How is hdl related to heart disease

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Related articles in Web of Science Google Scholar. Citing articles via Web of Science 6. Why are mineralocorticoid receptor antagonists the Cinderella in evidence-based treatment of myocardial infarction complicated with heart failure? Echocardiography for risk stratification in patients with pulmonary embolism at low risk of death: a response. Looking for your next opportunity? This condition, called atherosclerosis, increases your risk for cardiovascular diseases such as heart attack and stroke.

HDL, in contrast, is thought to remove cholesterol from arteries and carry it to the liver for removal from the body. Higher levels of HDL have been associated with a lower risk of cardiovascular disease. However, pharmaceutical approaches to reduce heart disease risk by raising HDL levels have had disappointing results. An international research team led by Dr. Daniel J. The scientists sequenced nearly a thousand genes near genetic regions previously associated with plasma lipid levels.

A cholesterol test, or screening, tells your health care provider the levels of LDL and HDL cholesterol in your blood.

This information helps your health care team determine your risk for heart disease or stroke. Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. However, the protective role of HDL cholesterol HDL-C has been seriously challenged by the evidence from recent genetic, epidemiologic and clinical trials. Of importance, such low levels have not been associated with increased adverse events.

Evidence from genetic trials also suggests that disorders of low LDL-C are associated with protection from coronary disease [4]. Moreover, Mendelian randomisation studies have shown that prolonged exposure to lower LDL-C beginning early in life is associated with a significant reduction in the risk of coronary heart disease in a log-linear fashion, and that this reduction is substantially greater than the current practice of lowering LDL-C beginning later in life [4].

Many observational studies have demonstrated that low levels of HDL-C are associated with an increased risk of coronary heart disease []. The Framingham Study was the first and most important epidemiologic trial showing a strong, graded, independent, inverse relationship between HDL-C and both cardiovascular disease and total mortality [5].

Besides, HDL seems to have anti-inflammatory [9], anti-oxidant [10], and antithrombotic properties [11] which may contribute to its atheroprotective effects. Mendelian randomisation studies have consistently shown that increased HDL-C levels caused by common variants in HDL-related genes are not necessarily associated with lower incidence of cardiovascular events [12,13]. Large-scale prospective cohort studies also contradict the previous finding of a linear inverse relationship between HDL and cardiovascular disease [7,].

Although it is a common finding that low levels of HDL predict increased cardiovascular risk, data from several cohorts have revealed a plateau in the inverse association above certain HDL levels. There is even a suggestion of increased cardiovascular outcomes in those with extremely high HDLs.

Recently, Madsen et al [17] examined the association of significantly elevated serum HDL-C concentrations with outcomes in two large population-based cohorts from Denmark 52, men and 64, women. A similar conclusion has been reached by Bowe et al [18], who evaluated the relationship between HDL-C and risk of death in a study involving 1. Figure 1. HDL cholesterol and risk of all-cause mortality in the general population.

Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies. Eur Heart J. The aforementioned data suggest that the old and the new observational studies yield different results regarding the cardiovascular effects of high HDL-C.

At this point, it is important to highlight that the sample size of individuals with very high HDL-C i. Furthermore, as mentioned by Madsen et al [17], in many of these studies individuals were categorised into larger groups, such as quintiles, and the focus was on low concentrations of HDL-C, thereby failing to elucidate associations at higher concentrations. A similar pattern of results against the protective effects of higher HDL was obtained in randomised intervention trials carried out with niacin, fibrates, and cholesteryl ester transfer protein inhibitors.