Where are we with high-density lipoprotein raising and inhibition of cholesteryl ester transfer for heart disease risk reduction?

HDL particle number and size as predictors of cardiovascular disease

Previous studies indicate that reduced concentrations of circulating high-density lipoprotein (HDL) particles can be superior to HDL-cholesterol (HDL-C) levels as a predictor of cardiovascular disease. Measurements of HDL particle numbers, therefore, bear a potential for the improved assessment of cardiovascular risk. Furthermore, such measurement can be relevant for the evaluation of novel therapeutic approaches targeting HDL. Modern in-depth analyses of HDL particle profile may further improve evaluation of cardiovascular risk. Although clinical relevance of circulating concentrations of HDL subpopulations to cardiovascular disease remains controversial, the negative relationship between the number of large HDL particles and cardiovascular disease suggests that assessment of HDL particle profile can be clinically useful. Reduced mean HDL size is equally associated with cardiovascular disease in large-scale clinical studies. Since HDL-C is primarily carried in the circulation by large, lipid-rich HDL particles, the inverse relationship between HDL size and cardiovascular risk can be secondary to those established for plasma levels of HDL particles, HDL-C, and large HDL. The epidemiological data thereby suggest that HDL particle number may represent a more relevant therapeutic target as compared to HDL-C.

Dietary lipids from an evolutionary perspective: sources, structures and functions

Lipids are a complex group of biomolecules whose precise functions remain poorly understood. As a result of this poor understanding, it is difficult to make mechanistically based recommendations for appropriate dietary intakes. It is equally difficult to develop methods that are capable of diagnosing functional impairments because of insufficiencies or excesses in particular fatty acids. Lipids are abundant building blocks of cellular membranes, supply components for lipid particle assembly and substrates for metabolic fuel, and provide a precursor pool for an astonishingly diverse range of signalling molecules. In each of these broad functions, the functional consequences of different structures of fatty acids are not fully understood. According to research on membrane functions through early evolution, docosahexaenoic acid provides two biophysical properties to membranes - accelerating the lateral motion of lipids and proteins within the plane of the membrane and simultaneously slowing the rate of diffusion/leakage of charged species across the plane of the membrane. The range of fatty acid structures used as substrates for assembly of either lipoproteins or milk fat globules is broad, yet the functional consequences of differences are not known. Different lipids signal into a remarkable range of biological processes. Saturated and monounsaturated fatty acids are becoming recognized as signal molecules in their own right. The complex composition of human milk lipids implies that diets with a diversity of fatty acids in complex lipid forms and structures is more beneficial than a narrow range of any particular group of fatty acids.

Characteristics of high-density lipoprotein subclasses distribution for subjects with desirable total cholesterol levels

Background

To investigate alteration of high density lipoproteins (HDL) subclasses distribution in different total cholesterol (TC) levels, mainly the characteristics of HDL subclasses distribution in desirable TC levels and analyze the related mechanisms.

Methods

ApoA-I contents of plasma HDL subclasses were determined by 2-dimensional gel electrophoresis coupled with immunodetection. 486 Chinese Adults subjects were assigned to different TC groups according to the third Report of NCEP (ATP- III) guidelines.

Results

The increase in contents of small preβ₁-HDL, HDL_3c, HDL_3b, and HDL_3a particles clustered and reduce in HDL_2b with increased of TC. The distribution of HDL subclasses have shown abnormality characterized by the lower HDL_2b (324.2 mg/L) contents and the higher preβ₁-HDL (90.4 mg/L) contents for desirable TC Chinese subjects. Among 176 desirable TC subjects, 58.6% subjects with triglyceride (TG) < 2.26 mmol/L, 61.2% subjects with HDL-C ≥1.03 mmol/L and 88.6% subjects with low density lipoprotein cholesterol(LDL-C) < 3.34 mmol/L, and the profile of HDL subclasses distribution for above these subjects was reasonable.

Conclusions

The particles size of HDL subclasses shifted towards smaller with increased TC levels. The TC was liner with HDL_2b contents and those can be reduced 17 mg/L for 0.5 mmol/L increment in TC levels. The HDL subclasses distribution phenotype was not expectation for Chinese Population with desirable TC levels. Thus, from the HDL subclasses distribution point, when assessing the coronary heart disease(CHD) risk not only rely on the TC levels, but also the concentrations of TG, HDL-C and LDL-C must considered in case the potential risk for desirable TC subjects with other plasma lipids metabolism disorders.

A prospective study of high-density lipoprotein cholesterol, cholesteryl ester transfer protein gene variants, and healthy aging in very old Japanese-american men

BACKGROUND

High-density lipoprotein cholesterol (HDL-C) and cholesteryl ester transfer protein (CETP) gene deficiency mutations that increase HDL-C levels have been associated with exceptional longevity. However, a recent clinical trial of a promising CETP inhibitor that markedly increases HDL-C was terminated due to increased mortality. In light of this controversy, we examined the relationship among HDL-C, CETP mutations, and longevity phenotypes in the long-lived Japanese-American men of the Honolulu Heart Program (HHP).

METHODS

Japanese-American men (n = 3562) were followed for up to 8 years, from average age 78 to average age 84 (maximum age 99), or until death. Total mortality, cause-specific mortality, and healthy survival were evaluated for associations with HDL-C level and CETP genetic variants common in the Japanese population (CD442G and Int 14A).

RESULTS

HDL-C was negatively associated with cardiovascular disease (CVD) mortality (p =.002) but not related to non-CVD (p =.147) or total (p =.547) mortality after adjustment for common risk factors. There was a trend for lower mortality for the men with the Int 14A variant. These men also had higher HDL-C levels (p =.047) and were significantly more likely to be healthy survivors (absence of six major age-related diseases and high physical/cognitive function) beyond the age of 90 years (p =.005).

CONCLUSIONS

Low HDL-C level is a risk factor for CVD mortality in elderly Japanese-American men. High HDL-C and the Int 14A variant of the CETP gene may increase odds for healthy aging.

Is raising HDL a futile strategy for atheroprotection?

The dramatic failure of clinical trials evaluating the cholesterol ester transfer protein inhibitor torcetrapib has led to considerable doubt about the value of raising high-density lipoprotein cholesterol (HDL-C) as a treatment for cardiovascular disease. These results have underscored the intricacy of HDL metabolism, with functional quality perhaps being a more important consideration than the circulating quantity of HDL. As a result, HDL-based therapeutics that maintain or enhance HDL functionality warrant closer investigation. In this article, we review the complexity of HDL metabolism, discuss clinical-trial data for HDL-raising agents, including possible reasons for the failure of torcetrapib, and consider the potential for future HDL-based therapies.