Beyond LDL Cholesterol: the Role of LDL Particles and HDL

Abstract

Currently available hypolipidemic treatments aim at reducing low density lipoprotein (LDL)-cholesterol. Unfortunately, cardiovascular events continue to occur despite LDL-lowering therapy with use of statins. Recent evidence has revealed that having increased concentrations of small LDL particles, though common, is an unhealthy pattern; high concentrations of small LDL particles correlate with much faster growth of atheroma, progression of atherosclerosis and earlier and more severe cardiovascular events and death. In addition, at any given level of total cholesterol, the relative risk of coronary artery disease increases with decreasing levels of high density lipoprotein (HDL)-cholesterol. Thus, the target for new interventions would be to reduce small LDL particles and increase HDL and/or its apolipoproteins, which are recognized to have major vascular protective effects ranging from prevention to stabilization and regression of atherosclerosis.