Recently, Lancet Diabetes and Endocrinology has published a review on the paradox of high density lipoprotein cholesterol (HDL-C). The HDL-C paradox refers to the fact that although HDL-C has been regarded as "good cholesterol" for decades and that low HDL-C can lead to atherosclerotic cardiovascular disease, several clinical studies that increase HDL-C have not yielded positive results. The authors believe that HDL actually contains hundreds of different lipid particles with different sizes, lipid and protein compositions. Clinical measurement of HDL-C only reflects cholesterol. The article also cites a study by Professor Zhao Dong of Anzhen Hospital in JACC. The study found that HDL-C measured clinically is actually cholesterol carried by HDL. Therefore, the new drugs currently developed to increase HDL-C may not increase the number of HDL particles, but only increase the cholesterol carried on HDL, that is to say, these drugs actually increase the cholesterol level.
HDL is the train and liver is the central station. The review authors point out that apolipoprotein A1 is the main protein component of HDL. Apolipoprotein A1 is like a train. In the blood, there are hundreds of different kinds of lipids to get on and off as "passengers". And the liver is like a "central station," where most lipid "passengers" get off and metabolize.
That is to say, the lipids on HDL trains are constantly changing. HDL-C carrying cholesterol is only equivalent to the total amount of cholesterol "passengers" on HDL "trains" at some point in time.
In fact, there are hundreds of lipids and more than 90 proteins in HDL. In terms of cholesterol, there are 10% free cholesterol and 35% cholesterol esters, less than 50%. More and more epidemiological studies have also found that HDL-C levels are too high, which, like "bad cholesterol" such as total cholesterol and low density lipoprotein cholesterol, also increase the risk of heart disease and death. The relationship between diabetes mellitus and HDL-C has attracted much attention. However, the authors also point out that HDL-C is low in about half of diabetic patients, and that abnormal glucose metabolism and impaired HDL function are mutually reinforcing. There is also growing interest in the potential of HDL as a therapeutic target for type 2 diabetes. In clinical trials, short-term and long-term treatment of elevated HDL can reduce blood sugar levels in patients with type 2 diabetes and prevent type 2 diabetes.
Do you want to remove the "good cholesterol" label of HDL-C? The authors believe that HDL-C is still a useful indicator for risk stratification in primary prevention, but it seems inappropriate to call it "good cholesterol".
The prevalence of low HDL-C in China is high, reaching 11%. It is also important to study HDL-C for the prevention and treatment of cardiovascular diseases in China.
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