Very low HDL levels: clinical assessment and management

Very low HDL levels: clinical assessment and management

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ABSTRACT In individuals with very low high-density lipoprotein (HDL-C) cholesterol, such as Tangier disease, LCAT deficiency, and familial hypoalphalipoproteinemia, there is an increased risk of premature atherosclerosis.However, analyzes based on comparisons of populations with small variations in HDL-C mediated by polygenic weleda skin food 75ml best price alterations do not confirm these findings, suggesting that there is an indirect association or heterogeneity in the pathophysiological mechanisms related to the reduction of HDL-C.Trials that evaluated some of the HDL functions demonstrate a more robust degree of association between the HDL system and atherosclerotic risk, but as they were not designed to modify lipoprotein functionality, there is insufficient data to establish a causal relationship.We currently have randomized clinical trials of therapies that increase HDL-C concentration by various mechanisms, and this HDL-C elevation has not independently demonstrated a reduction in the risk of cardiovascular events.

Therefore, this evidence shows that (a) measuring HDL-C as a way of estimating HDL-related atheroprotective system function is insufficient and (b) we still do not know how to increase cardiovascular protection with therapies aimed at modifying HDL metabolism.This leads us to a greater effort to understand the mechanisms of molecular action and cellular interaction of read more HDL, completely abandoning the traditional view focused on the plasma concentration of HDL-C.In this review, we will detail this new understanding and the new horizon for using the HDL system to mitigate residual atherosclerotic risk.