W März1,2,3, M E Kleber1,4, H Scharnagl2, T Speer5, S Zewinger5, A Ritsch6, K G Parhofer7, A von Eckardstein8, U Landmesser9, U Laufs10. 1. Medizinische Klinik V (Nephrologie, Hypertensiologie, Rheumatologie, Endokrinologie, Diabetologie), Medizinische Fakultät Mannheim der Universität Heidelberg, Heidelberg, Deutschland. 2. Klinisches Institut für Medizinische und Chemische Labordiagnostik, Medizinische Universität Graz, Graz, Österreich. 3. Synlab Akademie, synlab Holding Deutschland GmbH, Mannheim und Augsburg, Deutschland. 4. Institut für Ernährungswissenschaften, Friedrich-Schiller-Universität Jena, Jena, Deutschland. 5. Klinik für Innere Medizin IV, Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland. 6. Klinik für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich. 7. Medizinische Klinik II, Klinikum der Universität München, 81377, München, Deutschland. 8. Institut für Klinische Chemie, Universitätsspital, 8091, Zürich, Schweiz. 9. Klinik für Kardiologie, Charité, Berlin, Deutschland. 10. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin (IMED), Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland. ulrich.laufs@uks.eu.
Abstract
BACKROUND: Each year 16-17 million determinations of high-density lipoprotein cholesterol (HDL-C) are conducted and interpreted in Germany. Recently acquired data have led to a fundamental reassessment of the clinical significance of HDL-C. METHOD: This review article is based on a selective literature search. RESULTS: Low HDL‑C levels usually indicate an increased cardiovascular risk, particularly in primary prevention but the epidemiological relationship between HDL‑C and the risk is complex. The HDL plays a role in the back transport and excretion of cholesterol; however, the biological functions of HDL are dependent on the protein and lipid composition, which is not reflected by the HDL‑C concentration. If the composition of HDL is pathologically altered it can also exert negative vascular effects. CONCLUSION: Compared with low-density lipoprotein cholesterol (LDL-C), HDL‑C is of secondary importance for cardiovascular risk stratification and the calculation of the LDL-C:HDL‑C ratio is not useful for all patients. Low HDL‑C levels should prompt a search for additional metabolic and inflammatory pathologies. An increase in HDL‑C through lifestyle changes (e.g. smoking cessation and physical exercise) has positive effects and is recommended; however, HDL‑C is currently not a valid target for drug therapy.
BACKROUND: Each year 16-17 million determinations of high-density lipoprotein cholesterol (HDL-C) are conducted and interpreted in Germany. Recently acquired data have led to a fundamental reassessment of the clinical significance of HDL-C. METHOD: This review article is based on a selective literature search. RESULTS: Low HDL‑C levels usually indicate an increased cardiovascular risk, particularly in primary prevention but the epidemiological relationship between HDL‑C and the risk is complex. The HDL plays a role in the back transport and excretion of cholesterol; however, the biological functions of HDL are dependent on the protein and lipid composition, which is not reflected by the HDL‑C concentration. If the composition of HDL is pathologically altered it can also exert negative vascular effects. CONCLUSION: Compared with low-density lipoprotein cholesterol (LDL-C), HDL‑C is of secondary importance for cardiovascular risk stratification and the calculation of the LDL-C:HDL‑C ratio is not useful for all patients. Low HDL‑C levels should prompt a search for additional metabolic and inflammatory pathologies. An increase in HDL‑C through lifestyle changes (e.g. smoking cessation and physical exercise) has positive effects and is recommended; however, HDL‑C is currently not a valid target for drug therapy.
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Authors: Stephen Zewinger; Thimoteus Speer; Marcus E Kleber; Hubert Scharnagl; Rainer Woitas; Philipp M Lepper; Karolin Pfahler; Sarah Seiler; Gunnar H Heine; Winfried März; Günther Silbernagel; Danilo Fliser Journal: J Am Soc Nephrol Date: 2014-03-07 Impact factor: 10.121
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Authors: Winfried März; Marcus E Kleber; Hubert Scharnagl; Timotheus Speer; Stephen Zewinger; Andreas Ritsch; Klaus G Parhofer; Arnold von Eckardstein; Ulf Landmesser; Ulrich Laufs Journal: Clin Res Cardiol Date: 2017-03-24 Impact factor: 5.460
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Authors: Fatma Ben Cherifa; Jalila El Ati; Radhouene Doggui; Myriam El Ati-Hellal; Pierre Traissac Journal: Int J Environ Res Public Health Date: 2021-05-20 Impact factor: 3.390