Division of Lipoprotein Disorders, Presbyterian Center for Preventive Cardiology, 125 Baldwin Avenue, Suite 200, Charlotte, NC 28204, USA and Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
J Clin Lipidol. 2007 Mar;1(1):57-64. doi: 10.1016/j.jacl.2007.01.002. Epub 2007 Feb 15.
The protective role played by high-density lipoprotein (HDL) in atherogenesis is well-accepted, as is the significant inverse association of HDL cholesterol (HDL-C) with coronary heart disease (CHD) risk. What remains controversial is whether we are using the best measure(s) of HDL to identify and manage HDL-related cardiovascular risk. Measuring particle number has been postulated to offer additional and possibly more specific information regarding risk. Although HDL-C is thought to indicate the quantity of circulating HDL particles, it is underappreciated that the amount of cholesterol carried inside lipoprotein particles is highly variable among individuals with the same HDL-C. Numerous trials have investigated the relations of CHD with various measures of HDL other than those based on cholesterol content of the particles present. Studies regarding the association of alternate measures of HDL with CHD risk have been mixed, possibly due to diversity in clinical characteristics accompanying low HDL-C states, variability in cholesterol content of HDL particles, and substantial inter-correlations of HDL with other lipoprotein particles. Additional research is needed to assess the clinical settings in which individual HDL tests, after multivariate adjustment for confounding factors, provide superior independent prediction of CHD events beyond HDL-C. Such studies show promise in defining measures of particle number that will prove useful in future strategies to enhance management of CHD risk and assess response to therapy at an individual patient level.
高密度脂蛋白（HDL）在动脉粥样硬化形成过程中所起的保护作用已被广泛接受，HDL 胆固醇（HDL-C）与冠心病（CHD）风险之间的显著负相关关系也是如此。目前仍存在争议的是，我们是否使用了最好的 HDL 测量方法来识别和管理与 HDL 相关的心血管风险。测量颗粒数被认为可以提供有关风险的额外且可能更具体的信息。尽管 HDL-C 被认为指示循环 HDL 颗粒的数量，但人们对载脂蛋白颗粒内携带的胆固醇量在具有相同 HDL-C 的个体之间高度可变认识不足。许多试验已经研究了除基于颗粒中胆固醇含量以外的各种 HDL 测量值与 CHD 的关系。关于替代 HDL 测量值与 CHD 风险之间的关联的研究结果不一致，这可能是由于低 HDL-C 状态伴随的临床特征多样性、HDL 颗粒胆固醇含量的可变性以及 HDL 与其他脂蛋白颗粒之间的高度相关性所致。需要进一步研究来评估在多元校正混杂因素后，个体 HDL 测试在 CHD 事件预测方面是否具有优于 HDL-C 的独立预测能力的临床情况。这些研究有望定义颗粒数的测量方法，这些方法将有助于未来制定策略来增强 CHD 风险的管理，并评估个体患者的治疗反应。
