Would Janus’ view on HDL be useful?

Abstract

Low-density lipoprotein cholesterol (LDL-C) is generally considered to be pro-atherogenic and high-density lipoprotein cholesterol (HDL-C) to be anti-atherogenic. The clinical approach to the diagnostics and treatment of clinical manifestations of atherosclerosis is the examination of the lipid spectrum. In routine clinical practice, the effects of the HDL class are measured only by determining the concentration of HDL cholesterol. It is questionable whether this clinical approach provides sufficient information to evaluate both the overall cardiovascular risk and the effect of hypolipidemic therapy. Recent studies revealed a shift from large to small HDL particles within the HDL family in the state of atherosclerotic cardiovascular diseases (CVD). This trend of lipoprotein constellation seems to be pathognomonic for dysfunctional lipoprotein profile under pathological state of the cardiovascular system. Thus, the diagnostic and therapeutic approach based on "good" cholesterol concept needs remedying (Fig. 1, Ref. 28).

Is elevated triglyceride high density lipoprotein cholesterol ratio a risk factor that causes acute coronary syndrome to appear earlier?

“…Subtyping the HDL levels and planning treatment according to HDL subtype may prove better results in near future. (14). These results showed that TG or HDL might not be the only treatment parameters and maybe statins combined with pcsk9 inhibitor or ezetimib will allow us to reach the LDL goal or reduce the relative risk especially in young adults.…”

Lipoprotein profiling in early multiple sclerosis patients: effect of chronic inflammation?

“…Palavra et al [2] reported increased cardiovascular risk in MS patients due to the elevation of, among others, small HDL-C. In atherosclerosis, a shift from larger towards smaller HDL-C particles in the HDL-C profile was observed [35]. Interestingly, lean patients with relapsingremitting MS showed increased concentrations of small HDL-C and increased lipoprotein insulin resistance index [36], which may promote the progression of disease in these patients.…”

“…Apolipoprotein A-1 is the major protein component of HDL-C particles in plasma. Besides the replacement of apoA-1 with serum amyloid A protein [6,34,35], alterations of apoA-1 by myeloperoxidase (chlorination, oxidation, nitration, carbamylation) and by reactive carbonyls (oxidation, glycation) during systemic inflammation lead to the production of dysfunctional HDL-C and to the transformation of this originally anti-inflammatory molecule into a pro-inflammatory one [34]. Furthermore, autoantibodies to apoA-1 and HDL-C have been reported in patients with other autoimmune conditions such as systemic lupus erythematosus, rheumatoid arthritis and antiphospholipid syndrome with reported higher cardiovascular risk and may therefore represent another mechanism potentially leading to proinflammatory properties of apoA-1/HDL-C [34].…”

Improvement in cardiovascular risk markers by the combined effect of natural polyphenols and vitamins in patients after kidney transplantation

“…Its function lies in its active participation in the re-transport of cholesterol. However, most recent evidence reveals a controversy in the anti-atherogenic effect of HDL and pointed out the importance of HDL subfraction analysis in dyslipidemia diagnosis and treatment (22).…”