Low HDL-cholesterol: How it actually is?

Authors: Martin Šatný;  Michal Vrablík
Authors‘ workplace: Centrum preventivní kardiologie, III. interní klinika – endokrinologie a metabolismu 1. LF UK a VFN v Praze
Published in: AtheroRev 2021; 6(3): 147-152
Category: Reviews


The causal role of LDL-cholesterol (LDL-C) in the genesis and progression of atherosclerotic vascular lesions is completely indisputable and supported by robust evidence from a number of clinical studies. The role of HDL-cholesterol or HDL particles is plagued by a number of controversies, in which HDL-C ceases to be generally considered atheroprotective, i.e. “good cholesterol”. Recent data suggest that only in individuals without a history of overt atherosclerotic cardiovascular (CV) disease (CVD) low HDL-C levels are indirectly associated with the risk of future CV events. However, this relationship certainly does not apply to patients with metabolic syndrome or overt atheroslerotic CVD. It is crucial to be aware of the difference between HDL-C and HDL particles, which as such perform a number of functions. The measurement of HDL-C often loses its significance, as it does not give us any information about the quality of HDL-particles, which is absolutely crucial in the context of their atherogenicity or atheroprotection. Thus, HDL-C plays a somewhat ambiguous role in the assessment of CV risk and is increasingly being debated its clinical use. Rather, the detection of low HDL-C should lead to the investigation of other metabolic or inflammatory pathological conditions. The pillar of therapy of low HDL-C levels consists of regimen measures – smoking cessation, regular physical activity; pharmacotherapy is not recommended.


LDL-cholesterol – CV risk – atherosclerotic CVD – HDL-cholesterol – regimen measures

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Angiology Diabetology Internal medicine Cardiology General practitioner for adults
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