The importance of recognizing and treating low levels of high-density lipoprotein cholesterol: a new era in atherosclerosis management.
Low levels of high-density lipoprotein cholesterol (HDL-C) represent a major cardiovascular risk factor, with a stronger relationship to coronary heart disease than that seen with elevated levels of low-density lipoprotein cholesterol (LDL-C). HDL-C has important antiatherogenic effects, including reverse cholesterol transport, inhibition of LDL-C oxidation, and antiplatelet and anti-inflammatory actions. Patients with low HDL-C are also at an amplified risk of coronary heart disease due to the common coexistence of other risk factors, including excess adiposity, metabolic syndrome, type 2 diabetes mellitus, hypertriglyceridemia, and the atherogenic dyslipidemia characterized by small dense LDL-C. First-line therapy of low HDL-C generally consists of nonpharmacologic measures such as improved fitness and weight loss. Current pharmaceutical options include statins, fibrates, and nicotinic acid. A host of novel approaches involving HDL-C and reverse cholesterol transport hold the promise of fundamentally changing the natural history of atherosclerosis, the most common and important chronic disease in humans.
Cardenas
Gustavo A
GA
Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana, USA.
Lavie
Carl J
CJ
Cardenas
Vanessa
V
Milani
Richard V
RV
McCullough
Peter A
PA
D016632:Apolipoprotein A-I / Q000627:therapeutic use; D050197:Atherosclerosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D053480:Cholesterol Ester Transfer Proteins / Q000037:antagonists & inhibitors; D008076:Cholesterol, HDL / Q000097:blood*; D002995:Clofibric Acid / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004032:Diet; D015536:Down-Regulation; D004359:Drug Therapy, Combination; D015507:Drugs, Investigational / Q000627:therapeutic use; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000628:therapy*; D015444:Exercise; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009525:Niacin / Q000627:therapeutic use; D010455:Peptides / Q000627:therapeutic use; D011982:Receptors, Prostaglandin / Q000037:antagonists & inhibitors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D015431:Weight Loss
D016632:Apolipoprotein A-I; C506642:CETP protein, human; D053480:Cholesterol Ester Transfer Proteins; D008076:Cholesterol, HDL; D015507:Drugs, Investigational; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D010455:Peptides; D011982:Receptors, Prostaglandin; C501562:prostanoid D receptor 1, human; D009525:Niacin; D002995:Clofibric Acid