Lipids and cardiovascular disease 2 HDL and cardiovascular disease

The cholesterol contained within HDL is inversely associated with risk of coronary heart disease and is a key component of predicting cardiovascular risk. However, despite its properties consistent with atheroprotection, the causal relation between HDL and atherosclerosis is uncertain. Human genetics and failed clinical trials have created scepticism about the HDL hypothesis. Nevertheless, drugs that raise HDL-C concentrations, cholesteryl ester transfer protein inhibitors, are in late-stage clinical development, and other approaches that promote HDL function, including reverse cholesterol transport, are in early-stage clinical development. The fi nal chapters regarding the eff ect of HDL-targeted therapeutic interventions on coronary heart disease events remain to be written. Genesis of the HDL hypothesis HDLs were fi rst described in the 1960s after isolation by ultracentrifugation. Advances in precipitation of apoB-containing lipoproteins made it possible to measure the cholesterol content of HDL (HDL-C) in many individuals and enabled large-scale epidemiological studies of the relation between HDL-C concentrations and coronary heart disease. The fi rst compelling reports of the strong inverse association between HDL-C and coronary heart disease were from the Framingham Heart Study. 1