The effects of low-density lipoprotein and high-density lipoprotein on arteriosclerosis
What are the respective roles of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) in the formation of atherosclerosis?
Studies have shown that LDL-C is a fundamental factor in the development of atherosclerosis. LDL-C crosses the vascular endothelium and enters the vascular wall. LDL-C retained under the endothelium is phagocytosed by macrophages, which form foam cells. These foam cells proliferate and merge, constituting the lipid core of atherosclerotic plaques. Therefore, elevated LDL-C promotes the formation of atherosclerosis. Lowering LDL-C can slow the development of atherosclerosis.
Some studies suggest that atherosclerosis is a chronic inflammatory disease. LDL-C may be an initiating factor in this chronic inflammation.
HDL-C is a lipoprotein in the human body with anti-atherosclerotic properties. This is because HDL-C can remove cholesterol from foam cells and transport it to the liver for metabolism. HDL-C may also exert its anti-atherosclerotic effects through anti-inflammatory, antioxidant, and protective effects on vascular endothelial function.
Extensive epidemiological data also indicate a negative correlation between serum HDL-C levels and the incidence of coronary heart disease (CHD). For every 0.4 mmol/L (15 mg/dL) increase in serum HDL-C, the risk of CHD decreases by 2%–3%. HDL-C levels >1.55 mmol/L (60 mg/dL) are considered a protective factor against CHD.
Generally, LDL-C and total cholesterol (TC) move in parallel, but TC levels are also influenced by HDL-C levels. Therefore, it is best to use LDL-C instead of TC for risk assessment of CHD and other atherosclerotic diseases. Factors affecting TC also affect LDL-C levels.
Non-HDL-C refers to the total cholesterol contained in lipoproteins other than HDL, mainly including LDL-C and very low-density lipoprotein cholesterol (VLDL-C), with LDL-C accounting for more than 70%. Because the detection methods for VLDL-C are not yet mature, when triglycerides are between 2.27 and 5.64 mmol/L (200–500 mg/dL), non-HDL-C can be used as a second treatment target for high-risk groups such as those with coronary heart disease. The formula for calculating non-HDL-C is: Non-HDL-C = Total Cholesterol (TC) – HDL-C.
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