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(Circulation. 2004;109:III-8 – III-14.)
© 2004 American Heart Association, Inc.

Atherosclerosis: Evolving Vascular Biology and Clinical Implications

HDL Cholesterol and Protective Factors in Atherosclerosis

Gerd Assmann, MD; Antonio M. Gotto, Jr, MD, DPhil

From the Institute of Clinical Chemistry and Laboratory Medicine (G.A.), Central Laboratory, Westphalian Wilhelms-University, and the Institute of Arteriosclerosis Research at the University of Münster (G.A.), Münster, Germany; and Weill Medical College of Cornell University (A.M.G.), New York, NY.

Correspondence to Prof. Dr Gerd Assmann, Institute of Arteriosclerosis Research, University of Münster, Domagkstrasse 3, D-48149 Münster, Germany. E-mail assmann{at}uni-muenster.de

A low level of high-density lipoprotein cholesterol (HDL-C) is an important risk factor for cardiovascular disease. Epidemiological and clinical studies provide evidence that HDL-C levels are linked to rates of coronary events. The cardioprotective effects of HDL-C have been attributed to its role in reverse cholesterol transport, its effects on endothelial cells, and its antioxidant activity. Although some clinical trials suggest a benefit of raising HDL-C to reduce risk, further studies are needed, and HDL-C is still not considered a primary target of therapy in the National Cholesterol Education Program guidelines. However, HDL-C should be considered as part of the patient’s overall profile of established risk factors in determining treatment strategies.

Key Words: atherosclerosis • cardiovascular diseases • cholesterol • high-density lipoprotein (HDL) • lipoproteins • risk factors