HDL and risk of cardiovascular (CV) disease (CVD)

• high density lipoprotein cholesterol (HDL-C) is an independent risk factor for cardiovascular disease
• there is evidence that there is an inverse relationship between serum HDL-C and risk of coronary artery disease (1,2,3)
  • for every 1% decrease in HDL-C there is an associated 2-3% increase in risk of coronary artery disease - this is independent of concentrations of low-density lipoprotein cholesterol (LDL-C) and triglycerides (4)
  • the Veteran Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) showed that, in patients with desirable levels of LDL-C, increasing HDL-C levels by 6% led to a relative reduction in the combined outcome of death from coronary artery disease, non-fatal myocardial infarction and confirmed stroke
• one of the main mechanisms by which HDL-C is thought to protect against atherosclerosis is reverse transport - in this process excess cholesterol is transported via HDL-C from the peripheral tissues to the liver, and then excreted after conversion to bile acids or directly

Reference:

1. Ann Epidemiol. 1992 Jan-Mar; 2(1-2): 23-8.
2. Arteriosclerosis. 1988 May-Jun; 8(3): 207-11.
3. Atherosclerosis. 1996 Jul; 124 Suppl: S11-20.
4. Circulation. 1989 Jan; 79(1): 8-15.