High-Density Lipoprotein: Is the Good Cholesterol Turning Bad?

Low high-density lipoprotein cholesterol (HDL-C) is the most prevalent lipid abnormality in patients with known coronary heart disease (CHD). Since the 1960 s, epidemiologic studies have shown an inverse relationship between HDL-C levels and risk of developing CHD. This data correlates a 1-mg/dL increase in HDL-C with a 2% to 3% reduction in CHD events. The prevalence of low HDL-C among patients with CHD has prompted multiple trials to increase the concentration or mimic the function of HDL in an attempt to reduce cardiovascular events. This review outlines the cardioprotective functions of HDL-C, describes conditions that modify HDL structure and function, and presents an overview of clinical trials on HDL-raising therapies.