High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease

Article Details

Authors
Constantine E Kosmas MD, PhD, Ian Martinez MD, Andreas Sourlas, Kyriaki V Bouza MD, Frederick N Campos MD, Verenisse Torres MD, Peter D Montan MD, Eliscer Guzman MD

Article Type
Review

DOI
10.7573/dic.212525

Related Articles

Article Page

Abstract

Several prospective epidemiological studies have shown that there is a clear inverse relationship between serum highdensity lipoprotein-cholesterol (HDL-C) concentrations and risk for coronary heart disease (CHD), even at low-density lipoprotein-cholesterol (LDL-C) levels below 70 mg/dL. However, more recent evidence from genetic studies and clinical research has come to challenge the long-standing notion that higher HDL-C levels are always beneficial, while lower HDL-C levels are always detrimental. Thus, it becomes apparent that HDL functionality plays a much more important role in atheroprotection than circulating HDL-C levels. HDL cholesterol efflux capacity (CEC) from macrophages is a key metric of HDL functionality and exhibits a strong inverse association with both carotid intima-media thickness and the likelihood of angiographic coronary artery disease (CAD), independent of the HDL-C level. Thus, extensive research is being conducted to identify new agents with a favorable side effect profile, which would be able to enhance CEC, improve HDL functionality and potentially decrease cardiovascular risk. This review aims to present and discuss the current clinical and scientific evidence pertaining to the significance of HDL functionality over the actual HDL-C concentration in mediating the favorable effects on the cardiovascular system. Thus, we conducted a PubMed search until December 2017 through the English literature using the search terms ‘HDL function/ functionality’, ‘HDL properties’, ‘cardiovascular risk’ and ‘cholesterol efflux capacity’. We also included references from the articles identified and publications available in the authors’ libraries.

Keywords: ApoA-I Milano, cardiovascular disease (CVD), cholesterol efflux capacity (CEC), HDL-cholesterol (HDL-C), HDL functionality.

Citation: Kosmas CE, Martinez I, Sourlas A, Bouza KV, Campos FN, Torres V, Montan PD, Guzman E. High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease. Drugs in Context 2018; 7: 212525. DOI: 10.7573/dic.212525

Disclosure and potential conflicts of interest: Constantine E Kosmas is a member of the Dyslipidemia Speaker Bureau of Amgen, Inc. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at: http://www.drugsincontext.com/wp-content/uploads/2018/03/dic.212525-COI.pdf

Copyright: Copyright © 2018 Kosmas CE, Martinez I, Sourlas A, Bouza KV, Campos FN, Torres V, Montan PD, Guzman E. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Kosmas CE, Martinez I, Sourlas A, Bouza KV, Campos FN, Torres V, Montan PD, Guzman E. https://doi.org/10.7573/dic.212525. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: http://www.drugsincontext.com/high-density-lipoprotein-hdl-functionality-and-its-relevance-to-atherosclerotic-cardiovascular-disease

Correspondence: Constantine E Kosmas, 168-24 Powells Cove Blvd, Beechhurst, NY 11357, USA. cekosmas1@gmail.com

Provenance: invited; externally peer reviewed.

Submitted: 9 January 2018; Peer review comments to author: 1 March 2018; Revised manuscript received: 5 March 2018; Accepted: 5 March 2018; Publication date: 28 March 2018.

Drugs in Context is published by BioExcel Publishing Ltd. Registered office: Plaza Building, Lee High Road, London, England, SE13 5PT.

BioExcel Publishing Limited is registered in England Number 10038393. VAT GB 252772009.

For all manuscript and submissions enquiries, contact the Editorial office dic.editorial@bioexcelpublishing.com

For all permissions, rights and reprints, contact David Hughes david.hughes@bioexcelpublishing.com

Download free full text PDF