Really high hdl
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Understanding the Implications of Really High HDL Levels
High-Density Lipoproteins (HDL) Quantity vs. Quality
High-density lipoproteins (HDL) are often referred to as "good" cholesterol due to their role in removing excess cholesterol from the bloodstream and protecting against cardiovascular diseases. However, recent research indicates that the benefits of HDL are not solely dependent on its quantity but also on its quality and functionality .
HDL Quantity
The quantity of HDL is typically measured as serum HDL-C concentration. While high HDL-C levels are generally associated with reduced risk of coronary heart disease (CHD), this is not always the case. Factors such as age, gender, lifestyle, and disease states can influence HDL-C levels. For instance, regular aerobic exercise and healthy dietary habits can increase HDL-C levels, whereas acute infections and chronic inflammatory diseases can decrease them.
HDL Quality and Functionality
HDL quality refers to the composition and structural integrity of HDL particles, including their protein and lipid content, particle size, and extent of oxidation or glycation. High-quality HDL is characterized by a higher content of apolipoproteins, larger particle size, and better-defined shape. These attributes are crucial for HDL functionality, which includes antioxidant, anti-inflammatory, and cholesterol efflux activities .
The Role of HDL Functionality in Cardiovascular Health
Recent studies emphasize that HDL functionality is more critical than HDL-C levels in providing cardiovascular protection. HDL's ability to facilitate cholesterol efflux from macrophages, a process known as cholesterol efflux capacity (CEC), is a key metric of its functionality. High CEC is strongly associated with reduced carotid intima-media thickness and lower risk of coronary artery disease (CAD), independent of HDL-C levels.
HDL and Neurodegenerative Disorders
HDL's benefits extend beyond cardiovascular health. Emerging evidence suggests that HDL plays a significant role in cognitive function and may help protect against neurodegenerative disorders such as Alzheimer's and Parkinson's diseases. HDL's anti-inflammatory and antioxidative properties are believed to contribute to its neuroprotective effects.
HDL and COVID-19
HDL also exhibits antiviral properties. Studies have shown that native HDL can inhibit the activity of SARS-CoV-2, the virus responsible for COVID-19. However, this antiviral activity is compromised when HDL undergoes glycation, a common occurrence in patients with diabetes mellitus or hypertension. This may explain the higher susceptibility and mortality rates of COVID-19 in these patient groups.
Conclusion
While high HDL-C levels are traditionally viewed as beneficial, it is crucial to consider HDL quality and functionality for a comprehensive understanding of its health implications. High-quality, functional HDL offers significant protection against cardiovascular diseases, neurodegenerative disorders, and even viral infections like COVID-19. Therefore, strategies aimed at improving HDL functionality, rather than merely increasing HDL-C levels, may provide better health outcomes.
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