High-Density Lipoprotein Cholesterol as a Risk Factor and Target of Therapy after Acute Coronary Syndrome

Despite contemporary therapies for acute coronary syndrome (ACS), rates of morbidity and mortality remain high. Low levels of high-density lipoprotein (HDL) cholesterol are common among patients with ACS and predict risk for subsequent cardiovascular events, even on a background of intensive statin treatment. An extensive body of clinical and experimental data suggests that HDL cholesterol may promote favorable remodeling of coronary atherosclerotic plaque and ameliorate endothelial dysfunction, thrombotic tendency, inflammation, oxidative stress, and ischemia-reperfusion injury, which are all effects that might be beneficial after ACS. Clinical trials are in progress to test the hypothesis that strategies to raise levels of HDL cholesterol will reduce risk after ACS.