Editing High-density lipoprotein (section)

== Epidemiology ==
Men tend to have noticeably lower HDL concentrations, with smaller size and lower cholesterol content, than women. Men also have a greater incidence of [[atherosclerosis|atherosclerotic]] heart disease. Studies confirm the fact that HDL has a buffering role in balancing the effects of the hypercoagulable state in type 2 diabetics and decreases the high risk of cardiovascular complications in these patients. Also, the results obtained in this study revealed that there was a significant negative correlation between HDL and [[Partial thromboplastin time|activated partial thromboplastin time]] (APTT).{{Citation needed|date=December 2019|reason=removed citation to predatory publisher content}}

Epidemiological studies have shown that high concentrations of HDL (over 60&nbsp;mg/dL) have protective value against [[cardiovascular disease]]s such as ischemic stroke and [[myocardial infarction]]. Low concentrations of HDL (below 40&nbsp;mg/dL for men, below 50&nbsp;mg/dL for women) increase the risk for [[atherosclerotic]] diseases.<ref>{{Cite journal |last1=Ahmed |first1=Haitham M. |last2=Miller |first2=Michael |last3=Nasir |first3=Khurram |last4=McEvoy |first4=John W. |last5=Herrington |first5=David |last6=Blumenthal |first6=Roger S. |last7=Blaha |first7=Michael J. |date=2016-05-15 |title=Primary Low Level of High-Density Lipoprotein Cholesterol and Risks of Coronary Heart Disease, Cardiovascular Disease, and Death: Results From the Multi-Ethnic Study of Atherosclerosis |journal=American Journal of Epidemiology |volume=183 |issue=10 |pages=875–883 |doi=10.1093/aje/kwv305 |issn=0002-9262 |pmc=4867155 |pmid=27189327}}</ref>

Data from the landmark [[Framingham Heart Study]] showed that, for a given level of LDL, the risk of heart disease increases 10-fold as the HDL varies from high to low. On the converse, however, for a fixed level of HDL, the risk increases 3-fold as LDL varies from low to high.<ref>{{cite journal | vauthors = Rahilly-Tierney CR, Spiro A, Vokonas P, Gaziano JM | title = Relation between high-density lipoprotein cholesterol and survival to age 85 years in men (from the VA normative aging study) | journal = The American Journal of Cardiology | volume = 107 | issue = 8 | pages = 1173–7 | date = Apr 2011 | pmid = 21296318 | doi = 10.1016/j.amjcard.2010.12.015 }}</ref><ref>{{cite journal | vauthors = Rubins HB, Robins SJ, Collins D, Nelson DB, Elam MB, Schaefer EJ, Faas FH, Anderson JW | title = Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT) | journal = Archives of Internal Medicine | volume = 162 | issue = 22 | pages = 2597–604 | year = 2002 | pmid = 12456232 | doi = 10.1001/archinte.162.22.2597 | doi-access = free }}</ref>  <!--The prior sentences make more sense than this garbled explanation of it...So, for example, for a fixed LDL level of 220 mg/dl, the risk of coronary heart disease is 3-times normal if the HDL is low (25 mg/dl) but just one-third of normal if the HDL is high (85 mg/dl). On the other hand, for a fixed HDL level of 85 mg/dl, the risk of coronary heart disease is one-tenth normal if the LDL is low (100 mg/dl) and still only three-tenths of normal if the LDL is high (220 mg/dl). Phrased differently, this data implies that HDL is a more potent risk factor than LDL. Indeed, for a high HDL level (85 mg/dl), the risk of coronary disease remains lower than average even when the LDL level is high. Lowering LDL levels in such people, while of some benefit, merely converts a low risk situation to a very low risk situation.-->

Even people with very low LDL levels achieved by [[statin]] treatment are exposed to increased risk if their HDL levels are not high enough.<ref>{{cite journal | vauthors = Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, Kastelein JJ, Bittner V, Fruchart JC | title = HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events | journal = The New England Journal of Medicine | volume = 357 | issue = 13 | pages = 1301–10 | date = Sep 2007 | pmid = 17898099 | doi = 10.1056/NEJMoa064278 | author10 = Treating to New Targets Investigators | s2cid = 44794291 | doi-access = free }}</ref>{{Non-primary source needed|date=April 2024}}

Very high HDL-C levels (≥80&nbsp;mg/dL in men, ≥100&nbsp;mg/dL in women) appears to be detrimental to cardiovascular outcomes. Several genetic conditions cause abnormally low or high HDL-C levels, often without the expected change in cardiovascular disease rates.  In fact, when many known correlates of CVD risks are controlled for, HDL-C does not have any correlation with cardiovascular event risks. In this way, HDL-C only seems to serve as an imperfect, but easy-to-measure, proxy for a healthy lifestyle. What does correlate well with CVD risks even when these factors are controlled for is a direct measure of the capability for [[reverse cholesterol transport]] in a person's blood serum, the ''cholesterol efflux capacity'' (CEC).<ref name=Razavi>{{cite journal |last1=Razavi |first1=AC |last2=Jain |first2=V |last3=Grandhi |first3=GR |last4=Patel |first4=P |last5=Karagiannis |first5=A |last6=Patel |first6=N |last7=Dhindsa |first7=DS |last8=Liu |first8=C |last9=Desai |first9=SR |last10=Almuwaqqat |first10=Z |last11=Sun |first11=YV |last12=Vaccarino |first12=V |last13=Quyyumi |first13=AA |last14=Sperling |first14=LS |last15=Mehta |first15=A |title=Does Elevated High-Density Lipoprotein Cholesterol Protect Against Cardiovascular Disease? |journal=The Journal of Clinical Endocrinology and Metabolism |date=18 January 2024 |volume=109 |issue=2 |pages=321–332 |doi=10.1210/clinem/dgad406 |pmid=37437107|pmc=11032254 }}</ref>