Aktueller Stellenwert der HDL-Cholesterin-Bestimmung für die kardiovaskuläre Risikoabschätzung
Abstract
Zusammenfassung. In der klinischen Praxis wird der High-Density-Lipoprotein-Cholesterin (HDL-C)-Wert häufig als Kriterium für die kardiovaskuläre Risikovorhersage herangezogen. HDL-Teilchen erfüllen zahlreiche Funktionen, die theoretisch vor Atherosklerose schützen. Dementsprechend haben umfangreiche Studien eindeutig gezeigt, dass ein tiefes HDL-C ein wichtiger unabhängiger Risikofaktor für kardiovaskuläre Erkrankungen ist. Jedoch gilt es mittlerweile als fraglich, ob sehr hohe HDL-C-Spiegel immer kardioprotektiv sind. Dies lässt sich durch die strukturelle Heterogenität der HDL-Partikel und den Verlust der Schutzfunktionen von HDL im Zusammenhang mit Krankheiten erklären, was mit der einfachen Messung von HDL-C nicht festgestellt werden kann. Neue Marker für die funktionelle Kapazität der HDL-Partikel werden in Zukunft das HDL-C als traditionellen Parameter für die kardiovaskuläre Risikoabschätzung möglicherweise ersetzen.
Abstract. In clinical practice, high-density lipoprotein cholesterol (HDL-C) levels are frequently used for cardiovascular risk prediction. HDL particles perform numerous functions that theoretically protect against atherosclerosis. Accordingly, extensive studies have clearly demonstrated that low HDL-C is an important independent risk factor for cardiovascular diseases. However, it is now considered questionable whether very high HDL-C levels are always cardioprotective. This may be explained by the structural heterogeneity of HDL particles and the loss of HDL protective functions in the context of disease, which cannot be detected by the simple measurement of HDL-C. In the future new markers of the functional capacity of HDL particles may replace HDL-C as a traditional parameter for cardiovascular risk assessment.
Résumé. Dans la pratique clinique, le taux de cholestérol à lipoprotéines de haute densité (HDL-C) est fréquemment utilisé comme critère de prédiction du risque cardiovasculaire. Les particules HDL remplissent de nombreuses fonctions qui protègent théoriquement contre l’athérosclérose. En conséquence, des études approfondies ont clairement démontré qu’un faible taux de HDL-C est un important facteur de risque indépendant de maladies cardiovasculaires. Cependant, on considère aujourd’hui qu’il est douteux que des taux de HDL-C très élevés soient toujours cardioprotecteurs. Cela peut s’expliquer par l’hétérogénéité structurelle des particules HDL et la perte des fonctions protectrices des HDL dans le contexte de divers maladies qui ne peuvent être détectées par la simple mesure du HDL-C. De nouveaux marqueurs de la capacité fonctionnelle des particules HDL pourraient à l’avenir remplacer le HDL-C comme paramètre traditionnel d’évaluation du risque cardiovasculaire.
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