the improvement of HDL quality and the prevention of HDL dysfunctionality.
Highlights
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide
high-density lipoproteins (HDL)-C should be in the spotlight as a CVD lowering risk factor and HDL modulations should be considered in order to predict CVD risk [3]
This systematic review shows that Mediterranean diet (MD) influences HDL functionality, composition, and size
Summary
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. It is well known that high concentrations of circulating high-density lipoprotein-cholesterol (HDL-C) are inversely correlated with the risk of CVD [1]. While raising HDL-C is a theoretically attractive target, there is no evidence from randomized trials that increasing plasma HDL-C concentrations reduces CVD risk [2]. Several studies have shown that high-density lipoproteins (HDLs) are highly heterogeneous in size, shape, density, lipid and protein composition [3]. Sphingomielin-1-phosphate (S1P) is the most studied bioactive lipid bound to HDL and it has been negatively correlated with the severity of coronary artery disease [7]. It is becoming clear that circulating HDL-C plasma concentrations is not an appropriate marker of CVD risk and do not represent a reliable therapeutic target. Targeting HDL functionality rather than HDL-C concentrations may represent a more promising therapeutic target
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