Woudberg Nicholas J, Pedretti Sarah, Lecour Sandrine, Schulz Rainer, Vuilleumier Nicolas, James Richard W, Frias Miguel A
Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Endocrinology, Diabetes, Hypertension and Nutrition, Department of Internal Medicine Specialities, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Front Pharmacol. 2018 Jan 22;8:989. doi: 10.3389/fphar.2017.00989. eCollection 2017.
The cholesterol concentrations of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) have traditionally served as risk factors for cardiovascular disease. As such, novel therapeutic interventions aiming to raise HDL cholesterol have been tested in the clinical setting. However, most trials led to a significant increase in HDL cholesterol with no improvement in cardiovascular events. The complexity of the HDL particle, which exerts multiple physiological functions and is comprised of a number of subclasses, has raised the question as to whether there should be more focus on HDL subclass and function rather than cholesterol quantity. We review current data regarding HDL subclasses and subclass-specific functionality and highlight how current lipid modifying drugs such as statins, cholesteryl ester transfer protein inhibitors, fibrates and niacin often increase cholesterol concentrations of specific HDL subclasses. In addition this review sets out arguments suggesting that the HDL3 subclass may provide better protective effects than HDL2.
传统上，低密度脂蛋白（LDL）和高密度脂蛋白（HDL）的胆固醇浓度一直被视为心血管疾病的风险因素。因此，旨在提高HDL胆固醇的新型治疗干预措施已在临床环境中进行了测试。然而，大多数试验导致HDL胆固醇显著升高，但心血管事件并无改善。HDL颗粒具有多种生理功能，由多个亚类组成，其复杂性引发了一个问题，即是否应更多地关注HDL亚类和功能而非胆固醇含量。我们回顾了有关HDL亚类和亚类特异性功能的当前数据，并强调了当前的脂质修饰药物，如他汀类药物、胆固醇酯转移蛋白抑制剂、贝特类药物和烟酸，如何经常增加特定HDL亚类的胆固醇浓度。此外，本综述提出了一些观点，表明HDL3亚类比HDL2可能提供更好的保护作用。
