you've probably had your HDL cholesterol measured. your doctor told you higher is better. 60, 70, 80 — good numbers.
here's the problem: HDL cholesterol concentration is a poor proxy for HDL function.
HDL's job is reverse cholesterol transport — pulling cholesterol out of peripheral tissues and delivering it to the liver for excretion. That's the cardioprotective mechanism. But a high HDL-C number doesn't tell you whether your HDL is actually functioning.
Oxidation to apolipoprotein A-I (apo A-I), HDL's main protein, impairs its ability to interact with cholesterol transporters (ABCA1, ABCG1).
Dysfunctional HDL can actually promote atherosclerosis.
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the studies bear this out: raising HDL-C with drugs doesn't reduce cardiovascular events. torcetrapib raised HDL-C significantly and increased mortality. niacin raises HDL-C but adds no cardiovascular benefit. because the number went up but the function didn't.
the emerging measurement is cholesterol efflux capacity (CEC) — how well does your HDL actually pull cholesterol out of cells? that predicts cardiovascular risk better than the raw number.
The same thing destroying the body: oxidative stress, chronic inflammation, insulin resistance are the same things impairing HDL function
if your HDL is 70 but you're metabolically inflamed, your HDL number is meaningless. more useful is you pCEC score (predicted cholesterol efflux capacity)
