HDL-cholesterol modulation and its impact on the management of cardiovascular risk

Ann Clin Biochem 2008;45:122-128
© 2008 Association for Clinical Biochemistry


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Review Article

Gordon Ferns 1 2  and
Vuyolethu Keti 2

1 Postgraduate Medical School, University of Surrey, Daphne Jackson Road, Guildford, Surrey GU2 7WG, UK;
2 Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK

Corresponding author: Prof Gordon Ferns. Email: g.ferns{at}surrey.ac.uk

There is strong epidemiological evidence that HDL-cholesterol(HDL-C) is an independent cardiovascular risk factor. A lowHDL-C is a common finding in the general population, and isa feature of metabolic syndrome, the prevalence of which isincreasing globally. The importance of HDL-C as a coronary riskfactor is generally accepted, and has been incorporated intomost of the commonly applied risk engines. There are severalcauses of a low HDL-C, including rare genetic abnormalities,and more common conditions associated with lifestyle and drugtherapy. Not all of these are associated with an increased riskof coronary disease. A better understanding of HDL metabolismand the mechanisms by which it may exert its protective effectshas revealed why this may be the case. New therapeutic targetshave also been identified that may allow HDL-C to be raisedin patients with low levels. However, good clinical endpointstudies are still required to enable the setting of absolutetarget values for HDL-C in patients at high cardiovascular risk.

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