HDL Functions-Current Status and Future Perspectives

Abstract

Cardiovascular disease (CVD) is the leading cause of death in Western countries. A low HDL-C is associated with the development of CVD. However, recent epidemiology studies have shown U-shaped curves between HDL-C and CVD mortality, with paradoxically increased CVD mortality in patients with extremely high HDL-C levels. Furthermore, HDL-C raising therapy using nicotinic acids or CETP inhibitors mostly failed to reduce CVD events. Based on this background, HDL functions rather than HDL-C could be a novel biomarker; research on the clinical utility of HDL functionality is ongoing. In this review, we summarize the current status of HDL functions and their future perspectives from the findings of basic research and clinical trials.

Keywords: HDL; cholesterol efflux capacity; reverse cholesterol transport.

Figure 1

Schematic illustration of reverse cholesterol transport (RCT). RCT is a major atheroprotective function of HDL, a pathway by which HDL transports excess cholesterol from peripheral tissues, transfers it to the liver, and then excretes it from bile into the intestinal tract. Abbreviations: ABCA1: ATP-binding cassette protein A1, ABCG1: ATP-binding cassette protein G1, CETP: cholesteryl ester transfer protein, HDL: high-density lipoprotein, SR-B1: scavenger receptor class B member 1 (illustration was created using Biorender.com accessed on 7 December 2022).