HDL as a prognostic biomarker for coronary atherosclerosis: the role of inflammation

<p><b>Introduction</b>: Emerging evidence suggests that the role of high density lipoprotein (HDL) in the atherosclerotic process is not as clear as previously thought, since atheroprotective HDL becomes atherogenic in states of increased inflammatory processes.</p> <p><b>Areas covered</b>: In this review we aim to elucidate the role of HDL as a prognostic biomarker and we discuss therapeutic approaches that aim to increase HDL and their possible clinical benefit.</p> <p><b>Expert opinion</b>: Given the structural variability and biological complexity of the HDL particle, its role in the atherosclerotic process is far from clear. According to current evidence, the atheroprotective role of HDL turns atherogenic in states of increased inflammatory processes, while even minor alterations in systemic inflammation are likely to hinder the endothelial protective effects of HDL. In accordance, significant data have revealed that HDL-related drugs may be effective in reducing cardiovascular mortality; however they are not as encouraging or unanimous as expected. Possible future goals could be to quantify either HDL subclasses or functions in an attempt to reach safer conclusions as to the prognostic importance of HDL in coronary atherosclerosis. Having achieved that, a more targeted therapy that would aim to raise either HDL functionality or to remodel HDL structure would be more easily designed.</p

Correlation of ultra-high-frequency ultrasound measures with biochemical markers.

<p><b>(Fig 3A–</b>Association of serum phosphate with common carotid artery (CCA) medial thickness (MT), <b>Fig 3B–</b>Association of serum parathyroid hormone level (log transformed) with CCA MT, <b>Fig 3C–</b>Association of mean arterial pressure standard deviation score (SDS) with CCA MT, <b>Fig 3D–</b>Association of diastolic BP SDS with dorsal pedal artery MT).</p

Ultra-high-frequency ultrasound measurements of intima thickness (IT), medial thickness (MT) and the composite measure of IMT in carotid (Fig 2A) and dorsal pedal (Fig 2B) arteries in healthy controls and children with CKD4-5 and on dialysis (CKD4-5D) and transplanted patients.

<p>CCA–common carotid artery.</p

Ultra-high-frequency ultrasound images of carotid and dorsal pedal arteries, and comparison with images obtained by conventional ultrasound.

<p><b>Fig 1A</b>—Carotid artery scanned with 12 MHz (left) and 55 MHz (right) ultrasound. Outtake shows magnification of intima-media complex from 55 MHz image with outline of intima and media thickness. <b>Fig 1B</b>—Dorsal pedal artery of control child (left) and child on hemodialysis (right) scanned with 70 MHz probe).</p

Changes in ultra-high-frequency ultrasound measures at one year follow-up.

<p><b>(Fig 4A</b>—Comparison of baseline and 1-year follow-up measures of common carotid artery (CCA) medial thickness (MT) in transplanted children, <b>Fig 4B</b>—Comparison of baseline and 1-year follow-up measures of dorsal pedal artery intimal thickness (IT) in transplanted children).</p

Bland Altman plot comparing the composite measure of intima thickness and medial thickness (IT + MT) by ultra-high-frequency ultrasound with conventional cIMT.

<p>Bland Altman plot comparing the composite measure of intima thickness and medial thickness (IT + MT) by ultra-high-frequency ultrasound with conventional cIMT.</p

Additional file 1: of Patterns of adiposity, vascular phenotypes and cognitive function in the 1946 British Birth Cohort

Additional Methods and Results (including additional Tables and Figures). (DOC 688 kb