The high-density lipoprotein: Attribute matters rather than amount in therapeutic arena

Abstract

The ability of high-density lipoprotein (HDL-C) to absorb and recycle excess cholesterol from peripheral tissues back to the liver is particularly interesting. This ability may play a role in preventing atherosclerotic cardiovascular diseases, myocardial infarction, transient ischemic attack, and stroke. Prior epidemiological research has demonstrated that lower HDL-C concentration can be utilized to predict risk and has an inverse relationship with the risk of CVD. Elevated HDL-C levels are a hallmark of certain hereditary illnesses. However, this does not modulate to a lower risk of CVD. Researchers' focus has been diverted towards the shape and functions of the HDL molecule and its subclasses to correlate the possible causative association between HDL-C and adverse outcomes. Although a low level of HDL-C is a useful clinical predictor of CAD, raising the HDL-C level does not necessarily lower this risk. The possibility that HDL can either become less effective as an antioxidant or paradoxically enhance the oxidation and inflammation linked to atherosclerotic plaque under certain conditions contributes to the explanation of this dilemma. Thus, the functional properties of HDL, not merely the level, may need to be considered and developed. On the other hand, the available data indicates that higher HDL-C is not necessarily protective against cardiovascular disease. Conversely, it can be detrimental at extremely high levels. The objective of this review is to elucidate and discuss concisely the current clinical and scientific evidence related to the significance of HDL functionality over the biochemical HDL-C level in mediating the favorable effects on the cardiovascular system.