ABSTRACT
INTRODUCTION Recent clinical intervention trials have demonstrated that even with aggressive reductions in serum atherogenic lipoprotein burden achieved by statin therapy, there is still significant residual risk for cardiovascular morbidity and mortality (1,2). Clearly, when managing a patient’s global cardiovascular risk, it is imperative that all modifiable risk factors such as hypertension, impaired glucose tolerance or diabetes, cigarette smoking, obesity, inactivity, and dyslipidemia be managed with appropriate lifestyle modification and pharmacologic intervention. The National Cholesterol Education Program (NCEP) has continued to place primary emphasis on the therapeutic reduction of serum low-density lipoprotein cholesterol (LDL-C) and nonhigh-density lipoprotein cholesterol (non-HDL-C) for decreasing the morbidity and mortality of atherosclerotic disease in all of its manifestations (3,4). However, much recent basic scientific and clinical investigation suggests that established and novel approaches to managing high-density lipoprotein (HDL) metabolism may also significantly affect the risk for atherosclerotic disease and its sequelae, including myocardial infarction (MI), stroke, sudden death, and claudication (5,6). HDLs are the structurally most complex and functionally most diverse lipoproteins. Low serum levels of HDL constitute a widely prevalent risk factor for atherosclerotic disease. This chapter will review the epidemiology, metabolism, and antiatherogenic effects of HDL, and will also provide a comprehensive overview of how to manage low levels of this lipoprotein through lifestyle modification and pharmacologic intervention.
