值得商榷的HDL假说

Discussion on HDL hypothesis

大量流行病研究发现HDL-C(高密度脂蛋白胆固醇)水平与心血管事件发生呈负相关性,高水平的HDL-C能明显改善心血管事件发生风险。多年来人们试图将这一流行病学发现转化到临床应用中,通过各种途径升高HDL-C水平来降低心血管事件的发生,然而CETP(胆固醇酯转运蛋白)抑制剂的临床试验与内皮酯酶基因的遗传学研究却得到相反的结论:HDL-C水平升高,但心血管事件发生风险并未下降,甚至事件发生风险增加。因此对HDL假说提出了质疑。

A lot of epidemiological studies have demonstrated the negative correlation between high-density lipoprotein cholesterol （HDL-C） levels and incidence of cardiovascular events, and found the linearity between HDL-C increase and coronary heart disease （CHD） risk reduction. For many years, strategies have been developed to translate the convincing epidemiological finding into clinical application, that is, raising HDL-C level to reduce the occurrence of cardiovascular events through a variety of ways. However, the conclusions from clinical trails of cholesteryl ester transfer protein （CETP） inhibitors and genetic researches of endothelial lipase have gone in a converse direction. They declare that the risk of cardiovascular disease does not decline, even increases, though interventions have indeed increased the level of HDL-C. Given the above conclusion, the HDL hypothesis should be questioned.