Is It Time for HDL to Change Its Tune?

Abstract

Over the course of the past 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 the 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 appears optimally controlled may identify individuals more likely to benefit from more intensive lipid lowering. Article see p 1189 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 on observations from large population cohorts of an inverse relationship between HDL cholesterol (HDL-C) levels and prospective risk of cardiovascular events2 and of favorable effects with HDL-targeted interventions in animal models of atherosclerosis.3 Although HDL-C is used in traditional risk stratification, and raising HDL-C levels may contribute to the clinical …