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Kosmas et al. Vessel Plus 2019;3:2 I http://dx.doi.org/10.20517/2574-1209.2018.79 Page 5 of 7

particles also possess cytoprotective, anti-inflammatory, antioxidant, antiaggregating and anticoagulant
properties, which enhance their protective effect against CVD. These cardioprotective properties of HDL
are not solely dependent on the HDL plasma concentration but also depend on HDL functionality. This was
confirmed in a large meta-analysis of 108 randomized trials involving 299,310 participants at risk for CVD.
In this meta-regression analysis, it was clearly shown that simply increasing the serum levels of HDL-C does
[44]
not lower the risk of coronary heart disease events, coronary heart disease deaths, or total deaths . On the
other hand, there is extensive evidence that under certain conditions, such as the oxidative environment
of the acute-phase response, the HDL particles may lose their anti-inflammatory properties and become
pro-inflammatory and pro-atherogenic. Thus, future therapeutic agents targeting HDL may be required to
enhance HDL functionality rather than simply increase HDL-C concentration.

DECLARATIONS
Authors’ contributions
Conception and design, jointly developed the structure and arguments for the paper, made critical revisions
and approved final version: Kosmas CE
Wrote the first draft of the paper: Kosmas CE, Silverio D
Contributed to the writing of the paper: Sourlas A, Montan PD, Guzman E
Data collection, analysis and interpretation, final approval of manuscript: Kosmas CE, Silverio D, Sourlas A,
Montan PD, Guzman E

Availability of data and materials
Data and materials used to help write this article are available for public access.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2019.

REFERENCES
1. Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular
events. N Engl J Med 2007;357:1301-10.
2. Jafri H, Alsheikh-Ali AA, Karas RH. Meta-analysis: statin therapy does not alter the association between low levels of high-density
lipoprotein cholesterol and increased cardiovascular risk. Ann Intern Med 2010;153:800-8.
3. Rye KA, Barter PJ. Cardioprotective functions of HDLs. J Lipid Res 2014;55:168-79.
4. Barter PJ, Baker PW, Rye KA. Effect of high-density lipoproteins on the expression of adhesion molecules in endothelial cells. Curr
Opin Lipidol 2002;13:285-8.
5. Kosmas CE, Martinez I, Sourlas A, Bouza KV, Campos FN, et al. High-density lipoprotein (HDL) functionality and its relevance to
atherosclerotic cardiovascular disease. Drugs Context 2018;7:212525.
6. Favari E, Thomas MJ, Sorci-Thomas MG. High-density lipoprotein functionality as a new pharmacological target on cardiovascular
disease: unifying mechanism that explains high-density lipoprotein protection toward the progression of atherosclerosis. J Cardiovasc
Pharmacol 2018;71:325-31.