Cholesterol efflux capacity, macrophage reverse cholesterol transport and cardioprotective HDL.
OBJECTIVE
Randomized clinical trials provide strong evidence that pharmacological elevation of HDL-cholesterol (HDL-C) fails to reduce cardiovascular disease (CVD) risk in statin-treated humans. It is thus critical to identify new metrics that capture HDL's cardioprotective effects.


RESULTS
We review recent evidence that HDL's cholesterol efflux capacity is a strong inverse predictor of incident and prevalent CVD in humans. In light of those findings, we assess the proposal that impaired macrophage cholesterol efflux to HDL contributes to disease risk. We also discuss recent studies implicating small HDL particles in cholesterol efflux from macrophages.


CONCLUSIONS
These observations lay the foundation for a new approach to understanding mechanistically how HDL's functional properties help reduce CVD risk.
Department of Medicine, University of Washington, Seattle, Washington, USA.
Patrick M
PM
Hutchins
Jay W
JW
Heinecke
D000818:Animals; D001692:Biological Transport; D002318:Cardiovascular Diseases / Q000097:blood; D002784:Cholesterol / Q000378:metabolism*; D060467:Disease Resistance; D006801:Humans; D008075:Lipoproteins, HDL / Q000502:physiology*; D008264:Macrophages / Q000378:metabolism*
D008075:Lipoproteins, HDL; D002784:Cholesterol