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High-Density Lipoproteins

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Therapeutic Lipidology

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Low plasma levels of cholesterol carried by high-density lipoprotein (HDL) particles are firmly established as a major cardiovascular risk factor. Paradoxically, cardiovascular mortality is also elevated at extremely high levels of HDL cholesterol. Furthermore, genetic epidemiology often does not support a causal relationship between HDL cholesterol and cardiovascular risk.

HDL particles contain multiple protein and lipid components and are highly heterogeneous in their metabolism, structure and biological function. Small, dense, protein-rich HDLs display elevated anti-atherogenic activities as compared to large, light, lipid-rich particles.

HDL metabolism and function are altered in both low and extremely high HDL cholesterol (HDL-C) states. Low HDL-C levels are typically accompanied by reduced circulating levels of large HDL and deficient biological activities of small HDL particles. Reduced capacity of HDL to efflux cholesterol from lipid-loaded macrophages is associated with both the presence of cardiovascular disease and the risk of future cardiovascular events. However, therapeutic HDL-C raising, which predominantly increases levels of large HDL, have repeatedly failed to reduce cardiovascular events in patients treated with statins. Such flagrant controversy between classic epidemiology, genetic epidemiology and clinical trials needs to be urgently resolved in order to allow further development of HDL-targeting therapies.

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Authors and Affiliations

  1. ICANalytics Team, Institute of Cardiometabolism and Nutrition (ICAN), Hospital Pitie – Salpetriere, Paris, France

    Maryam Darabi

  2. Department of Medicine, Hospital Pitie – Salpetriere, Sorbonne University, Paris, France

    Emile Zakiev

  3. Hospital Pitie – Salpetriere, Sorbonne University, INSERM Unit 1166, Paris, France

    Anatol Kontush

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  1. Maryam Darabi
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  2. Emile Zakiev
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  3. Anatol Kontush
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Correspondence to Anatol Kontush .

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Editors and Affiliations

  1. The University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Michael H. Davidson

  2. Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Univerity School of Medicine, Baltimore, MD, USA

    Peter P. Toth

  3. Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA

    Kevin C. Maki

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Darabi, M., Zakiev, E., Kontush, A. (2021). High-Density Lipoproteins. In: Davidson, M.H., Toth, P.P., Maki, K.C. (eds) Therapeutic Lipidology. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-56514-5_18

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