Tuesday, February 3, 2009

HDL can be bad?

Curr Opin Lipidol. 2007 Aug;18(4):427-34.

The paradox of dysfunctional high-density lipoprotein.
Ansell BJ, Fonarow GC, Fogelman AM.

Atherosclerosis Research Unit, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. bansell@mednet.ucla.edu

PURPOSE OF REVIEW: This review addresses how, in atherosclerosis or systemic inflammation, HDL can lose its usual atheroprotective characteristics and even paradoxically assume proinflammatory properties.
RECENT FINDINGS: Specific chemical and structural changes within HDL particles can impede reverse cholesterol transport, enhance oxidation of LDL, and increase vascular inflammation. HDL may be viewed as a shuttle that can be either anti-inflammatory or proinflammatory, depending on its cargo of proteins, enzymes, and lipids. Some therapeutic approaches that reduce coronary risk, such as statins and therapeutic lifestyle changes, can favorably moderate the characteristics of proinflammatory HDL. In addition, apolipoprotein A-I mimetic peptides and other compounds that target functional aspects of HDL may offer novel approaches to reduction in cardiovascular risk.

SUMMARY: Current data suggest that under some conditions HDL can become dysfunctional and even proinflammatory, but this characterization can change with resolution of systemic inflammation or use of certain treatments.


  1. There is a test that can be ordered the "VAP panel", which costs the same or less apparently as a lipid panel, but which gives a detailed breakdown of cholesterol subparticles. I've ordered it and it's interesting, though I can't say that it necessarily changes therapy. What is helpful is that it can directly measure LDL, therefore the LDL can be known even in patient's with high triglycerides. It also has a breakdown of I believe three HDL subparticles.

  2. This is from the company that does this. How long does it take?

    More Comprehensive Test
    The VAP Test uses an advanced technology that provides a more accurate, individualized picture of heart disease risk, so doctors and healthcare professionals can take steps to prevent future heart attacks. The VAP Expanded Lipid Profile measures not only the basic information provided by the routine cholesterol test, but also identifies hidden cholesterol problems that can increase the risk of developing heart disease-even if routine cholesterol test results are "normal." As a result, the VAP Test was named one of "Ten Ways to Live Longer" by Forbes.com, and was selected as one of "Five Tests Worth Paying for" by The Wall Street Journal.

  3. From my experience, it takes about as long as a regular old lipid panel. I'll see if I can pull some results and post it. To my knowledge, the cost, at least in CA is about the same.


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