Cholesterol Research Today is a free monthly online journal that collates and summarizes the latest research about Cholesterol, including details on high cholesterol, hdl, ldl, diet, risks.

Low high-density lipoprotein cholesterol: an important consideration in coronary heart disease risk assessment.

Majeed F, Miller M

Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.

PURPOSE OF REVIEW: One aim is to summarize evidence from observational studies and clinical trials evaluating the inverse relationship between high-density lipoprotein and coronary heart disease. Other aims are to explore the mechanisms underlying the reported cardioprotective effects of high-density lipoprotein and to evaluate therapeutic modalities to increase high-density lipoprotein levels and functionality. RECENT FINDINGS: In addition to reverse cholesterol transport, recent data suggest that high-density lipoprotein possesses antioxidant, anti-inflammatory and fibrinolytic properties and the inverse relationship between high-density lipoprotein cholesterol and coronary heart disease is most evident with associated elevations in low-density lipoprotein cholesterol and triglyceride. Recent data suggest, however, that even after low-density lipoprotein cholesterol is sufficiently reduced, residual coronary heart disease risk persists with low high-density lipoprotein cholesterol. The excess death rate reported with the high-density lipoprotein cholesterol raising drug torcetrapib appears to have been the result of an off-target effect of the drug, rather than an effect attributable to cholesteryl ester transfer protein inhibition. SUMMARY: Low high-density lipoprotein cholesterol remains an important consideration in coronary heart disease risk assessment, however several issues remain unresolved. They include the extent to which low high-density lipoprotein cholesterol in the absence of other risk factors augments risk, the relationship between high-density lipoprotein functionality and levels of high-density lipoprotein cholesterol and whether and to what extent improving these parameters independently offsets coronary heart disease risk.

Published 4 March 2008 in Curr Opin Endocrinol Diabetes Obes, 15(2): 175-81.
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