The role of high-density lipoprotein (HDL) cholesterol in the prevention and treatment of coronary heart disease: expert group recommendations

摘要: P studies from all parts of the world have consistently reported that a low plasma level high-density lipoprotein (HDL) cholesterol is strong predictor coronary heart disease (CHD). Multiple lines evidence suggest HDL has direct beneficial effect on arterial wall. Metabolically, particles induce removal cells, including those in atherosclerotic plaques. Apolipoprotein A-I (apoA-I), major protein HDL, activates mobilization ester stores macrophages, leading to reduction content this cell type atherosclerosis. At least 2 specific receptors participate mediating protective effect. Intravenous infusion rabbits prevents atherosclerosis, and introduction expression human apoA-I gene mice stimulates regression preexisting appears deliver liver for excretion, function termed, “reverse transport.” form recombinant liposomes, infused into hypercholesterolemic humans, produced net excretion body, directly demonstrating stimulation reverse transport. also other functions may contribute its ability protect against CHD. Examples include anti-inflammatory antioxidant properties. Experiments antiatherosclerotic potential strongly support findings epidemiology clinical trials, apparent benefit raising not secondary relation risk factors, justify renewed evaluation as target prevention treatment Many patients with levels high triglyceride levels, elevated concentrations highly atherogenic triglyceride-rich remnants (derived chylomicrons very low-density lipoproteins [VLDLs]). The PROCAM study demonstrates associated particular lipid profile. Such predominantly abdominal obesity, prevalence insulin resistance, characterized by relatively fasting glucose insulin. Increased VLDL production impaired lipolysis link concentration. A concentration indicate chylomicron remnants, these which possess apolipoprotein C-III, are an increased Insulin resistance causes production. This constellation metabolically linked factors often termed “the metabolic syndrome.” between incidence CHD curvilinear mirrors corresponding curve LDL seen Framingham Heart Study. Low predicts both sexes (Figure 1), but strength be greater women than men. meta-analysis 4 large prospective epidemiologic defined differences shifts cardiovascular risk. An increase 1 mg/dl (0.026 mmol/L) equated independent relative events 2% men 3% women. In words, depressed herald at triglycerides, persons diabetes nondiabetics, women, without known US National Health Nutrition Examination Survey III (1988 1991) shows 40 ( occur about 35% adult 15% However, higher percentage who develop mg/dl. Study, 57% developed had mg/dl, Cholesterol Recurrent Events (CARE) trial, 40% myocardial infarction Statin reduces whose low. Nonetheless, baseline subsequent event rates was present statin-treated 5 6 trials. For example, Scandinavian Simvastatin Survival Study (4S), CARE Long term Intervention Pravastatin IschFrom Harvard School Public Health, Boston, Massachusetts. Manuscript received January 14, 2002; revised manuscript accepted March 2002. Address reprints: Frank M. Sacks, MD, 665 Huntington Ave, Massachusetts 02115. E-mail: fsacks@hsph.harvard.edu.