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Kosmas et al. Vessel Plus 2019;3:2 Vessel Plus
DOI: 10.20517/2574-1209.2018.79

Review Open Access

Dysfunctional high-density lipoprotein and
atherogenesis

Constantine E. Kosmas , Delia Silverio , Andreas Sourlas , Peter D. Montan , Eliscer Guzman 1
2
1
3
2
1 Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA.
2 Cardiology Clinic, Cardiology Unlimited PC, New York, NY 10033, USA.
3 School of Medicine, University of Crete, Heraklion 71003, Greece.
Correspondence to: Dr. Constantine E. Kosmas, Department of Medicine, Division of Cardiology, Montefiore Medical Center,
168-24 Powells Cove Blvd., Beechhurst, NY 11357, USA. E-mail: cekosmas1@gmail.com
How to cite this article: Kosmas CE, Silverio D, Sourlas A, Montan PD, Guzman E. Dysfunctional high-density lipoprotein and
atherogenesis. Vessel Plus 2019;3:2. http://dx.doi.org/10.20517/2574-1209.2018.79
Received: 24 Nov 2018 First Decision: 22 Dec 2018 Revised: 23 Dec 2018 Accepted: 30 Dec 2018 Published: 21 Jan 2019

Science Editor: Alexander N. Orekhov Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
High-density lipoprotein (HDL) plays a major role in reverse cholesterol transport (RCT) but also exhibits, anti-
inflammatory, endothelial/vasodilatory, anti-thrombotic, antioxidant, anti-aggregating, anticoagulant and cytoprotective
functions, which enhance its protective effect against cardiovascular disease. However, the function of HDL is
dependent upon genetic, environmental and lifestyle factors. Modification of the protein or lipid components of HDL
in certain conditions may convert the HDL particles from anti-inflammatory to pro-inflammatory and pro-atherogenic
by limiting their ability to promote RCT and to prevent LDL modification. In our review, we will present the clinical and
scientific data pertaining to the factors and conditions that impair HDL functionality and we will discuss the effects of
dysfunctional HDL on atherogenesis.

Keywords: High-density lipoprotein, high-density lipoprotein functionality, atherogenesis, cardiovascular disease

INTRODUCTION
There is extensive clinical evidence showing that there is a clear inverse relationship between serum high-
density lipoprotein-cholesterol (HDL-C) concentrations and the risk for cardiovascular disease (CVD),
[1]
which is independent of the concentration of low-density-lipoprotein cholesterol (LDL-C) . Actually, in a
large meta-analysis, which included 20 randomized controlled trials with 543,210 person-years of follow-up
and 7,838 myocardial infarctions, it was shown that, after adjustment for on-treatment LDL-C levels, age,
hypertension, diabetes, and tobacco use, statins do not affect the relationship between HDL-C concentration

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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