Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA.
Virginia Commonwealth University Health Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Curr Cardiol Rep. 2023 Dec;25(12):1725-1733. doi: 10.1007/s11886-023-01987-3. Epub 2023 Nov 16.
Review updates for the association of HDL-cholesterol with atherosclerotic cardiovascular disease (ASCVD) and discuss the approach to incorporating HDL-cholesterol within risk assessment.
There is a U-shaped relationship between HDL-cholesterol and ASCVD. Both low HDL-cholesterol (< 40 mg/dL in men, < 50 mg/dL in women) and very-high HDL-cholesterol (≥ 80 mg/dL in men) are associated with a higher risk of all-cause and ASCVD mortality, independent from traditional risk factors. There has been inconsistency for the association between very-high HDL-cholesterol and mortality outcomes in women. It is uncertain whether HDL-cholesterol is a causal ASCVD risk factor, especially due to mixed results from Mendelian randomization studies and the collinearity of HDL-cholesterol with established risk factors, lifestyle behaviors, and socioeconomic status. HDL-cholesterol is a risk factor or risk enhancer in primary prevention and high-risk condition in secondary prevention when either low (men and women) or very-high (men). The contribution of HDL-cholesterol to ASCVD risk calculators should reflect its observed U-shaped association with all-cause and ASCVD mortality.
回顾高密度脂蛋白胆固醇（HDL-C）与动脉粥样硬化性心血管疾病（ASCVD）的相关性，并讨论在风险评估中纳入 HDL-C 的方法。
HDL-C 与 ASCVD 之间存在 U 型关系。低 HDL-C（男性<40mg/dL，女性<50mg/dL）和极高 HDL-C（男性≥80mg/dL）均与全因和 ASCVD 死亡率升高相关，独立于传统危险因素。极高 HDL-C 与女性死亡率之间的相关性存在不一致性。HDL-C 是否是 ASCVD 的因果风险因素尚不确定，特别是由于孟德尔随机化研究和 HDL-C 与已确立的风险因素、生活方式行为以及社会经济地位之间的共线性导致结果混杂。在一级预防中，HDL-C 是原发性预防的危险因素或危险因素增强剂，在二级预防中，无论男性还是女性，低（<40mg/dL）或极高（≥80mg/dL）HDL-C 均是高危条件。HDL-C 对 ASCVD 风险计算器的贡献应反映其与全因和 ASCVD 死亡率呈 U 型关系。
