How good can HDL Cholesterol be? Recent Evidence and way forward for Clinical Practice

Abstract

The science of “Lipidology” is flourishing in endless ways. The services included under the lipid testing
do not provide generalised risk assessment for possible
atherosclerotic cardiovascular disease (ASCVD) but
provide specialised services, including genomic and
molecular biomarkers for personalised care. The seminal discovery of lipoprotein fractions seems like a step
next door in the much wider cosmos of metabolomics
and proteomics, where knowledge of lipoprotein subfractions as villains or saviours seems like the trailer of
the Larger Amphitheatre. Low-density lipoproteins
(LDL) though differently defined in the literature, were
categorised as “large buoyant LDL” (lbLDL) and
“small dense LDL” (sdLDL).1 Over time, the knowledge base evolved to incorporate different fractions
among lipoproteins based upon size and density with
high-density lipoproteins (HDL) to incorporate nascent
HDL, HDL2 and HDL3