High-density lipoprotein as a therapeutic target: clinical evidence and treatment strategies.
ABSTRACT The clinical importance of low serum levels of high-density lipoprotein (HDL) cholesterol is often under-recognized and underappreciated as a risk factor for premature atherosclerosis as well as for cardiovascular morbidity and mortality. Low serum levels of HDL are frequently encountered, especially in patients who are obese or have the metabolic syndrome. In prospective epidemiologic studies, every 1-mg/dL increase in HDL is associated with a 2% to 3% decrease in coronary artery disease risk, independent of low-density lipoprotein (LDL) cholesterol and triglyceride (TG) levels. The primary mechanism for this protective effect is believed to be reverse cholesterol transport, but several other anti-inflammatory, antithrombotic, and antiproliferative functions for HDL have also been identified. In recognition of these antiatherogenic effects, recent guidelines have increased the threshold for defining low levels of HDL for both men and women. The first step in achieving these revised targets is therapeutic lifestyle changes. When these measures are inadequate, pharmacotherapy specific to the patient's lipid profile should be instituted. Niacin therapy, currently the most effective means for raising HDL levels, should be initiated in patients with isolated low HDL (HDL <40 mg/dL, LDL and non-HDL at or below National Cholesterol Education Program (NCEP) targets based on global cardiovascular risk evaluation). Patients who have both low HDL and elevated LDL should receive a statin or statin-niacin combination therapy, and patients with concomitant low HDL and elevated TGs should receive a fibrate initially, with a statin, niacin, or ezetimibe added thereafter as needed to help attain NCEP lipoprotein targets.
SourceAvailable from: Pei-Chieh Ko[Show abstract] [Hide abstract]
ABSTRACT: The present study assessed the effects of vegetarian and omnivorous diets on HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), TAG and the ratio of HDL-C to total cholesterol (TC) by gender.Public Health Nutrition 06/2014; 18(04):1-6. DOI:10.1017/S1368980014000883 · 2.48 Impact Factor
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ABSTRACT: Evidence for an association between total cholesterol, low- and high-density lipoproteins (LDL and HDL, respectively), triglycerides, and prostate cancer is conflicting. Given that prostate cancer and dyslipidemia affect large proportions of Western society, understanding these associations has public health importance.Cancer Epidemiology Biomarkers & Prevention 10/2014; 23(11). DOI:10.1158/1055-9965.EPI-14-0458 · 4.32 Impact Factor
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ABSTRACT: Objective-It is controversial whether statins improve high-density lipoprotein (HDL) function, which plays an important role in reverse cholesterol transport in vivo. The aim of the present study was to clarify the effects of rosuvastatin and atorvastatin on reverse cholesterol transport in macrophage cells in vivo and their underlying mechanisms. Approach and Results-Male C57BL mice were divided into 3 groups (rosuvastatin, atorvastatin, and control groups) and orally administered rosuvastatin, atorvastatin, or placebo for 6 weeks under feeding with a 0.5% cholesterol+10% coconut oil diet. After administration, although there were no changes in plasma HDL cholesterol levels among the groups, plasma from the rosuvastatin group showed an increased ability to promote ATP-binding cassette transporter A1-mediated cholesterol efflux ex vivo. In addition, capillary electrophoresis revealed a shift in HDL toward the pre-beta HDL fraction only in the rosuvastatin group. Mice in all 3 groups were intraperitoneally injected with H-3-cholesterol-labeled and cholesterol-loaded macrophages and then were monitored for the appearance of H-3-tracer in plasma and feces. The amount of H-3-dependent-tracer excreted into feces during 48 hours in the rosuvastatin group was greater than that in the control group. Finally, H-3-cholesteryl oleate-HDL was intravenously injected into all groups, blood samples were taken, and the count of H-3-cholesterol was analyzed. Plasma H-3-cholesteryl oleate-HDL changed similarly, and no differences in fractional catabolic rates were observed. Conclusions-Rosuvastatin enhanced the ATP-binding cassette transporter A1-dependent HDL efflux function of reverse cholesterol transport, and this finding highlights the potential of rosuvastatin for the regression of atherosclerosis.Arteriosclerosis Thrombosis and Vascular Biology 08/2014; 34(10). DOI:10.1161/ATVBAHA.114.303715 · 5.53 Impact Factor