Department of Pharmacological and Biomolecular Sciences, Università Degli Studi Di Milano, Milan, Italy.
Curr Atheroscler Rep. 2022 May;24(5):365-377. doi: 10.1007/s11883-022-01012-y. Epub 2022 Mar 10.
High-density lipoproteins (HDL) are responsible for the transport in plasma of a large fraction of circulating lipids, in part from tissue mobilization. The evaluation of HDL-associated cholesterol (HDL-C) has provided a standard method for assessing cardiovascular (CV) risk, as supported by many contributions on the mechanism of this arterial benefit. The present review article will attempt to investigate novel findings on the role and mechanism of HDL in CV risk determination.
The most recent research has been aimed to the understanding of how a raised functional capacity of HDL, rather than elevated levels per se, may be responsible for the postulated CV protection. Markedly elevated HDL-C levels appear instead to be associated to a raised coronary risk, indicative of a U-shaped relationship. While HDL-C reduction is definitely related to a raised CV risk, HDL-C elevations may be linked to non-vascular diseases, such as age-related macular disease. The description of anti-inflammatory, anti-oxidative and anti-infectious properties has indicated potential newer areas for diagnostic and therapeutic approaches. In the last two decades inconclusive data have arisen from clinical trials attempting to increase HDL-C pharmacologically or by way of recombinant protein infusions (most frequently with the mutant A-I ); prevention of stent occlusion or heart failure treatment have shown instead significant promise. Targeted clinical studies are still ongoing.
高密度脂蛋白（HDL）负责在血浆中运输很大一部分循环脂质，部分来自组织动员。HDL 相关胆固醇（HDL-C）的评估提供了评估心血管（CV）风险的标准方法，这得到了许多关于这种动脉益处机制的贡献的支持。本文综述文章将尝试探讨 HDL 在 CV 风险确定中的作用和机制的新发现。
最近的研究旨在了解 HDL 的功能能力提高，而不是水平本身升高，如何可能导致假定的 CV 保护。明显升高的 HDL-C 水平似乎与升高的冠状动脉风险相关，表明存在 U 形关系。虽然 HDL-C 降低肯定与升高的 CV 风险相关，但 HDL-C 升高可能与非血管疾病相关，如年龄相关性黄斑病变。抗炎、抗氧化和抗感染特性的描述表明了诊断和治疗方法的潜在新领域。在过去二十年中，试图通过药理学或重组蛋白输注（最常见的是突变 A-I）增加 HDL-C 的临床试验得出了不确定的数据；支架闭塞的预防或心力衰竭的治疗反而显示出了显著的希望。有针对性的临床研究仍在进行中。
