High-density lipoprotein and coronary heart disease – an update

There is increasing evidence for a protective effect of high density lipoprotein (HDL) on the cardiovascular system. Patients with low concentrations have been shown to be at an increased risk of coronary heart disease, and there is evidence that high concentrations confer a degree of protection. But there is uncertainty about when HDL should be measured, its role in the assessment of patients and its relative importance in making decisions about therapy. This review presents recent epidemiological findings and discusses the possible mechanisms of action of HDL. Insights from disease states are presented, and the results of intervention studies are discussed. Recent guidelines for the use of HDL in patient assessment are discussed, together with the options for therapy aiming to increase HDL concentrations. There are studies underway which should provide more information about the effects of current therapy, and perhaps lead to the development of new treatment options, and these are briefly summarised.