Purpose of Review

Review updates for the association of HDL-cholesterol with atherosclerotic cardiovascular disease (ASCVD) and discuss the approach to incorporating HDL-cholesterol within risk assessment.

Recent Findings

There is a U-shaped relationship between HDL-cholesterol and ASCVD. Both low HDL-cholesterol (< 40 mg/dL in men, < 50 mg/dL in women) and very-high HDL-cholesterol (≥ 80 mg/dL in men) are associated with a higher risk of all-cause and ASCVD mortality, independent from traditional risk factors. There has been inconsistency for the association between very-high HDL-cholesterol and mortality outcomes in women. It is uncertain whether HDL-cholesterol is a causal ASCVD risk factor, especially due to mixed results from Mendelian randomization studies and the collinearity of HDL-cholesterol with established risk factors, lifestyle behaviors, and socioeconomic status.

Summary

HDL-cholesterol is a risk factor or risk enhancer in primary prevention and high-risk condition in secondary prevention when either low (men and women) or very-high (men). The contribution of HDL-cholesterol to ASCVD risk calculators should reflect its observed U-shaped association with all-cause and ASCVD mortality.

中文翻译：

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高密度脂蛋白胆固醇在动脉粥样硬化性心血管疾病风险评估中的应用：探索和解释“U”形曲线

审查目的

回顾 HDL-胆固醇与动脉粥样硬化性心血管疾病 (ASCVD) 关联的最新动态，并讨论将 HDL-胆固醇纳入风险评估的方法。

最近的发现

HDL-胆固醇与 ASCVD 之间存在 U 形关系。低 HDL 胆固醇（男性 < 40 mg/dL，女性 < 50 mg/dL）和极高 HDL 胆固醇（男性 ≥ 80 mg/dL）均与全因和 ASCVD 的较高风险相关死亡率，独立于传统的危险因素。女性极高的 HDL 胆固醇与死亡率结果之间的关联并不一致。目前尚不确定 HDL-胆固醇是否是 ASCVD 的因果危险因素，特别是由于孟德尔随机研究的混合结果以及 HDL-胆固醇与已确定的危险因素、生活方式行为和社会经济状况的共线性。

概括

HDL-胆固醇在一级预防中是一种危险因素或风险增强剂，在二级预防中，当HDL-胆固醇水平较低（男性和女性）或很高（男性）时，它是一种危险因素或风险增强剂。HDL-胆固醇对 ASCVD 风险计算器的贡献应反映其与全因死亡率和 ASCVD 死亡率之间观察到的 U 形关联。