Modification of High-Density Lipoprotein Functions by Diet and Other Lifestyle Changes: A Systematic Review of Randomized Controlled Trials.

Albert Sanllorente,Olga Castañer,Camille Lassale,Álvaro Hernáez,Montserrat Fitó,Maria Trinidad Soria-Florido

doi:10.3390/jcm10245897

Abstract

High-density lipoprotein (HDL) functional traits have emerged as relevant elements that may explain HDL antiatherogenic capacity better than HDL cholesterol levels. These properties have been improved in several lifestyle intervention trials. The aim of this systematic review is to summarize the results of such trials of the most commonly used dietary modifications (fatty acids, cholesterol, antioxidants, alcohol, and calorie restriction) and physical activity. Articles were screened from the Medline database until March 2021, and 118 randomized controlled trials were selected. Results from HDL functions and associated functional components were extracted, including cholesterol efflux capacity, cholesteryl ester transfer protein, lecithin-cholesterol acyltransferase, HDL antioxidant capacity, HDL oxidation status, paraoxonase-1 activity, HDL anti-inflammatory and endothelial protection capacity, HDL-associated phospholipase A2, HDL-associated serum amyloid A, and HDL-alpha-1-antitrypsin. In mainly short-term clinical trials, the consumption of monounsaturated and polyunsaturated fatty acids (particularly omega-3 in fish), and dietary antioxidants showed benefits to HDL functionality, especially in subjects with cardiovascular risk factors. In this regard, antioxidant-rich dietary patterns were able to improve HDL function in both healthy individuals and subjects at high cardiovascular risk. In addition, in randomized trial assays performed mainly in healthy individuals, reverse cholesterol transport with ethanol in moderate quantities enhanced HDL function. Nevertheless, the evidence summarized was of unclear quality and short-term nature and presented heterogeneity in lifestyle modifications, trial designs, and biochemical techniques for the assessment of HDL functions. Such findings should therefore be interpreted with caution. Large-scale, long-term, randomized, controlled trials in different populations and individuals with diverse pathologies are warranted.

Highlights

Low concentrations of high-density lipoprotein (HDL) cholesterol (HDL-C) have been linked with greater incidence of coronary heart disease in epidemiological studies [1,2]
We have summarized the existing evidence regarding the effect of lifestyle changes on High-density lipoprotein (HDL) functional traits
In subjects at cardiovascular risk, an effect on HDL functions was suggested after the intake of Monounsaturated Fatty Acids (MUFA) and long-chain PUFAs, whilst an antioxidant-rich dietary pattern was able to improve HDL function in both groups, healthy individuals and subjects at high cardiovascular risk

Summary

Introduction

Low concentrations of high-density lipoprotein (HDL) cholesterol (HDL-C) have been linked with greater incidence of coronary heart disease in epidemiological studies [1,2]. The most studied HDL atheroprotective function is reverse cholesterol transport (Figure 1), which can be measured in vitro by the cholesterol efflux capacity (CEC) technique. HDLs can carry on their surface pro-inflammatory proteins related to HDL dysfunctionality, such as serum amyloid A (SAA) and alpha-1-antitrypsin [13]. This lipoprotein could present a protective effect on the endothelial layer of the arteries [12]. A healthy endothelium maintains a proper permeability and regulates vascular tone, helping to prevent atherosclerosis In this regard, HDLs have shown the capacity to improve the release of nitric oxide, a potent vasodilator secreted by the endothelium. Nitric-oxide production can be evaluated in vitro in cellular cultures of endothelial cells [12]

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Discussion

Conclusion