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Cite this article
The Importance of Recognizing and Treating Low Levels of High-Density Lipoprotein Cholesterol: A New Era in Atherosclerosis Management
1 Department of Cardiology, Ochsner Medical Center, New Orleans, LA
2020 University of Michigan Medical School, Ann Arbor, MI
2021 Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI
Rev. Cardiovasc. Med. 2008, 9(4), 239–258;
Published: 30 December 2008
Low levels of high-density lipoprotein cholesterol (HDL-C) represent a major cardiovascular risk factor, with a stronger relationship to coronary heart disease than that seen with elevated levels of low-density lipoprotein cholesterol (LDL-C). HDL-C has important antiatherogenic effects, including reverse cholesterol transport, inhibition of LDL-C oxidation, and antiplatelet and anti-inflammatory actions. Patients with low HDL-C are also at an amplified risk of coronary heart disease due to the common coexistence of other risk factors, including excess adiposity, metabolic syndrome, type 2 diabetes mellitus, hypertriglyceridemia, and the atherogenic dyslipidemia characterized by small dense LDL-C. First-line therapy of low HDL-C generally consists of nonpharmacologic measures such as improved fitness and weight loss. Current pharmaceutical options include statins, fibrates, and nicotinic acid. A host of novel approaches involving HDL-C and reverse cholesterol transport hold the promise of fundamentally changing the natural history of atherosclerosis, the most common and important chronic disease in humans.
High-density lipoprotein cholesterol
Reverse cholesterol transport system
Cholesteryl ester transfer protein