(Circulation. 2001;103:2213.)
© 2001 American Heart Association, Inc.
Current Perspective |
Low High-Density Lipoprotein Cholesterol as a Risk Factor in Coronary Heart Disease
A Working Group Report
From Weill Medical College of Cornell University, New York, NY.
Correspondence to Antonio M. Gotto, Jr, MD, DPhil, C/O Jesse Jou, Weill Medical College of Cornell University, 445 E 69th Street, Olin Hall 205, New York, NY 10021. E-mail amg_editorial@mail.med.cornell.edu
Key Words: heart diseases • lipoproteins • drugs
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Introduction |
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A working group meeting was convened from January 7 to 8, 2000, in Naples, Florida, to assess low HDL cholesterol (HDL-C) concentration as a risk factor for coronary heart disease (CHD). The 30 speakers and discussants at this 2-day meeting included specialists in epidemiology, endocrinology, molecular biology, public health, lipid metabolism, cardiovascular medicine, and preventive cardiology from the United States, Europe, and Australia (Appendix). The group’s wide-ranging presentations and discussions considered the latest knowledge on HDL metabolism and the effects of interventions for raising HDL-C levels on the development of atherosclerosis. It was generally accepted that low HDL-C may be a marker for the metabolic syndrome, an enhanced atherosclerotic disease state that is also associated with an impaired response to insulin, hypertriglyceridemia, and abdominal obesity. Therefore, beyond risk assessment based on LDL cholesterol (LDL-C) alone, the case has been made for considering HDL-C in tandem with triglycerides (TG) as synergistic coronary risk factors.1 The following article summarizes the participants’ discussion of low HDL-C as an independent CHD risk factor and identifies areas requiring further research.
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Influence of Genetic Factors and Environment on the Atherogenicity of Low HDL-C |
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Although population studies indicate that a high level of HDL-C in general protects against CHD,2 3 a high HDL-C concentration in any given individual may not necessarily confer cardioprotection. The atherogenicity of low HDL-C seems to be influenced by an array of genetic and environmental factors.
Tangier disease, a disorder caused by mutations in the
ATP-binding cassette transporter 1
(ABC1)
gene,4 is characterized by
the absence of normal HDL, with only a very small
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