High-density lipoprotein and cardiovascular risk reduction: promises and realities.

In a recent article in the Revista Española de Cardiologı́a, Cordero et al. reported a study of the concentrations of high-density lipoprotein cholesterol (HDL-C) in 959 unselected consecutive patients who were admitted for chest pain. The authors found that low levels of HDL-C (<40 mg/dL) were independently associated with diagnosis of acute coronary syndrome (ACS), that is, the lower the level of HDL-C, the greater the prevalence of ACS. This article appears at a time when the assumed protective role of HDL-C against arteriosclerotic cardiovascular disease (CVD) has been called into question after the publication of the ACCORD clinical trial and the premature discontinuation of the AIM-HIGH study. In view of this, it is worth asking ourselves about the actual role of HDL-C in CVD.