title: High-density lipoprotein functionality in coronary artery disease.
abstract: The role of high-density lipoprotein (HDL) in cardiovascular atheroprotection is well established. Epidemiological data have clearly demonstrated an inverse relationship between HDL levels and the risk for coronary artery disease, which is independent of the low-density lipoprotein levels. However, more recent data provide evidence that high HDL levels are not always protective and that under certain conditions may even confer an increased risk. Thus, a new concept has arisen, which stresses the importance of HDL functionality, rather than HDL concentration per se, in the assessment of cardiovascular risk. HDL functionality is genetically defined but can also be modified by several environmental and lifestyle factors, such as diet, smoking or certain pharmacologic interventions. Furthermore, HDL is consisted of a heterogeneous group of particles with major differences in their structural, biological and functional properties. Recently, the cholesterol efflux capacity from macrophages was proven to be an excellent metric of HDL functionality, because it was shown to have a strong inverse relationship with the risk of angiographically documented coronary artery disease, independent of the HDL and apolipoprotein A-1 levels, although it may not actually predict the prospective risk for cardiovascular events. Thus, improving the quality of HDL may represent a better therapeutic target than simply raising the HDL level, and assessment of HDL function may prove informative in refining our understanding of HDL-mediated atheroprotection.
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute (CEK), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine (GC), Winthrop University Hospital, Mineola, New York; Department of Medicine (JWC, SL), Emory University School of Medicine, Atlanta, Georgia; and St. Francis Hospital-The Heart Center (TJV), Division of Cardiology, Center of Advanced Cardiac Therapeutics, Roslyn, New York.
authors.forename: Constantine E
authors.initials: CE
authors.lastname: Kosmas
authors.forename: Georgios
authors.initials: G
authors.lastname: Christodoulidis
authors.forename: Jeh-wei
authors.initials: JW
authors.lastname: Cheng
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Vittorio
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood / Q000502:physiology*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D008075:Lipoproteins, HDL